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Home My Public Portal About9803 LAS TUNAS DR_Plumbing__ 76 A 667 -,CE 817 7-69 1. p �p PERMIT® g APPLICATION PERMI FOR -PLUMBING `f COUNTY OF LOS. ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS / (.+ COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY ` FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST r r - NUMBER FIXTURE OR ITEM EACH FEE CROSS ST. � WATER CLOSET 1.50 OWNER MAIL BATHTUB 1.50 ADDRESS it/ SHOWER 1.50 CITY J 4 TEL. NO. LAVATORY 1.50 CONTRACTOR SINK 1.50 ADDRESS F s A „ �LCi l DISHWASHER 1.50 CITY TEL. NO. CLOTHES WASHER 1.50 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.50 DISTRI NO. GROUP ZONE r PR SEED BY LAWN SPRINKLER SYSTEM 2.00 Og C—Z �� WATER HEATER 1.50 IINND ST APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD u OUTLETS OVER 30 5 PER SYSTEM O Lu Z. Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 2 00 ; TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan Check applicant - UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. NO. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 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 GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED-BY L S ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT/(AMT LEGAL OWNER OF,A D INTEND TO RESIDE IN.THE A:��D RESIDENTIAL PROP Y. FINAL SOF S . JACK R. ALLEN, SUPERVISING MECHANICAL ENG' PERMIT VALIDATION CK. M.O. C SH` PLAN CITEVAI.IDA ONS CK. M.0. CASH ► Ar-8 0 0 79 DECj 5 A 35-0N Al 7'6 A'¢67'=FE•817 8/88 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES u DEPARTMENT OF COUNTYLDMSION EER BUILDING AND SAFETY BDD»ssJOHN A. LAMBIE, COUNTYRCOLEMAN W. JENKINS. SUPTDING LOCALTfY 7;,.,,,I--- cL FOR APPLICANT TO FILL IN(PRINT OR TYPE) NEAREST //7l CROSS ST. L7 O404 •Ps, d -05 NUMBER FIXTURE OR ITEM EACH FEE 6/ WATER CLOSET 1.50 a 100 OWNER FLAIL BATH TUB 1.50 ADDRESS ay SHOWER 1.50 CITY TEL. NO. LAVATORY 1.50 CONTRACTOR ® SINK 1.50 ADDRESS Q •7d DISHWASHER 1.50 CITY TEL. NO.�//-' J4// CLOTHES WASHER 1.50 STATE LIC LICENSE NO-;l CLASS SWIMA4ING POOL RECEPTOR 1.50 .:.. .. DISTRICT NO. GROUP ZONE PRO ES BY LAWN SPRINKLER SYSTEM 2.00 L v CD WATER HEATER 1.50 INDUSTRIAL 1 n r r 0 GAS'SYSTEM OUTLETS 1.50 WASTE APPROVAL 41/-11164#jftP CTION AE RW ` ~- OUTLETS OVER1� 1 v 5 PER SYSTEM •30 g�. v ( N 6.r Z //�� ECia //yy■�� Dry" - L% ::. 1 O s t� j '. . Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 9 2 00 - TOTAL FEE �j /� Q APPROVALS DATE INSP OR•S SIGN URE Plan check applicant + UNDER SLAB WORK Name ROUGH PLUMBING Address , GAS PIPING i GAS VENT City Tel. No. .:i HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES n WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING S PLUMBING. � GAS TEST i d 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQLDBY OS ANGELES COUNTY AND STATE OF CALIFORNIA OR T LEGAL O EROF,AND INTEND TORESIDE IN,THE A RESIDE IAL PROPERTY. e,. FINALSIGNATURE JACK R. ALLENSU ERVISING HANICAL ENG'R. OF PERMITTEE PERMIT VALIDATION C K: M.O. CASH PLAN CHIEC IIDATION CK. M.O. CASH 1 6 s 3 occ:-, s�1g 5 D 3 0.50~ �+ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT x Department of County Engineer ` DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer 1 TR: T a. GROUP ZON . FOR APPLICANT TO FILL IN . L. $ALCH PLUMBER 1 g u _ REC IVSD BY READY FOR DATE ISSUED 5FREE" ' t J "S CALIF. FIRST INSPECTION _ r G ADDRESS PHONE PI_yrnouth 4.161 111v� t ' a4.5 N `� � BUILDING \ CITY •EV No. . ADDRESS COUNTY /� LOCALITY C:I E LICENSE NO. D XPIRES NEAREST /�p� CROSS BT. �� ( � U 5 T7 60 4, PERMIT FEES �,QQ NUMBER ,/ TYPE OF FIXTURE OR ITEM FEE OWNER L r��..d'q� 0e 'WATER CLOSET(TOILET) 0 1349 M ADDREnS9 ? �r► ® f�(Ls71 p BATH TUB ® O O CITY ( /�tyQ B �TEL. Na,y tAj G'i 9FIOWER O. O 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) 0 0. O APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK 0 O O AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0 0. O ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER GAS SYSTEM OUTLETS @ O.?O OF THE RESIDENTIAL PROPERTY. DEBPK48ED ABOVE. WATER HEATER O O BIGNPATUE REF a�• _ SLOP SINK a O. O INSPECTION RECORD FLOOR BINK Cel O. O FLOOR DRAIN a 0.60 I r• n T•�a 4-� !