HomeMy Public PortalAbout9553 LAS TUNAS DR_Plumbing__ 76A667-CE0617 4-67
APPLICATION FOR PLUMBI G PER
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ( LGA
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM- EACH FEE
OWNEF
WATER CLOSET
$1.25 MAIL
BATH TUB 1.25 ADDRESS Ilel
SHOWER 1.25 CITY TEL. NO.
LAVATORY i.25 CONTRACTOR tD
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.STATE Lic
LAUNDRY TUB 1.25 LICENSE NO. ��� CLASS� B-1��3
CLOTHES WASHER 1.25 DISTRICT NQ. GROUP ZONE P E E, BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD d
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 21
00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE W` GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE -IS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
VALIDATION JACK R. ALLEN
cK. ' M.O- CASH SUPERVISING MECHANICAL ENG'R.
L >��0 6 0 3 sEP13 5 D 3.5 Or,
ION
DECLARATI
WORKER'S I have
a certificate
of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT
76A667A
I hereby affirm that I have a certificate of consent to self insure,
or a eertificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab. C.)
/? 5044- �1�„��4�COUNTI(OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. mpany 7�'
R— Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ����
Certified copy is filed with the county building inspect* ADDRESS L A-%. -tVIJ C::�.
deppartment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date �f Z q 3 Applicant �� BATH TUB WATER CLOSET NEAREST �n
CERTIFICATE OF EXEM ION FROM WORKERS' CROSS OK l
COMPENSATION INSURANCE ASSESSOR Q�
(This section need not be completed if the work involved by the SHOWER MAP BOOK W$, PAGE Lc.>Jq PARCEL 0
permit is for one hundred dollars($100)or less.) LAVATORY .— uJ OWNER
I certify that in the performance of the work for which this permit ' �J
is issued, I shall not employ an person in an manner so as to' MAIL p�-o f
become subject to the Workers'Compensation Laws. ' SINK S �� ADDRESS_�O, dR� E GQ%J^ AJ E
DISWASHER CITY
f`UQ`1TEL.NO.-ig-7.737(q
Date CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT: If, at er mak•ng this Certificate of
Exemption,you should become subject to,the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS O (� /J /7�
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM v. '
LICENSED CONTRACTORS DECLARATION CITY �-Q^�/` TEL.N0�18 }_
I hereby affirm that I am licensed under provisions of Chapter 9 / WATER HEATER U0 s-w - a
(commencingwith Section 7000 of Division 3 of the Business and STATE / LIC. O
) GAS SYSTEM OUTLETS LICENSE NO. C CLAS V
Professions Code, and my license is in full force and effect.
OUTLETS OVER DISTRICT PROCESSED BY 0
,/ `I'-/ 5 PER SYSTEM
License Number Gj- 1/s'�Q�S��Lic.Class '� �a� ��a� � U
(� FINAL /� VALIDATION W
tilEl'ACK13. -01�tSTK[EL(�t DATE 6,,.�O'-q`� G.
Contractor a 2 / Cl)
FINAL Z
I am exempt under Sec. BY
BAP.C.for this reason
Date: Plan check fee ,
Signa PLUMBING PERMIT ISSUING FEE$ ZS
❑ / TOTAL
Plan check applicant _
SINGLE FAMILY H.A.; F
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): } T 3� b
EJ 1,
Tel.No, s
I,as owner of the property,will do the work and the structure T I TT100- 65-
is not intended or offered for sale (Section 7044, Business r _
and Professions Code). ' ;•I��i.-E: � P'•f'-'
CONSTRUCTION LENDING AGENCY ( i-iHNGE {I{
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.) q
Lender's Name roc•i i 4 __
y�{'
1 H { L4
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 oses. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date