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Home My Public Portal About9232 LIVE OAK AVE_Plumbing__ 76A667A CE 817 IREV.6/749)~ ©5 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BU' I ADD NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET ' NEAREST �� BATH TUB CROSS SL SHOWER OWNER MAIL OF6&A LAVATORY ADDRESS 6& SINK CITY L TEL DISHWASHER CONTRA/0 If CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY d TEL.NO. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. CLASS GAS SYST UTLETS L� APPROVALS DATE INSPECTOR'S SIGNATURE OUT( O R UNDER SLAB WORK 5 PE EMo ROUGH PLUMBING }} ` GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST �� f�j �� QQ Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ =` (i i:� ;'� 3' if TOTAL FEE FINAL 41160 f;,° PL CHECK VALIDATION Plan check applicant Name Gv�/✓ Address y City Tel.No. /4' ra � q n I HEREBY ACKNOWLEDGE T I VE READ THIS APPLICATION AND STATE f G 2 3 A THAT THE ABOVE IS CORRECT A AGREE COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSREGULATI PLUMBI PERMIT VALIDATION �� O O O O O I HEREBY CERT( THAT PROPER GISTERED AND/OR LICENSED AS REQUIRED BY LONG NTY AND S F CALIFORNIA OR THAT I AM THE 2 O O 0 0 LEGAL OWNER OF A I ND TO RESIDE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O O O 0 0-1, SIGNATURE 1,00-78 OF P R TEE DISTRICT NO. P ES ED BY INDUSTRIAL WASTE APPROVAL WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certFficate of Workers' Compensation Insurance, CE 817(REV. 10/81) u or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � �� r(nQjk U� Certified copy is filed with the county building inspec- ADDRESS f tion department. NUMBER FIXTURE OR ITEM � FEE WATER CLOSET LOCALITY—;&x D/a, C`+ Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER/7/ ' (This section need not be completed if the work involved by SHOWER MAIL' the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compe soli q Laws. DISHWASHER 1 CONTRACTOR nI Date J AppIica1_ / CLOTHES WASHER NOTICE TO APPLICANT: If, a ter mak' this Certifi ate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY Compensation provisions of the Labor Code, you must forth- TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICWNO. OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS tO G (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATI License Number Lic. Class DATE O FINAL U Contractor Date BY I am exempt under Sec. O B.&P.C. for this reason U Plan check fee W a Date: PLUMBING PERMIT ISSUING FEE$ JET Z Signature TOTAL FEE ,3 Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address La for the following reason (Section 7031.5, Business and Pr fessions Code): City Tel. No. - 5 9 2$a I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® # 0 0 0 0 0 5 7044, Business and Professions Code). I o - 34.50CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for o 0 o 3 IL 5 0Z the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). .1. 1 3-86 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 entjoned property o inspect'on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign tur f Permittee Date