HomeMy Public PortalAbout9145 LONGDEN AVE_Plumbing__ D.B. 17 25M SETS 72-43APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES' PL '
NG-
WM.J.FOX.CHIEF ENGINEER
NATURE OF .INSTALLATION oISTRi T' O: GROUP 'ZONE _r Erpm 1 m O.
ROUGH. FIXTURES COMPLETE '
HEATER -_ CESSPOOL I_I SEPTIC TANK REOEIVED;DY READY FOR DATB mUED,
/ Xe
.FIRST INSPBCTION Q /l
AS- M.ISCELLANEOU
APPLICANT FILL IN HEAVILY OUTLINED PORTION .ONLY
sJOB
E . NAME /� ADDRESS
N . .
ADDRESS 1 �.. �i LOCALITY �.. .
NEAREST
CITY C TEL.No.. CROSS ST. A
COUNTY
CERT.No. EXPIRES•
• � NAME -
LOCATION OF SEPTIC TANS, OR CESSPOOL a MAIL "
3 ADDRESS
NORTH O
CITY. TEL.No.
I AM THE LEGAL
POSSESSOR OF THS A®OV L08
ANGELES COUNTY CERTIFICATErOF gUALiFICATION
-pw>AeeR
1,AM THE LEGAL.OWNER,.OF THB PROPERTY DESCRIBED
ABOVE.
•OWtiBR
CORRECTIONS
SOUTH
- . J
DESCRIPTION OF WORK a
` .z
BATH TUB QURNACE 19
-SHOWER DISHWASHER �.
LAVATORY REFRIGERATOR -
KITCHEN SINK WATER SOFTENER
FLOOR SINK ®AND.TRAP-' -
LOP SINK m^OR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN
DATE .INSPBCTOR'9.NAME
WATER HEATER DENTAL LAVATORY
- - ROUGN.PLUMBIN6 ._ I .. .I
No
AAS. SODA FOUNTAIN
OUTL GAS PIPING' I
-
GAS VENT I.
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
�CESSPOOL SEPTIC TANK' ? SEWERIBIE
/
UTILITY CO.NOTIFIED IV
TOTAL FEE r� 5+ `-'� � '�1��,i
FINAL
- , WORKERS'COMPENSATION DECLARATION APPLICA OOT FOR PLUMBING PERMIT
I hereby, affirm that 14wve�a certificate of consent to self in 7490 6A667A
sure,or a certificate of Workers'Compensation Insurance,or a n
certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS U
Policy No. Company .
Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE)
Certified
copy is filed with the county building inspection NUMBER FIXTURE OR ITEM @ FEE ADDRESS (4 S
LOCALITY Te 1 c+
WATER CLOSET(TOILET)
Date Applicant BATH TUB , O CROSS ST. L�NEAREST I
CERTIFICATE OF EXEMPTION FROM WORKERS' 1211
COMPENSATION INSURANCE SHOWER OWNER _kW%AeS
(This section need not be completed If the work involved by MAIL /a
the permit is for one hundred dollars($100)or less.) LAVATORY 42 ADDRESS —t i c�S LG`t JeL,%
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so ! SINK ifs CITY L l l TEL.NO.2_g6-ISJ(
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY TEL.NO.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM 3 OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL 5vALIDATION
fect• HOSE BIB DATE !.
License Number Lic. Class A(` I e4 a
FINAL 3303 220.50 00
Contractor Date BY 1 ITEMS W
I am exempt under Sec. 2 0 a 50 W
B.BP.C. for this reason
TOTAL r
Plan check fee 10. OHE�K 220.50 w
Date: PLUMBING PERMIT ISSUING FEE$ o CHANGE
Signature TOTAL FEE 0
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant 0000-0001 6/18/96
1 hereby affirm that I am exempt from the Contractor's License Name 6970 1 AM 8041
Law for the following reason (Section 7031.5, Business and
Professions Code): Address
dI, as owner of the property, will do the work and the City Tel. No.
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 No.above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above entioned prqDerty for45Wction Pur,oses
C1 SEE REVERSE FOR EXPLANATORY LANGUAGE
16
nature of Permittee �/ Date