HomeMy Public PortalAbout9821 LIVE OAK AVE_Plumbing__ DB5.17 12.34 APPLICATION FO,R PLUMBING PERMIT
: DMSION OF BUILDING AND SAFETY 1
Dep. ent of County Engineer
.County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER ADDRESS Z Q
CASSATT D.GRIFFIN,SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
OWNER SSC DISTRICT_NO I GROUP. READY FOR INSPECTION
MAIL
ADDRESS Z 'S T P6-A ZZPA .4 J A.✓ d1
gAza e4- -'�� �
INDUSTRIAL _
CITY TEL NO WASTE APPROVAL'
PLUMBER Z" LIAI&LLIA INSPECTION RECORD
ADDRESS G ® 8 , r �w,AD
CITY 6. A)11- TEL. NO. 4Alle
LICENSE NO. 17 `DC7 NUMBER
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NUMBER TYPE OF FIXTURE OR ITEM FEE I
WATER CLOSET (TOILET) 0
BATH TUB 9-v
y SHOWER
!� LAVATORY (WASH BASIN) I
KITCHEN SINK (f
DISHWASHER
LAUNDRY TUB OR TRAY t(y A
CLOTHES WASHER
TOTAL NO ® 080 APPROVALS
DATE INSPEGTOR'S SIGNATURE
GAS SYSTEM=.j OUTLETS @ 1.00 �
/ UNDER SLAB WORK
WATER HEATER @WATER HEATER 1:00 Zoo
ROUGH PLUMBING �S
PERMIT i 00 GAS PIPING
TOTAL FEE IKO 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 FIXTURES �0 Zlo
PLUMBING. M r
ALL-
I HEREBY CERTIFY'THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED v.
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY, -
SIGNATURE
OF PERMITTEE FINAL Z W
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
5 8 7 5 Il JUL 21 3 9.4 0
BY
DEPUTY
. E
WORKER'S COMPENSATION DECLARATION 76A6 PW 9/89 ��������8®gyp ®� �������� ����p�
76A66 � �I
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)
_I COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
Policy No Company - I ,
❑ Certified copy is hereby furnished BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS L i t!� �/�j,4 r`�j
—
❑ Certified copy is filed with the county budding inspection
department NUMBER FIXTURE OR ITEM ® FEE LOCALITY
Date Applicant - WATER CLOSET - CROSS T l `S /n!_e/den (o&—_s,y
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION INSURANCE ASSESSOR I -
(This-section need not be completed if,the work involved by the SHOWER MAP BOOK /� PAGE PARCEL
permit is for one hundred dollars($100)or less.) LAVATORY OWNER ( „\.a
I certify that in the performance of the work for which this permitA l�lA
is issued, I shall not employ any person in any manner so as toSINK MAIL
become subject to the Workers' Compnon Laws I ADDRESS ��f.:
en a
DISWASHER CITY - TEL NO
Date Appiicanl CLOTHES WASHERr
NOTICE TO APPLICANT If, after making this Certi icate of ) CONTRACTOR db
Exemption,you should become subject to tl a Workers'Compensation SWIMMING POOL RECEPTOR /I
provisions of the Labor Code, you must forthwith comply with such ADDRESS 83� C$M e(L-(!AaC,19u
provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY � TEL NO9/g_"1,7I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER -commencin with Section 7000 of Division 3 of the Business and STATE �j LIC /� 0
( 9 ) LICENSE NO J /! CLASS !J
Professions Code,and my license is in full force and effect GAS SYSTEM OUTLETS V
OUTLETS OVER � � •;� DISTRICT NO PROCESSED BY cc
License Number `5�L"1''q1&9� Lic Class 5 PER SYSTEM
O F"
/) [ �/ r p C� FINAL V
/1 • I"1l�IOO r CJ-/ DATE z_Z _ Z, VALIDATION W
Contractor Date fn
❑ I am exempt under Sec By AL Z
B&P C for this reason 5
Date
Plan check fee ,.
C.
Signature. PLUMBING PERMIT ISSUING FEE$ �!)/ _ iti k J
ElTOTAL FEE D _ t 6 6. ACCT•.i _
M.r„
Plan check applicant 33�07 39.30
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Names 1 ITEM
.,fir ti
I hereby affirm that I am exempt from the Contractor's License Law - � -y ' - - ` �,,_,o -�
for the following reason (Section 7031 5, Business and Professions Address z - TOTAL 3�,m 30
Code) — - CHECK
❑
City Tel No _ :X,x -CHECK .77.Jtr
I, as owner of the property,will do the work and the structure �y�,��� ltd.
is not intended or offered for sale (Section 7044, Business _ OWE '
.M-
and Professions Code)
CONSTRUCTION LENDING AGENCYQOPP-MoQ,�,y l: q`
I hereby affirm that there is a construction lending agency for the I v 77�
performance of the work for which this permit is issued (Sec 3097, - JJC13" i 1 AM 9:07
Civ C) t9
Lender's Name
Lender's Address
L certify that I have read this application and state that the above ® l
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
Signature of Permittee Date