HomeMy Public PortalAbout9429 LEMON AVE_Plumbing__ '76Ae67 APPLICATION FOR -PLUMBING PERMIT
PBS.17 3.55 1
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles ��f P� _ Q
BUILDING
l .f� vy
WM.J. FOX. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN. SUPT OF BUILDING
LOCALITY
FOR
'�APPLIC�A�N/T TOO FILL /IN. CROSS r D s
OWNER /j* MJ4597 DISTRICT NO GR�[O !PP '�y
O E I READY FOR INSPECTION
MAILADDRESSy�9'+7
CITYAe.��d INDUSTRIAL
�
y�!!--a 41" TEL NO 990 / 9 WASTE APPROVAL
PLUMBER p� INSPECTION RECORD
ADDRESS
CITY TEL NO
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) $
BATH TUB -
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK'
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER/
( -
TOTAL NO @ Oso APPROVALS
DATE INSPECTORS SIGNATURE
GAS SYSTEM OUTLETS @ 1 00
WATER HEATER @-70—. UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S 1 00
GAS PIPING
TOTAL FEE Z
GAS VENT
'I HEREBY ACKNOWLEDGE THAT 1 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
PLUMBING
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE A86VE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PRO ERTY. pp FINAL �y
SIGNATURE /lol � la.� 1` �F''(1� '/'�y~
OF PERMITTEEY % D [L(?
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
AC0 7 3 1 7 AUG 31 3 2.0 0 to
7 1254
DBS-1APPLICATION FOR PLUMBING PERMIT'
DBS-17
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING
WM. J. FOX, COUNTY ENGINEER _ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITYl-'
OR APPLICANT TO FILL IN NEAREST
CROSS ST.
OWNER DISTRICT NO. GROUP I BEADY FOR InsPEcnola
MAIL
ADDRESS
INDUSTRIAL
CITY jL. NO. Q WASTE APPROVAL
i x
PLUMBER ' - „ • - INSPECTION RECORD
ADDRESS L -
CITY /,��.,�-�. / Z TESL. NO. /_��/ J�
LICENSE NO. �� ,. U V +J �] +,� l 3� _
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) $
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
1
I LAUNDRY TUB OR TRAY
I --
CLOTHES WASHER
1 _
I
TOTAL NO. @ 0.60 APPROVALS
DATE INSPECTORS SIGNATURE
GAS SYSTEMTOUTLETS Qa 1.00 " f
--
WATER HEATER @ 7.00 UNDER SLAB WORK
ROUGH PLUMBING
PERMIT S 1 00 GAS PIPING
TOTAL FEE 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
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST _,
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THS ABOVE —UTILITY CO. NOTIFIED -
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE
OF PERMITTEE. FINAL
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
IC0 3 3 1 3 MY 9 3 8.60 0
ST
DEPUTY
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that l have a certif tate of consent to self 76A667A
insure, or a cern ate of Workers' Compensation Insurance, - CE 817(REV 10/81)
or a certified py thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
P hcy Company
Certified copy is her by ed FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ,-/� �_
❑ Certified coy is ed t u building inspec- ADDRESS ,-!
tion d� a NUMBER FIXTURE OR ITEM @ FEE i�
LOCALI- c
Date _ WATER CLOSET, NEAREST /J
CERTIFICATE OF E TION M W RKERS' BATH TUB CROSS ST ��-�`�
COMPENSATIO UR OWNER
SHOWER
(This section need not be completed if the work involved by MAIL
the permit is for'one hundred dollars(;100)or less.) LAVATORY ADDRESS .� ti"' `�. "•` t �- }
I certify that in'the performance of the work for which this - _
permit is issued, I shall not,employ any person in any manner SINK CITY i TEL,NO
so as to become subject to the Workers'Compensation Laws DISHWASHER -
CONTRACTOR C � •
Date Applicant CLOTHES WASHER ADDRES G`—/ S?�
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- LAWN SPRINKLER SYSTEM �CITY 1 l•���4 TEL N ��
L
with comply with such provisions or this permit shall be STATE LIC '
deemed revoked WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NPSED 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.
and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALI ON 0'
DATE — O
License Number Lic Class V
6C9C9
Contractor Date BY
E] u
I am exempt under Sec tu
E3.
H
B&P C for this reason 31 U S A
Plan check fee
' Date
PLUMBING PERMIT ISSUING FEE$ } o-o 0 0 0 5_
Signature w - - - - - , TOTAL FEE o f o 0 1 6,50
Plan check applicant
SINGLE FAMILY ° ° ° 16505
HOME OWNER-BUILDER DECLARATION Name �- ( 1 6=8 5
I hereby affirm that I am exempt from the Contractor's License �p/ a
Law for the following reason (Section 7031 5, Business andAddress
Professions Code) City Tel No ��/
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section ,
7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY
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 )
Lender's Name
Lender's Address
I certify that I have read this application and state that the ,
ob e information is correct I agree to comply with all County
oWee
egulating Plumbing, and hereby
f this County to enter upon the
or inspection purposSEE REVERSE FOR EXPLANATORY LANGUAGE
Date