HomeMy Public PortalAbout10114 LIVE OAK AVE_Plumbing__ 10176AS07 17 B-Eo APPLICATION FOR PERMIT-
DEPARTMENT OF BUILDING AND SAFETY L
t_ COUNTY OF LOS ANGELES
Y WILLIAM J. FOX, CHIEF ENGINEER
m FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
VALLEY BOULEVARD PLUMBiNG CO. S' — — ! 7�-' — 3
PLUMBER RECEIVED BY READY FOR DATE ISSUED
300 EAST ALLEY BLVD. c 9-INSPECTION
ADDRESS T
t=LMLAD Al. 2-2719 BUILDING
CITY TEL. NO. ADDRESS
COUNTY S LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
/ MAIL
WATER CLOSET (TOILET) Q 0.50 S O ADDRESS /V
BATH TUB Q 0.50 a CITY TEL. NO. %.5_ ��
SHOWER Q 0.50 0 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.50 d APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK ® 0.50 STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q 0.50 O ANGELES COUNTY LICENSE, OR I AM THE LEGALZNER
OF THE RES I DENTIALIP OPERTY DES3:RIIIBBBEEDDABOVE
/ IGAS SYSTEM OUTLETS Q 0.50 D SIGNATURE OF 1/ y� f,
1 WATER HEA ER Q 0.50 PERMITT_ '''Y ..YY
i SLOP SINK Q O.So I INSPECTION RECORD
FLOOR SINK Q 0.50
FLOOR DRAIN Q 0.50 I _
DISHWASHER Q 0.501
DRINKING FOUNTAIN Q 0.50
URINAL @ O 501 ..1
HOUSESEWER Q 0.501 z
MISCELLANEOUS
I� o
I .
I�
I
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING �1 I
GAS PIPING Ito_);.V1"'e
GAS VENT
CESSPOOL 1.00I CESSPOOL
SEPTIC TANK: I SEPTIC TANK
I DRAIN ( ) PIT ( ) Q7.001 I SEWER
PERMIT • I 1,00 GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE
FINAL
'WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9189
76A667A APPUCAT8ON FOR PLUMB NG PERMIT
I hereby affirm that I have a certificate of consent to self insure, ;
I or a certificate of Worker's Compensation Insurance, or a certified
copy thereof'(Sec.3800 Lab.CQ
COUNTY OF LOS ANGELESY DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
Policy No Company
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
10
Certified copy is filed with the county buildingtinspection ADDRESS -�/
EJ
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
64
Date Applicant WATER CLOSET 5 U NEAREST
CERTIFICATE OF EXEMPTION.FROM.WORKERS' BATH TUB CROSS ST
COMPENSATION INSURANCEASSESSOR PAGE��Q
D3 p 0/60
(This section need,not be completed If the work involved by the SHOWER I j �J MAP BOOK PARCEL
permit is for one hundred dollars($100)or less.) ` l OWNER
I certify that in the performance of the work for which this permit 4 LAVATORY lS w-
is issued, I shall not employ any person in any manner so as to SINK MAIL ) /�
/become subject to the Workers' Compensation Laws. ADDRESS
2 DISWASHER pp 3 CITY°"`T�? �2 G= TEL.NO
Date Applicant CLOTHES WASHER ! t� `-
NOTICE TO APPLICANT: If, after making thi ertificate of CONTRACTOR
Exemption,you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR i I
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL NO
Ihereby affirm that I�am licensed under provisions of Chapter 9 WATERHEA7ER d
(commencing with Section 7000) of Division 3 of the-Business and STATE LIC O
Professions Code,and my license is in full force and effect. IGAS SYSTEM OUTLETS LICENSE NO CLASS U
' OUTLETS OVER DISTRICT NOP OCESSED BY a:5 PER SYSTEM /= "� l O
License Number Lic.Class 5J V U
FINAL
DATE ��., 'VALIDATION W
Q.
Contractor Date (n
FINALZ
I am exempt under Sec. By 57 T
B.BP.0 for this reason
Plan check fee
Date.
Signature •
PLUMBING PERMIT ISSUING FEE$ 2S
❑ TOTAL FEE _70 -(O
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law, c
for the following reason (Section 7031.5, Business and Professions Address
Code):
City � Tel No — i�4•G�v a -_
I, as owner of the property,will do the work and the structure aft �rrttta )
is not intended or offered for sale (Section 7044, Business
and Professions Code). ® I ITENS
CONSTRUCTION LENDING AGENCY - . TOTAL 70® 71D
I hereby affirm that there is a construction lending agency for the ij
performance of the work for which this permit is issued (Sec 3097, CHECK 70.;'I I
CHANGE 1
Lender's Name
Lender's Address I �li i -I �1 5
I certify that I have read this application and state that the above ®
information is correct. I agree to comply with all County ordinances AN 10 42:
and State laws regulating Plumbing, and hereby authorize i
r resentatives of this County to enter upon the above-mentioned
4oper inspec on purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
./
Signature of ittee ate