•1•,•r' f!I - 1�:'�!'+-' DISHWASHER @ O. p dti1 L r DRINKING FOUNTAIN @ O. URINALO. O J HOUSE SEWER I 0.10 Z_ MISCELLANEOUS 0! A 13 APPROVALS DATE IrJSPEOTOR'S NAME � n ROUGH PLUMBING �,�, `I °! /��,.�Gf�lt e•�� GAS PIPING GAS VENT CESSPOOL 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT 1.00 GAS TEST , • TOTAL FEE $ UTILITY CO.NOTIFIED C FINAL 1 76A667 DBS# 17 6-58 76 A X667—CE 817 8/68 APPLICATION FOR PLUM NG P.ER HT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST �+ CROSS Si. W NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1.50 MAIL BATH TUB 1.50 ADDRESS SHOWER' . 1.50 CITY Q ,LP TEL. NO. r LAVATORY 1.50 CONTRACTOR e e ` 1� SINK \ 1.50 ADDRESS Q c DISHWASHER 1.50 CITY TEL. NO.STATE:- LIC CLOTHES WASHER 1.50 LICENSE NO. ,�s CLASS G! SWEMhIING POOL RECEPTOR 1.50 DIST 1 UF) E PR Y SES BY LAWN SPRINKLER SYSTEM 2.00 - 7p7 Q CD WATER HEATER 1.50 INDUSTRLfl1. o WASTE APPROVAL F- GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD v W OUTLETS OVER 5 PER SYSTEM .30 y Z r Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 2 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address ._ - GAS PIPING GAS VENT City J Tel. No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 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 GAS TEST PLUMBING. 1 HEREBY CERTIFY'THAT I AM PROPERLY REGISTERED AND/OR • UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF / f� CALIFORNIA OR THAT I AM THE LEGAL OWNER F.AND INTEND TO RESIDE IN.THE ABO S IBE RESIDENTIA PR PE FINAL SIGNATURE , ��ZRMIT ALLEN, SUPERVISING MECHANIC N OF PERMITTEE > - VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 7697' Vl g D �F. 0~ I WORKERS'COMPENSATION DECLARATION 7GA667A I hereby affirm that I have a' certificate of consent to self C. 617(:-.o) APPLICATION F®R PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) �J COUNTY OF LOS ANGELES // BUILDING AND SAFETY Policy No& Coln i Certified copy is-hereby furnish FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDINGJ S NUMBER FIXTURE OR ITEM FEE Certified copy is filed with the county building inspection y 0 ADDRESS QS �� 4 L/ tSn.V.01 n. A WATER CLOSET LOCALITY rDate pplican � NEAREST 5_4 — BATH TUB CROSS ST. CERTIFICATE.OF EXEMPTION FROM WORKERS"'E' COMPENSATION INSURANCE SHOWER OWNER his section need.not be completed if the work involved . MAIL �/ (I p LAVATORY ADDRE "L e.W- �� 9L by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO. (�j I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRALTO2ege ,+e t� 0 so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS dd �/ Date Applicant SWIMMING POOL RECEPTOR UJ NOTICE TO APPLICANT: If, after making this Certificate of CITY��j/�h/lC�� TEL.N M Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. _ Compensation provisions of the Labor Code,you must forth- LICENSE NO with CLASS with comply with such provisions or this permit shall be WATER HEATER ,deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. P CESSED B LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of.Chapter 5 PER SYSTEM 9 (commencing with,Section 7000)of Division 3 of the Busi- FINAL ness and Professions Code, and my license is in full force and' DATE f _LQ_8r VALIDATION effect. yj> DLic.Class � FINAL -License Number BY I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE 'Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name re I hereby affirm that I am exempt from the Contractor's Address ��'Bd/� License Law for the following reason (Section,7031.5, Busi- City Tel.No. ;ness and Professions Code): I, as owner of the