HomeMy Public PortalAbout9413 LEMON AVE_Plumbing__ 76A667-C$817 6-60
APPLICATION FOR PLUMBING PERMIT
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING y�
JOHN A. LAMBIE. COUNTY ENGINEER
ADDRESS
WILLIAM A. JENSEN. SUPT OF BUILDING -/
LOCALITY >G its /.1
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. �o
NUMBER FIXTURE OR ITEM
OWNER u
WATER CLOSET d MAIL
BATH TUB ADDRESS
CITY TEL NO.
SHOWER S
LAVATORY CONTRACTOR .
SINS ,j f
ADDRESS
DISHWASHER j CITY NO.
CONTRACWHudara {�
LAUNDRY TUB REGISTRATION NO 16,0 6 V 7 COUNTY
CLOTHES WASHER J DISTRICTNO.' GROUPNE P ESSED BY
WATER HEATER b LI ��� &
GAS SYSTEM op INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
f7 O
U
a
O
I-
L)U
W
a
U1
a $1.00 PER ITEM
OR FIXTURE S _ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE / ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. - UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE .5„ '{V��GG%I''�LG'f���ifr
��
FINAL
Or VALIDATION ROBERT A. WOOD,
CQ. r.o. CASH SUPERVISING MECHANICAL ENG'R
U
14.
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A f PLUMBING �Y�
insure;or a,certificate of Workers' Compensation Insurance, CE 817(REV 10781) ^
or a ceitfied y thereof (Sec 3800, lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Polic o Company
Certified copy js hereby fur lied
+ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
❑' Certified co y is filed with n uilding.inspec- ADDRESS ~¢��
tion a NUMBER. FIXTURE OR ITEM @ FEE
' -•- LOCALITY_/_,;;VVL
Date AP t WATER CLOSET NEAREST
CERTIFICATE OF EXEM F KERS' BATH TUB CROSS ST O _
COMPENSATION INSURANCEOWNER'
(This section need not be completed if the work involved by' SHOWER
the permit is for one hundred dollars ($100)or-less.)' LAVATORY MAIC
< ADDRESS 9.' 1..1 t i"i. .� ; ..•� ,t ���i
I certify that in the performance of the work for which this r }` ' = 1
permit"is issued, Ishall not employ any person m any manner SINK CITY ti: ti• TEL NO
so as,to become subject to the Workers'Compensation,Laws. _ DISHWASHER
CONTRALTO
Date Applicant CLOTHES WASHER ADDRESS
_ NOTICE TO APPLICANT If, after making this Certificate of "
Exemption,, you should••become subject to-the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code,you must forth- CITY' fi:bW/ TEL N
with,com I with such pr or this ' ermit shall be LAWN SPRINKLER SYSTEM• Lcc�r�7////
P Y P P � STATE 'LIC
deemed,revoked , , WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT N Air
CESSED BY^,
I hereby affirm that I am licensed under,provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of-Division 3 of the Business OUTLETS OVER y,_
an d,Profess ions'Code„and my license is in full force'and effect _ 5 PER SYSTEM' FINAL �/p► TION
o DATE -'�
License Number obc Class
&1�
09
O
Contractor° Date
eV�e
❑' I am exempt under Sec
B&P C for this reason Plan,CheCk fee
Date PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE G -5 T Jr Q A
Plan check,applicant
SINGLE FAMILY # e a o o o 5
HOME OWNER-BUILDER DECLARATION Name �_ e
I hereby affirm that I am exempt 1,o o 6 Q from the Contractor's License Addres fief/ �/
Low,for the following reason (Section 7031 5, Business and
Professions Code) City Tel No 0 0 0 1 6 5 0=
❑ j, as owner of the property, will do the work and the
structure is not intended or'offered for sale, (Section I Q 6'1-8 55
7044, Business and'Professions Code) ,
CONSTRUCTION LENDING AGENCY, y-
I hereby affirm that'there is a construchon,lendmg agency for
the performance of the work'for which this•permit is issued ,
(Sec 3097, Civ C ) m
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 jaws regulating Plumbing,.ond hereby
representatives of this County to enter upon the
tioned pro erty for inspection pur oses •
SEE REVERSE'FOR EXPLANATORY LANGUAGE
Sign ee • . 5'al e