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Home My Public Portal About9684 LIVE OAK AVE_Plumbing__ 76A667-CE817-11-57 6� APPLICATION FOR PLUMBING .PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION JOHN A. LAMBIE, County Engiaeer ADDRESS CASSATT D. GRIFFIN, Supt of Building LOCALITY �� ^ �' �`y FOR APPLICANT TO FILL IN NEAREST ' CROSS ST. NUMBER FIXTURE OR ITEM f WATER CLOSET OWNER MAIL BATH TUB ADDRESS SHOWER CITY TEL. NO. v, LAVATORY CONTRACT60N 1ANA PLUMGH'4C CONTRACTORS u SINK ADDRESS 13329 E. Ecfor Sfreaf DISHWASHER CITY City of Indus'rry, GWNO- ED. 7-7226 LAUNDRY TUB CONTRACTOR'S 96496 STATE ❑ REGISTRATION N COUNTY CLOTHES WASHER DISTRI n GRO' READY FOR INSPECTION WATER HEATER1�6NE �TI ` GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD APPROVALS @ $1.00 PER ITEM DATE I PECTOR'S SI NATURE OR FIXTURE $ UNDER SLAB WORK PERMIT $ Al 00 Y ROUGH PLUMBING TOTAL FEE O GAS PIPING R. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .a HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES } 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR y GASTEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF s CALIFORNIA OR THAT, AM THE LEGAL OWNER OF THE ABOVE ±. UTILITY CO.NOTIFIED DESCRIBED RESIDEN},.E PROP RTY. SIGNATURE ( rt-0- �•rte__ /�L� y OF PERM IT r FINAL i ROBERTA.WOOD. Or ALIDATION SUPERVISING MECHANICAL ENG'R CK. M.O. CASH WORKEg;S'COMPENSATION DECLARATION APPUCAVON FOR PLMMC ONG Pamir Cn' I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 L insure, ora certificate of Workers' Compensation Insurance, 76A667A ora certifiedicop'y'ihereof (Sec..3800, Lab. C.) COUNTY OF LOS ANGELES. DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. UILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) / Oa Certified copy is filed with the county building inspec- ADDRESS J tion deparim`ent. NUMBER, FIXTURE OR ITEM @• FEE 'LOCALITY WATER CLOSET Date- ApplicantNEAREST IL CERTIFICATE OF EXEMPTION.FROM WORKERS' BATH TUB CROSS ST. 7 COMPENSATION.INSURANCE OWNER (This section need not be corirplefed if the work Involved by SHOWER MAIL A4 a 11 62. e ,. the permit is for one hundred dollars ($100)or less.) • LAVATORY `ADDRESS -1 t� P,� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK 'CITY 1 TEL. NO. so as-to become subject to the Workers'Compensation Laws. DISHWASHER -T G oR CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY Thereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS L (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER J and Professions Code,and my license is in full force and effect. 5 PER SYSTEM >= DATE VALIDATION . O License Number Lic. Class CJ. FINAL Contractor Date BY 0. ❑, I am exempt under Sec. iU B.BP:C. for this reason ELI Plan check fee Z Date: PLUMBING PERMIT ISSUING FEE$ �3 Signature TOTAL FEE SINGLE FAMILY. Plan check applicant ' HOME,OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License r i t= +�• = Law for the following reason (Section 7031.5,'Business and Address i . Professions Code): City Tel. No. _ -5 7, rJE 1, as owner of the property, will do the-work and the a structure is not intended or offered-for sale (Section 7044, Business and Professions Code): D 3 @ i-Ai r L �= w� 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.). i'HiIR;C Lehder's Name U9 1-0-PUI Lender's Address _ I certify that I have read this application and state that the 'S I" '1�;-{, above information is correct. I agree to camply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentionedproperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE (140,4 All Signature of Permittee Date WORKERS'COMPENSATION DECLARATION Ap l!—P UCATPON FOR PLUMENG NG PERMPT i Hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 uau insure, or a certificate of Workers' Compensatiorrinsurance, 76A667A or 6 certified copy.thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 4`. .Policy Na. 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 n �} LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB - CROSS ST. COMPENSATION INSURANCESHOWER OWNER (This section need not be completed if the work involved by MAIL o the permit is for one hundred dollars ($100).or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY do TEL NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER 0' NOTICE TO APPLICANT: if, after making this Certificate 'of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 '' GAS SYSTEM OUTLETS �✓� // (commencing with Section 7000) of Division 3 of the Business � OUTLETS OVER O and Professions Code,and my license is in full force and effect. 5 PER YSTEM FINAL VALIDATION r DATE -L, License Number Lic. Class 0: FINAL _ Contractor Date BY CY aI am exempt under Sec. B.BP.C.•for this reason 99 Plan check fee �p �fQ D Date: PLUMBING PERMIT ISSUING FEE$ Signature' TOTAL FEE Q Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address (yiti;i_;S Law for the following reason (Section 7031.5, Business and Professions Code):. aCity _ _ 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 L_In'•.3� __ (Sec. 3097, Civ. C.). {{ Lender's Name Lender's Address r-',t I certify thot this plication and state that the D or o is correct. I ee to comply with all County �SS rdinances t to la re sting Plumbing, and hereby uth a rep a ves of t is CouNto enter upon the ve-me roperty for nspectiu poses. �� SEE REVERSE FOR EXPLANATORY LANGUAGE i9natu Date