HomeMy Public PortalAbout9415 LEMON AVE_Plumbing__ $6A8$7-CE817 6-60
APPLICATION FOR PLUMBING PERMIT �
RTCTYGGDEPATT OF COUNTY
BUILDING AND SAFETY DIVISION sviLD>rrc L�
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN. SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS 3T.
NUMBER - FIXTURE OR ITEM OWNER `
WATER CLOSET MAIL
BATH TITS ADDRESS
CITY TEL NO.
/ SHOWER
LAVATORY CONTRACTOR 'vedlAlt .
smx ADDRESS 442 W_ FlaetI.A.goad pl
.
�. DISHWASHERCITY G TEL. NO. `
Eel
CONTRACTOR'S
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHER DIST AICT NO.} GROUP I ZONE CI SED BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
- WASTE APPROVAL
INSPECTION RECORD
P
P.
0
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O '
w
a
m
a $1.00 PER IT
OR FMTURE $ APPROVALS f DATE INSPECTORS SIGNyA�TURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING /
GAS PIPING I
1 HEREBY ACKNOWLEDGE THAT 1 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
PLUMBING. HOT WATER HEATER /1
/q�
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES qy� n _!"S/
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST WWI
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO NOTIFIED _ i v v
SIGNATURE j t�1 f f-1 �'a„�"•��Il�fi'"
OF PERMITTE FINAL
®� VALIDATION ROBERT A. WOOD,
SCK/J
9.0. CASH SUPERVISING MECHANICAL ENG'R
U ;� 9 7 s � *R23 5 D 14 .00 .
WORKERS' COMPENSATION DECLARATION . APPLICATION FOR PLUMBING 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 ) ICOUNTY'OF LOS ANGELES BUILDING AND SAFETY
Polic ToCorn
pany ,
Certified copy-is hereby fyrntshed '
FOR APPLICANT TO'FILL IN(PRINT OR TYPE) BUILDING
ADDRESS
❑- Certified copy is filed u y building inspec- NUMBER FIXTURE-OR ITEM @. FEE
tion de ariment _ LOCAUT 7-7
WATER CLOSET
`Date -Applica NEAREST.
CERTIFICATE OF EXE RKERS' BATH TUB CROSS ST ` A
COMPENSAT INS RANCE OWNER
(This section need-not be complete if the work Involved by.
SHOWER•
MAIL
the permit is for one hundred dollars (5100)or-less.) ' r LAVATORY ADDRESS?s < '•,\ + •tm ,r '' .� �` "r�
•I certify that in the performance of the work for which'this - �_;.' • •'
permit is issued,•I shall not'employ any person tn any manner SINK , CITY s ''t TEL NO' '
so as to become subject to the Workers Compensation Laws r d
DISHWASHER. CONTRACTOy
Date /applicant CLOTHES WASHER ' ,.
ADDRES
NOTICE'TO APPLICANT 'If, after,making this Certificate of 5'%
Exemption,-you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code„you must forth- CITY G6 �/� TEL NO
LAWN SPRINKLER'SYSTEM
with comply with such•provisions or,.this•permit shall be STATE . LIC
deemed revoked Q
WATER HEATER LICENSE N _21�l CLASS
'LICENSED CONTRACTORS DECLARATION- DISTRICT IAOROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9GAS SYSTEM, OUTLETS �v
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (((JJJJ
and Professions Code,and my license is in full force and effect 5 PER SYSTEM
FINAL VA ATION
License Number Lic Class a DATE`� ✓ u
` �d FIN 119
ContractorDate B �
.0
❑ �+
I am exempt under Sec V �
y
B&P C for this reason ►
. - Plan check fee , _- - •• ,
Date PLUMBING PERMIT ISSUING FEE$
Signature � �3 1 4•9 A
' TOTAL FEE .
SINGLE FAMILY
Plan check applicant # 0.0 0-0 0 5
-- -
HOMEOWNER-BUILDER DECLARATION -Name. 5 O
I hereby affirm that I am exempt from the Contractor,'s License 6.Address �,�
Law for the following reason (Section 7031.5, Business and o 0 0 ),&5 d U
Professions Code) City' Tel No7
❑ j, as owner of the property, will do the'work and the 1-0. 1 6-85
structure is not intended or offered for sale (Section ►
7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I•hereby affirm that there is a consfruction lending agency for T”
the performance of the work for which-this permit is issued ,•.
(Sec_ 3097, Civ C )
Lender's Name '
Lender's Address "
I certify that I have read this application and state that the
o e information is correct I agree to comply with all County T
i an and State jaws regulating-Plumbing, and hereby' ►
t, r resentatives of this County'to enter upon the
ab ned property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE -
Signa ittee Da