HomeMy Public PortalAbout10018 LIVE OAK AVE_Plumbing__ 76AS67 n 5-50 12 APPLICATION FOR PERMT
t7 DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER PLUMBING I
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
VALLEY BOULEVARI) Pi 120 /
PLUMBER. RECEIVED BY READY FOR DATE ISSUED
8300
EAS . 15: FIRST INSPECTION L/ _5�/
ADDRESS f1 j
Ar, 2--2719 BUILDING o0
CITY TEL NO ADDRESS
COUNTY / LOCALITY
�
LICENSE NO EXPIRES �Y(
NEAREST
PERM FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE
O W N E R &.-g
MAIL �V
WATER CLOSET (TOILET) @ O 50 $ Qd ADDR SS lJ /]
�J BATH TUB Q O 50 CI TEL. NO. �S
SHOWER Q O SO V 1HEREBY A01KNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ O 50 I f Q APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
/ I
KITCHEN SINK @ O 50 STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q O 50 U ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
/ I
GAS SYSTEM OUTLETS O 50 OF THE RESIDENTIA P PERTY DESCRIBED ABOVE'
niL D
TI SIGNATURE OF
/ WATER HEATER @ O 50 PERMITT
SLOP SINK Q o So INSPECTION RECORD
FLOOR SINK Q o Sol
FLOOR DRAIN @ O 50
DISHWASHER @ O SO
DRINKING FOUNTAIN Q O 50
URINAL @ O 501 „J
HOUSE SEWER @ 0 501 Q
MISCELLANEOUS
O
I
APPROVALS
^f DATE INSPECTOR'S NAME
ROUGH PLUMBING �)
GAS PIPING �L�{'i��✓� .3A�
GAS VENT ,Ips" w 17
CESSPOOL Q 1 00 I CESSPOOL
SEPTIC TANK' SEPTIC TANK
DRAIN ( ) PIT ( ) Q 1 00 I SEWER
PERMIT 1-00 GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE $
L
FINAL /O'
r J
WORKER'S COMPENSATION DECLARATION v 20-0028 DPW 9/89 (�(� q Q�
I hereby affirm that I have a certificate•of consent to self insure, 76A667A ) MI!'PPYCATT O�fl� FOR PLUMBING PERMIT
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec 3800 Lab C) ) f
COUNTY OF LOS ANGELES y DEPT OF PUBLIC WORKS DEPT. O_F'PUBLIC WORKS DIV.
Policy No Company
- f
.Certified copy is hereby furnishedQ
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county budding inspection -'
department - NUMBER FIXTURE OR ITEMS ® FEE - LOCALITY
Date Applicant WATER CLOSET NEAREST M1
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST -
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed,if the work involved by the SHOWER., MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) WNERAA
I certify that in the performance of the work for which this permit LAVATORY ' /��f>
MAIL
is issued, I shall not employ any person in any manner so.as to SINK ADDRESS /QD/ L i v 4 Q
become sub/ect to the,WorkersCompensation Laws .
• DISWASHER - S j i CITY• Teti � lJ . Ci1 TEL NO Q+B-5
Date 'Applicant CLOTHES WASHER 1 L1li o T
NOTICE TO APPLICANT 'If, after making this Certificate of CONTRACTOR
Exemption,you should become'sublect to the Workers'Compensation SWIMMING POOL RECEPTOR '
provisions\of the Labor Code;you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoketl LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL NO >'
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER a-
(commencing with Section 7000 of Division 3 of the Business and STATE LIC 0
( 9 ) LICENSE NO CLASS
Professions Code,and my license is in full force and effect GAS SYSTEM OUTLETS V
OUTLETS OVER 'DISTRICT NOQ P1jOCES� BYY 1 - Ir
O
5,PER SYSTEM ��0 .:}_�'
License Number Lic Class
FINAL { V
DATE •�� •9� VALIDATIO�.f_ a
Contractor Date ` - i O�AL �, 57 - 3
7 - 3 fn
FINAL i
I am exempt under Sec } D BY c- • q—
,w_w
CHECK
B&P C for this reason -
Date Plan check fee ® CHANGE-' ,I `=
Signature
PLUMBING PERMIT ISSUING FEE$ Ie" 0,0
i 13 1S f +4!� 1 `i
❑ TOTAL FEE Q J J'-_r j 1 l rl,,�..
SINGLE FAMILY
Plan check applicant -14 1 Al C°1
- - _ '
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
Code)
❑ / Tel No
I,as owner of the property,will do the work and the structure City
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) f
1 / t •
Lender's Name
Lender's Address
(ooh L ,ve
I certify that I have read this application and state that the above ® % V__
information is correct I agree to comply with all County ordinances
and State laws regulating Plumbing, and hereby authorize
representatives of this County to Zener upon the above-mentioned
property fo ns ection purpo Sr SEE REVERSE FOR EXPLANATORY LANGUAGE
I
sl gnkt4re of erm Date ,
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