property, am exclusively contracting I z`0 9 2.5.A with licensed contractors to construct the project (Section 7044,'Business and Professions Code). W o o o o o 5 I CONSTRUCTION LENDING,AGENCY I 2;° 0 1 0.00 I hereby affirm that there is a construction lending agency Ifor the performance of the work for which this permit is o 0 0 1 (10070- issued(Sec.3097,Civ.C.). Lender's Name 0 8,2 6'—81 Lender's Address I certify that I have read this application and state that the above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the , Nove-mentioned roperty for inspection purposes. �ar Signature of PermitteeC&//� Date I i� WORKER'S COMPENSATION DECLARATION 6876ADPW 8/89 APPLICATION FOR PLUMBING PERMIT I hereby`affirm that 1 have a.certificate of consent to self Insure, or a certificate of W.9rker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No. Company COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. � ❑ Certified copy is hereby fumished. U,—* FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ..5 Certified copy Is filed with the cou ding inspection ADDRESS depart �j NUMBER FIXTURE OR ITEM 0 FEELOCALITY Y Date —� �r-AppIICa �� WATER CLOSET NEAREST EARle All CERTIFICATE OF EXEMPTION FR09 WORKERS' CROSS ST. COMPENSATION INSURANCE BATH TUB ASSESSOR. (This section need not be completed if,the work Involved by the SHOWER MAP BOOK PAGE PARCEL permit Is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as too SINK MAILIF become subject,to the Workers'Compensation Laws. ADDRESS � Ude DISWASHER CITYTEL.NO. 3C Date Applicant CLOTHES WASHER CONTRACTOR r -,— NOTICE TO APPLICANT: If, after making this Certificate of f/l f' G Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR r provisions of the Labor Code,you must forthwith comply wjth such ADDRESS .Z.6 /- provisions-or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY �.. TEL.NO. d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER I (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM. OUTLETS LICENSE NO. U CLASS V Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY (Y did/1 6 PER SYSTEM Q License Number4�1�_Lic.Class — FINAL vf- ATE VAEIDATION CILW Contra 0" Date :I ACCT.s Cn FINAL ❑ I am exempt under Sec. BY B.&P.C.for this reason 135.95 Plan check.fee , I ITEMS' Date: Signature O PLUMBING PERMIT ISSUING FEE$ O TOTAL 135. 95 TOTAL FEE {-��( 135.95 El Plan check applicant . I3 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address (000-01101 7/8/93 Code): +-V r ti� ❑ City Tel.No. `!■o 1,as owner of the property,will do the work and the structure All I t `i 1 42 Is not Intended or offered for sale(Section 7044, Business and Professions Code). ' 5 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit Is Issued (Sec.3097, / Civ.C.) Lender's Name Lender's Address I 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 lawspVulating Plumbing, and hereby authorize represents' f t ounty to enter upon the above-mentioned prop y r in a urposes. ^ SEE REVERSE FOR EXPLANATORY LANGUAGE Ignature of Permittee Date .1 WORKERS'COMPENSATIONDECLARATION +`�'. /314 LI ATION FOR PLUMBING PERMIT w .l herty;{ffirm that I have a certificate of consent to self 78A8g7q (�-•� •'insure, ora certificate of Workers'Compensation Insurance, CE 817(REV.8/88) or a certified copy thereoLf5gc. 3800, Lab. C.) Pol' No ' cue-1w�ar� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS �y pan Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS• Aos 7l t. do depar ment. NUMBER FIXTURE OR ITEM ® FEE LOCALITY T' Dat Applisa _ , WATER CLOSET NEAREST /� 1 CERT ICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER ,(This section noed not be completed if the work Involved by MAIL a / �+ tho permit is for one hundred dollars($108)or loss.) LAVATORY ADDRESS 4T®3 kC B% V LA.1a I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. t so as to become subject to the Workers'Compensation Laws. DISHWASHERr 9 CONTRACTOR ` Date Applicant CLOTHES WASHER ADDRESS, 1?,,, .S 7 NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL.NO. J Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM i'�w 9 � with comply with such provisions or this permit shall be STATE CLASS deemed revoked. WATER HEATER LICENSE NO.Aa P LICENSED CONTRACTORS DECLARATION DISTRICES BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER A and Professions Code,and my license is in full force and effect. 