HomeMy Public PortalAbout9958 LIVE OAK AVE_Plumbing__ 76A68Y'"1I7, s%;® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRIFO. GROUP I ZONE PERMIT NO.
PLUMBS NTANA PLUMBING CONTRACTORS
RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS
344 W. Carvey - Monterey Park, Calit. AA
ATlauuc2-4654 CUmberlmd 8 N40 BUILDING 9 /
CITY TEL NO ADDRESS 7
COUNTY LOCALITY
LICENSE NO EXPIRES
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) Q O 50 I$ ADDRESS
BATH TUB Q O 50 I� CITY TEL NO
SHOWER Q O 50I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q O 501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK Q O Sol STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q O Sol ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS Q O 50
1 SIGNATURE OF
WATER HEATER Q O 50 I�
PERMITTE
SLOP SINK Q O 501 INSPECTI RECORD
FLOOR SINK Q O 50
FLOOR DRAIN Q O 501
IDISHWASHER Q O 501 1�GSFT /.tr19', L..L Ss��0iw11-.'!m
DRINKING FOUNTAIN Q O .01--
1
0I •O t. - '" '�Y_S?� S,ca.tr �•
URINAL Q O 501
HOUSESEWER Q O 501
MISCELLANEOUS
I� O
I I
I
APPROVALS
I '
DATE INSPECTOR'S NAME
ROUGH PLUMBING /� �f
GAS PIPING /11nY' '
GAS VENT rl
CESSPOOL Q 1 00 I 1 CESSPOOL
SEPTIC TANK 1 I SEPTIC TANK
I DRAIN ( ) PIT ( ) Q 1 001 1 SEWER °
PERMIT l 1 00 GAS TEST
TOTAL FEC $ UTILITY CO NOTIFIED may.
4 �• FINAL
WORKERS'COMPENSATION DECLARATION :�•' APPUCAVON FOR PLUMBNG PERMIT
I hereby affirm that I have a certificate of consent to self^ 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81)
or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company
Certified copy is hereby furnished
F-1Certified
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,_
LOCALITY ,
Date Applicant WATER CLOSET -NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB OSS ST RL `fit
COMPENSATION INSURANCE SHOWER OWNER Crec-,
(This section need not be completed if the work involved by
the permit is for one hundred dollars ($100)or less.) MAIL
LAVATORY r ADDRESS
I certify that in the performance of the work for-which this S S iQdC30416
permit is issued, I shall not employ any person in any'manner SINK CITY TEL NO h O�-
so as to become subject to the Workers Compensation Laws DISHWASHER o�U
� CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS,
NOTICE TO APPLICANT If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL NO
LAWN SPRINKLER SYSTEM
with comply with such provisions,or this permit shall be I ISTATE LIC
deemed revoked WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO P ESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL
DATE VALIDATION 0
License Number Lic Class &L
FINA O
Contractor Date BY
❑ I am exempt under Sec 96
' B &P C for this reason - e
Plan check fee
Date
PLUMBING PERMIT ISSUING FEE$
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 Address
Law for the following reason (Section 7031 5, Business and
Professions Code) City Tel No
❑ 1, as owner of the property, will do the work and the ;P Q 1 3,)1 A
structure is not intended or offered for sale (Section
7044, Business and Professions Code) #f o,o o 0 o rj
CONSTRUCTION LENDING AGENCY 2,0 0 4 6,5
I hereby affirm that there is a construction lending agency for ,
the performance of the work for which this permit is issued '0 Y, o 4,(�5 O=
(Sec 3097, Civ C )
Lender's Name ,03 0 1 -813
Lender's Address
1 certify that I have read this application and state that the
above information is correct 1 agree to comply with all County
ordinances and State jaws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGEqZ1'01— Wlf,� 2&,&3
"
Sig ature of Permittee ate