HomeMy Public PortalAbout9211, 9211 1/2, 9213 LAS TUNAS DR_Plumbing__ /72
76A667 (GE-817)
A4PPLICATIONtOR PL MB1NG PERMIT
t.
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO ADDRESS UILDING 17AIi -7'
L" G4�J
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM @ FEE
OWNER
WATER CLOSET 1.75 ,,t.,
MAIL /
BATH TUB 1.75 ADDRESS
SHOWER 1.75 CITY l TEL NO
LAVATORY 1.75 CONTRACTOR �^
SINK 1.75 ADDRESS
DISHWASHER 1.75 CITY /� TEL NO v
CLOTHES WASHER 1.75 STATE LIC
LICENSE N CLASS
SWIMMING POOL RECEPTOR 1,75
DISTRICT NO (- OUP ZONE PR ESSED BY
LAWN SPRINKLER SYSTEM 1.75 '•7r Jel
WATER HEATER 1.75 INDUSTRIAL
WASTE APPROVAL
a
GAS SYSTEM OUTLETS 1.75 '
INSPECTION RECORD cj
OUTLETS OVER C
5 PER SYSTEM .30 O
H
V
W
d
h
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REOU I RED BY LOS ANGELES COUNTY AND STATE OF _
CALIFORNIA OR THAT I AM HE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESC BED SIDENTIAL PROPERTY FINAL V 5
SIGNATURE
OF PERMITTE
PERMIT VALIDATION CK M.0 ("CASH
PLAN CHECK VALIDATION CK M O. O"I'6POCT 4 5 .0 4.7 5 e�jd �,�N
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I h/a%,y affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) u
or a certified copy thereof (Sec 38 , Lab C ) s j' COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No � �ompany ll6�lG �4lLCP�1��[
❑ Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /� iz-
t n /�/ ,
14 Certified copy is filed with the county building mspeo- ADDRESS ' / Kms/ (iC(iG
tion de artm nt NUMBER FIXTURE OR ITEM @ FEE
Q y LOCALITY L
Date o� Applicant 21 A446�) WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FRO ORKERS' BATH TUB CROSS ST ClG?
COMPENSATION INSURA CE OWNER
(This section need not be completed if the work involved by SHOWER
the permit is for one hundred dollars $100 or less. MAIL � f,P L J7
p ( ) ) LAVATORY ADDRESS .LxS" T
I certify that in the performance of the work for which this � ���/ ?
permit is issued, I shall not employ any person in any manner SINK CITY 1 ,14 TEL' lJ
so as to become subject to the Workers'Compensation Laws DISHWASHER
CONTRACTOR Lo-{/�
Date Applicant CLOTHES WASHER ADDRESS U P
NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers' CITY h/ EL NO ll�l
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
de
with comply with such provisions or this permit shall be I STATE 02 Y
q Z// LIC
deemed
deemed revoked WATER HEATER LICENSE NO
LICENSED CONTRACTORS DECLARATION DISTRICT NO ROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /a G O �O t
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license Is to full force and effect 5 P R SYSTEM / nn FINAL / VALIDATION
20 6U42�FO�I Lr 3 oC L�G _ DATE 1
O toe
License Number Lic Class
V
Contractor W l/�Date f B
❑ I am exempt under Sec
B &P C for this reason /� �i W
Plan check fee d
Dat PLUMBING PERMIT ISSUING FEE$ �D!cS� Z
Signature —'
TOTAL FEE p�ocr SO
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address
Law for the following reason (Section 7031 5, Business and
Professions Code) City Tel No
❑ j, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section
7044, Business and Professions Code) ;2 5 7 5 2 A
CONSTRUCTION LENDING AGENCY
I hereby nffirm that there is a construction lending agency for # • • • • • 5
the performance of the work for which this permit is issued
(Sec 3097, Civ C ) ( • • 2 2 5 0
Lender's Name • - 22500'
Lender's Address 1 0.24-86
j certify that I have read this application and state that the ,
above information is correct I agree to comply with all County
ordinances and State jaws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date