15 PER YSTEMFINAL b (DATION C —f DATE C License Number271 -[ Lic. Class a +-- � FINAL C Contractord�<y" �e +u��a� 2_Z BY C Ar❑ I am exempt under Sec. B.BP.C. for this reason Plan check fee ;P 7 0 9.9 A s PLUMBING PERMIT ISSUING FEE$ `j # 0 0 0 0 0 5 Signatu TOTAL FEE 1 - - 1650 Plan check applicant j SINGLE FAMILY ° O 6 0 HOME OWNER-BUILDER DECLARATION Name 00 -1 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. ❑ I, 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). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I 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 laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- Toned p oper r i ctton purpos s. SEE REVERSE FOR EXf LATIATORY LANGUAGE a ignot a Pe 1ttee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PL6MBING PERMIT I h by affirm that I have a certificate of consent to self -76A667A in re, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) !r certified copy thereof(Sec. 380R, Lab. C.) ' COUNTY OF LOS ANGELES BUILDING AND SAFETY cy No. tm-1414 Compan do L ❑ Certified copy is hereby furnished. U BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM FEE LOCALITY Dote/. Appli4ant WATER'CLOSET NEAREST CERTIFICATE OF EXEMPTION FROMW&RKEd1,1 BATH TUB CROSS ST.. COMPENSATION INSURANCE OWNER 2021 7/Z7 (This seetion need not be completed if the work Involved by SHOWER the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS �, I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, .you should become subject to the Workers' SWIMMING POOL RECEPTOR i Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY �_ TEL.NO. with comply with such provisions or this permit shall be STATE LIC. 1 deemed revoked. WATER HEATER LICENSE NO,/ / PC CLASS13 4 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER Q and Professions Code;and my license is in full force and effect. 5 PER SYSTEM FINALVALIDATION 0 /� —!a u License Number/ DATE 4S775L/%0 Lic. Class �^ +� 9E FINAL O Contractorg—� }�_T� �4Date Q' +. BY ❑ lam.exempt under Sec.• C. y B.BP.C. for this reason ' Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signatur, TOTAL FEE „ Plan check applicant T.!7 1 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name ,5 I hereby affirm that I am exempt from the Contractor's License Address �'0 1 b Law for the following reason (Section 7031.5, Business and Professions Code): " City Tel. No. ❑ I, 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). i CONSTRUCTION LENDING AGENCY I hereby affirm that there,is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name ' I � . Lender's Address I certify that I have read this application and state that the f above information is correct. I agree to comply with all County ' ordinances and State laws regulating Plumbing, and hereby �J' authorize representatives of this County to enter upon the ) above-mentioned property for inspection purposes. 