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Home My Public Portal About9516 LEMON AVE_Plumbing__ .,7 25M SETS 7-47 APPLICATION FOR PEram AR` INTENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER PLUMBING NATURE OF INSTALLATION DISTRICTNO. ROu o E PERMIT NO. ROUGH FIXTURES COMPLETE L HEATER CESSPOOL —I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION A8 MISCELLANEOUS � � APPLI-C/ANT FILL IN HEAVILY OUTLINED PORTION ONLYJOB " E NAME / !® ��/9� L�/� ✓/SC�9 /4 ADDRESS 30 �145PO�C m ADDRESS / LOCALITYNEAREST A. CITY / lwel_:' (_ Of STEL.No.�r A J CROSS ST. COUNTY CERT.No EXPIRES IZ m NAME LOCATION OF SEPTIC TANK, OR CESSPOOL; 3 MAIL ADDRESS NORTH O CITY .e- I .No. 1 AM THE L64�iL '4 OF THE ABOVLOS ANGELES COUNTY CERTIFICAT QUALIFICATION.E i PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH :.1 DESCRIPTION OF WORK i BATH TUB FURNACE 17 LY SHOWER DISHWASHER D LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS � �/ WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME /� WATER HEATER DENTALLAVATORY ROUGH PLUMBING METER GAS SODA FOUNTAIN OUTL GAS PIPING GAS VENT I I / CESSPOOL TOTAL NUMBER OF FIXTURES Q Q SEPTIC TANK I I CESSPOOL SEPTIC TANK ----fff--- SEWER S ®O UTILITY CO:NOTIFIED TOTAL FEE FINAL � �/ ' WORKERS"COMPCNSATIO14 DECLARATION APPLICATION FOR PLUMBING PERMIT 1 4( herd`affirm that I have a certificate of consent to self 76A667A 'sure, '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 ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / C Jam^ o Certified copy is filed with the county building inspec- ADDRESS J (oy /L 6�" , tion department NUMBER FIXTURE OR ITEM rr FEE LOCALITY Date Applicant WATER CLOSET r NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB / CROSS ST T �- - ✓�L b/ ' COMPENSATION INSURANCE SHOWER f0 OWNER �2 �S A) S /-J (This section need not be completed if the work involved by MAIL G the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS /` 1""Nv I certify that in the performance of the work for which this �� permit is issued, I shall not employ any person in any manner SINK CITY % TEL NQ �J so as to become subject to the Workers Comphon Laws DISHWASHER _ !l� /1� CONTRACTOR �q fir" C,_ t Date A2 Applican CLOTHES WASHER ADDRESS NOTICE O APPLICANT If, afte�akiiengg his Certificate of Exemption, you should becomblect to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL NO LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE ��r� LIC deemed revoked WATER HEATER LICENSE NO e�7 CLASS i3^� LICENSED CONTRACTORS DECLARATION DISTRICT NO PR SED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINALCL VALIDATI 0 License Number?r' �� 31 Lic Class DATE FIN Coniracto �� Date � 318-y BY AL v ❑ I or(/exempt under Sec G / 9 B&P C for this reason (�V' 111 •N 4 1 �k/ 6 V)Plan check fee Date o 0 0 (1 U PLUMBING PERMIT ISSUING FEE$ 1 2 0 - 4 Signature ' TOTAL FEE 0 SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name /� -�('� �G°A) I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Address 60 /!/Y/ Professions Code) City 77 Tel ❑ 1, 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 LENDINGAGENCY 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 ► above information is correct I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize represe Glives of this County to enter upon the above-mentic, Property for inspection purposes 3SEE REVERSE FOR EXPLANATORY LANGUAGE Sip' toe �rmitYee bate