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HomeMy Public PortalAbout9552 LIVE OAK AVE_Plumbing__ 76A667-CE817 3-59 APPLICATION FOR PLUMBING PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS CASSATT D. GRIFFIN, Supt of Building LOCALITY L FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL ADDRESS BATH TUB SHOWER CITY TEL. NO. LAVATORY CONTRACTOR f SINS ADDRESS DISHWASHER CITY �I ytTEr NO. /3 CONTRACTOR'S STATE LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROU P ZONE PR E WATER HEATER �! GAS SYSTEM INDUSTRIAL , WASTE APPROVAL INSPECTION RECORD Cl <'!?, 1121 . D 1,12 A/ P Am-40 ,�`'�a w©1'0'0e1zpAr O $1.00 PER ITEM I 7o RaR, 69A2 OR FIXTURE /0 t'I o APP OVALS DATE INSPECTOR'S S GNATUR PERMIT $ 2 00 UNDER ORK r TOTAL FEE Q� ROUGH PLUMBING GAS PIPING ANDHEREBY ACKSTATE TH TN THE EABOVEHAT S CORRECTI HAVEREAD AND AGREETHISAICATITOLCOMPLY GAS VENT �Qp7 1y1.4'�L.�..S/!/al"/G WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER 3' 90 //N! /APiLY�A1 PLUMBING. �y� I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES S—Af4,0 MI4—fi-I 1AX LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO NOTIFIED 7i O I' 19� 1.P SIGNATURE OF PERMITTE FINALvA, ��LLJJ�B1l L/ Or UDATION ROBERT A. WOOD, CR. M.O. CASH SUPERVISING MECHANICAL• F.NG'R L,104 4 5 Ou DEC 17 5 w 1 2.00 M WORKERS'COTION'DETION 780 887A [ hereby afirm that I have a.certificate of consent to self ce 817 (2-80) APPLICATION FORP U M B I N G PERMIT insure, or a certificate of Workers'Compensation Insurance,or I I a certified copy thereof(Sec 3800,Lab.C.) f COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING aNUMBER• FIXTURE OR ITEM • FEE ADDRESS _ Certified copy is filed with the county building inspection spect�on I department WATER CLOSET LOCALITY Date Applicant NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' , COMPENSATION INSURANCE SHOWER OWNER 0xvArr, ^ LAVATORY MAIL (This section need not be completed if the work involved ADDRESS a0 by the permit'is for one hundred dollars ($100) or less.) SINK 1 TEL N Oja& U CITY .� I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR 0 so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS U Date Applicant ",,ell UJ SWIMMING POOL RECEPTOR a NOTICE TO APPLICANT If, after making this Certificate of CITY TEL NO N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC Z Compensation provisions of the Labor Code, you must forth- LICENSE NO CLASS with comply 'with such provisions or this permit shall be WATER HEATER deemed revoked I GAS SYSTEM OUTLETS DISTRICT NO y�/ PR ESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM - 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL D� DATE VALIDATION ness and Professions Code, and my license is in full force and o effect FINAL License Number Lic.Class BY Contractor Date lam exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE S� Lic or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address, LicenseLaw for the following reason (Section 7031 5, Busi- City Tel *No Hess and Professions Code) 23506A I, as.owner of the property, am exclusively contracting with licensed contractors to construct the project 0 0 0 5 (Section 7044, Business and Professions Code). 2'0 0 1'6,5 0 CONSTRUCTION LENDING AGENCY '0 0 0 1"6'5 0 5 I hereby affirm that there is a construction lending agency , for the performance of the work for which this permit is 04 0 5•—8 2 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon- the above-m nUoned property fo mspec)ion purposes Signature of PermittW Date