00 SEE REVERSE FOR EXPLANATORY LANGUAGE ; Signature9 ermitf a Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 t insure, or a certificate of Workers'Compensation Insurance, 76A667A or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS ! //• tion department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY WATER CLOSET NEAREST Date Applf4ant CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ,COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed-if the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS /Z10 I certify that in the performance of the work for which'this permit is issued, I shall not employ any person in any manner SINK Ge 40 C CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. JA DISHWASHER CONTRACTOR C�y� Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR P y I CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE �� CC. LIC. deemed revoked. WATER HEATER LICENSE NO. LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby off irm.that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ^r/ (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER %57C/o/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION License Number 9�%�o Lic. Class DATE V � �� FINAL IM Contractor"-2/144414Q/- Date BY C ❑ I am exempt under Sec. W B.BP.C. for this reaso �� D' Plan check fee Z to PLUMBING PERMIT ISSUING FEE$ ✓Signature , TOTAL FEE Plan cheek applicant ' SINGLE FAMILY =F 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 P ffe ions Code): City Tel. No. �f�`L 1.00 LJ I, as owner of the property, will do the work and the 1 T SEEKS strudture is not intended or offered for sale (Section 7044, Business and Professions Code). " ' TOTAL IAL 4 1 m 00 CONSTRUCTION LENDING AGENCYi.lj K 4 i,(Itis 1 hereby affirm that there is a construction lending agency for the performance of the work for which,this permit is issued -QHAN1G1E .013 (Sec. 3097, Civ. C.). Lender's Name 00011_Li001 /23 9 Lender's Address I 1tG ! {_ I 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 laws regulating Plumbing, and hereby authorize re sentatives of this County to enter upon the abov -m onedTprtVfof5?spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa rmit Date i ' COUNTY OF LOS ANGELES TEMPLE CITY # 008 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9707220073 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL 10: F A S: TR: 6561 LT: 74 BL: .001 9803 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802209 ASSESSOR IOR NEAREST CROSS STREET: GOLDEN WEST 8587-026-015 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY 19 FLOOR SINKS) 1.00 FIX 16.35 TENANT: TOTAL FEES 44.10 ISSUED ON: OC SS 0 CARL'S JR. 07/22/97 TC 07 2/98 OWNER: TEL. NO: FINAL DATE FINAL CODE: VERMEULEN CHARLES I CO TR — 11591 CIELO PL 1712A n- �.Y C 0 -OF WORK I INSTALL FLOOR SINK IN EXISTING RES AURANT APPLICANT: 0: ROFF ENT. (714) 990-0999— SPE I CONDITIONS: CONTRACTOR: TEL. 0: APPROVALS DATE INSPECTOR SIGNA RE ROFF ENTERPRISES (714) 990-0999- 561 MERCURY LANE LIC. NO UNDER SLAB WORK BREA, CA 92821 526870 B WATER SERVIC PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. ' MUSH PLUMBING LIC. N0: GAS PIPING sW 5 VENT T WKIER ffUYrR— PLUMBING R LAWN SPRINKLERS GAS TEST UTILITY COMP_MV_W0_T=D V MUff TAMWIS711f REPORT ID: DPR263 ROUTE TO: BS0508 •-COUNTY-OF•LOS ANGELES TEMPLE CITY' # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0510070004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE. (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 6561 LT: 74 BL: .001 9803 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917802209 ASSESSOR INFORMATION NUMBER: NEAREST•CROSS STREET: 8587-026-015 01 PERMIT ISSUANCE FEE •27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C 26 MISCELLANEOUS FIXTUR 1.00 FIX 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: CARL'S JR #7358 10/07/05 JK 04/05/06 OWNER: TEL. NO: FINAL FINAL BY: CODE: SENIOR CLASSIC (714) 736-8900- Q! ONE CENTER POINTE DR gp- LA PALMA, CA 90623 DESCRIPTION OF WORK INSTALATION OF WATER USING DEVICE APPLICANT: TEL. NO: MICHAEL STRANO (323) 888-9823- 1001 GOODRICH BLVD. SPECIAL CONDITIONS: LOS ANGELES CA 90022 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE LOS ANGELES PLUMBING & BACKFLOW (323) 888-9823- 1001 GOODRICH BLVD. LIC. NO UNDER SLAB WORK LOS ANGELES, CA 90022 534844C-36 WATER SERVICE PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508