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Home My Public Portal About10634 1/2 LIVE OAK AVE_Plumbing__ /0 C 7 DBS-17 APPLICATION FOR PLUMBING P.ERMIT . DBS-1 f .0-B9 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN I NEAREST , L--- CROSS ST OWNER V' DISTRICT NO GROUP ZONE READY FOR INSPECTION MAIL ADDRESS CITYAUNP" DUSTRIAL TEL NOJJ Q "J /�'— WASTEAPPROVAL PLUMBER INSPECTION RECORD ADDRESS CITY . NO LICENSE NO. _ � kee NUMBER TYPE OF FIXTURE OR ITEM -FEE WATER CLOSET (TOILET) @ $100 $ BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $100 KITCHEN SINK @ $1 00 DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $1.00 WATER HEATER @ $100 GAS SYSTEM @ $1 00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT 1 00 ROUGH PLUMBING $ , GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL_PROPERTY.- 9 SIGNATUREOF PERMITTEE y�Tf� �- FINAL i6 JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT A. WOOD, \CHIEF PLBG INSPECTOR CK. M.O. CASH �J �4 6 I:, APR 2 3 1 .0 D in APPLICATION FOR ,PLUMBING PERMIT, IDBS;17 3D1VISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles f WM.J. FOX, COUNTY ENGINEER ADD EISS CASSATT D. GRPO GRIFFIN SUT F BUILDING LOCALITY FOR APPLICANT TO FILL IN -NEAREST CROSS ST OWNER DIS TRIC NO GROI�,P ZONE READY FOR INSPECTION MAIL I ASI ADDRESS �y INDUSTRIAL CITY TEL NO WASTE APPROVAL PLUMBERBAXTER R SON INSPECTION RECORD ADDRESS 2536 N San Gabriel 44 4--pe4lov CITY S. San .dabbrieie4l_ 'NOAT. 0-6241 LICENSE NO NUMBER - TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) 5 BATHTUB' SHOWER . - LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY �y..�. - CLOTHES WASHER TOTAL NO @ o so APPROVALS DATE INSPECTORS SIGNATURE GAS SYSTEM OUTLETS @ 1 00 WATER HEATER @ 1 00 UNDER SLAB WORK ROUGH PLUMBING PERMIT $ 1 00 GAS PIPING, TOTAL FEE GAS VENT 1•HEREBY' ACKNOWLEDGE. THAT-IHAVE READ THIS APPLICATION' HOT"WATER HEATER AND S1 ATE THAT THE,ABOVE IS CORRECT AND AGREE TO COMPLY r WITH ALL COUNTY ORDINANCES AND STATE LAWS REGU ING PLUMBING FIXTURES PLUMBING 1HEREBY CERTIFY TH AM P P ISTERED /OR aAS TEST s,r LICENSED AS REOUIR BY LOS GEL PITY AND TE 0 CALIFORNIA OR,7 T I LEG WNER LITY CO.NOTIFIED DESCRIBED RESJ NTIAL ERTY.- f SIGNATU • OF PER TT FINAL ,��6 WILLIAM J. FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,CHIEF PLBG. INSPECTOR G4389 !AR22 3 8.00 in WORKER'S COMPENSATION DECLARATION 720-0026 6A667ADPW9f69 APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self insure, � or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec. 3800 Lab.C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company Certified copy is hereby furnished. r-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM rn FEE LOCALITY Date Applicant WATER CLOSET NEAREST 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($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS become subject to the Workers' Compensation Laws. DISWASHER CITY TEL.N0. _ Date_ Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption, you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. d If 1 hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER l (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS SCE SE NO. / CLASS U IF Professions Code,and my license is in full force and effect. W OUTLETS OVER DISTRICT NO. PROCESSED BY �J 5 PER SYSTEM LL License Number Lic.Class FATE VALIDATION a Contractor Date _ Q ❑ 1 am exempt under Sec. BV AL a BAP.C.for this reason 2 Date: Plan check fee Poo.Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE SINGLE FAMILY Plan check applicant 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): ❑ 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE I WORKER'S COMPENSATION DECLARATION 20.0026 DPW 9/89 APPLICATION FOR- PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self insure, _ , or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec 3800 Lab C) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No Company - \ Certified copy is hereby furnished O FOR APPLICANT TO�FILL IN(PRINT OR TYPE) BUILDING - ,# �� -•,�', !_ Certified copy is fled with the county buildinginspectionADDRESS ,�r'•i�•�':/ _�arlr'+, ,y' 'S; department NUMBER FIXTURE OR ITEM @FEE LOCALITY ;F 3F A Date Applicant WATER CLOSET NEAREST /./ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS S7 �" w COMPENSATION INSURANCE ASSESSOR r(This section need not be completed if the work'involved by the SHOWER MAP BOOK PAGE PARCEL 7 rJ permit is for one hundred dollars($100)or less.) OWNER y ' r j _ I certify that in the performance of the work for which this permit LAVATORY . is issued, I shall not employ any person in any manner so as to MAIL r J^ SINK ADDRESS become subject to the Workers' Compensation Laws DISWASHER - CITY ai i�, �` r;i t; r' �;, .TEL NO f •ti Date I ': '.r' Applicant__ �','�f; i.E..j 6_ ,a r/��,1 CLOTHES WASHER - ,•t t,r ' NOTICE TO,APPLICANT If; after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR f t ~ ! provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY WATER HEATER 't fK r f a fr_4j�Yt. TEL NO f f`! , d I hereby affirm that I am licensed under provisions of Chapter 9 � " 0 (commencing with Section 7000)of Division 3 of the Business andSTATE LIC ✓ LICENSE NO fL r '3�';' '^ CLASS Professions Code, and my license is in full force and effect GAS SYSTEM OUTLETS — W DISTRICT NO PROCESSED BY • - 'r OUTLETS OVER ,r' J 5 PER SYSTEM r f UL License Number Lic Class a f - FINAL DATE VALIDATION - ,� r _ - 1• Contractor Date ❑ „ `'-,,`. FINAL O I am exempt under Sec BY: d B&P C for this reason W Plan check'fee I— Date Signature PLUMBING PERMIT ISSUING FEE$ ^r, •- ❑ TOTAL FEE Plan check applicant SINGLE FAMILY ;3 HOME OWNER-BUILDER DECLARATIONName I hereby affirm that I am exempt from the Contractor's License Law- for aw'for the following reason (Section 7031 5, Business and Professions Address �• 7 > Code) p I City Tel No ❑ I, as owner of the property,will do the work and the structure S � " is not intended or offered for sale (Section 7044, Business and Professions Code) CONSTRUCTIONLENDING AGENCY y I hereby affirm that there is a construction lending agency for the J performance of the work for,which-this permit is issued (Sec 3097, Civ C) t Lender's Name 14 Lender's Address „ .,I certify that I have read this application and state that the above r,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-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE