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Home My Public Portal About10684 LORA ST_Plumbing__ 76AG67C (CE-61713) -9/74 ' APPLICATI.ON FOR PLUMBING PERMIT BUILDIN D SAFETY DIVIS.16 :.FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING NUMBER CROSS ST.FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET (j LOCALITY BATH TUB NEAREST .� L /L� /�U� SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL.NO. DISHWASHER ) CONTRACTOR � /13�. CLOTHES WASHER ADDRESS ', Ut SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM CITY TEL. NO. STATE LIC p 7 WATER HEATER LICENSE NO. CLASS a DISTRICT NO. GROUP CESSE BY ..7GAS SYSTEM Z OUTLETS JXPE �7 C OUTLETS OVER ( ~� CD 5 PER SYSTEM INDU RIAL WASTE APPROVAL LLI INSPECTION RECORD «CL. Plan check fee PLUMBING PERMIT ISSUING FEE $ s l� TOTAL FEE Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. No. GAS PIPING .�-�- I 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 'HOT WATER HEATER PLUMBING. , I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ' LICENSED' AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIOFATLI RE PERMITTEE t FINAL r /_ PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION M.O. CASH 5 9 b tiDEC 2 5 D 1 9.5 0 Aid 76A607-CE817 10-60 APPLICATION FOR"PLUMBING PERMIT COUNTY OF LOS ANGELES . . . . . DEPARTMENT OF COUNTY ENGINEER BUII.DIIVG AND SAFETY 'DIMON BUILDING y�/ / JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS' 1VCO 6 DIP,A - WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY �. FOR APPLICANT TO FML IN " NEAREST n CROSS ST. d7 1 NUMBER FIXTURE OR ITEM OWNER. WATER CLOSET MAIL / p i BATH TUBADDRESS CITY 22 TEL.NO. 6Z SHOWER LAVATORY CONTRACTOR r SINS ADDRESS I . D]HIWASHER CTrY kDw/t /TEL.NO. LAUNDRY TUB SEGISI�ATION NO. ��L�/ COUNTY ❑ CLOTHES WASHER DISTRICT N GROUP IZO E p SEED BY WATER HEATER / a GAS SYSTEM grC✓ INDUSTRIAL WASTE APPROVAL y INSPECTION RECORD 0 O U GO• Gr a. i ! $1.00 PER.ITEMOR FIXTURE APPROVALS DATE INSPECTOR'S SIGNATURE r n PERMIT 51 2 00 UNDER SLAB WORK p' TOTAL FEE p ROUGH PLUMBING /o `l// _fl 1 HEREBY ACKNOWLEDGE THAT 1 HAVE BRAD THIS APPLICATION .. GAS PIPING / . AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT n. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - PLUMBING. HOT WATER HEATER ` I HEREBY CERTIFY TH. M PROPERLY REGISTERED AND/oR PLUMBING FIXTURES y - •LICENSED AS REQUIRED/BY LO A S COUNTY AND STATE OR GAS TEST CALIFORNIA OR THAT AM ' L O NBR OF THE ABOVE DESCRIBED RESIDENTIAL Ro UTILITY CO.NOTIFIED SIGNATURE OF PER 17F FINAL LZ--r � � . ,'VALIDATION ROBERT A.WOOD CK. M-0. CASH SUPERVISING MECHANICAL,ENG'R ..v```' WORKERS'G,OMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76AG67A or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) gDDRESS Certified copy is filed with the county building Inspec- tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Date Appligan} WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 40e,,4 COMPENSATION INSURANCE SHOWER OWNER_� (This section need not be completed If the work Involved by the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this �� permit is issued,I shall not employ any person in any manner SINK �' CITY /� G� �T— TEL.NO. vy� so as to become subject to the Workers'Compensation Laws. DISHWASHER 12 Sb CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS yO (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER a and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION �() DATE License Number Lic. Class 0 FINAL Contractor Date BY ❑ I am exempt under Sec. W B.BP.C. for this reason 101- Plan check fee ® Z Date: PLUMBING PERMIT ISSUING FEE$ 13 0 Signature TOTAL FEE SINGLE FAMILY Plan check applicant � HOME OWNER-BUILDER DECLARATION Name '� I hereby affirm that I am exempt from the Contractor's Licensee: e Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. I, as owner of the property; will do the work and the I I j I i EMES structure is not intended or offered for sale (Section 7044, Business and Professions Code). ® ;[i ( � 35.50 CONSTRUCTION LENDING AGENCY (•i,Iw�J E 35.5"1 i[{` CK I hereby affirm that there is a construction lending agency for I the performance of the work for which this permit is issued CHANGE .00 (Sec. 3097, Civ. C.). Lender's Name LLI�1�l—[lir 1 �;au/9• ! Lender's Address 9079 _ AM Z:355 I certify that I have read this application and state that the above information is correct. I agree to comply with all County Poo ordinances and State laws regulating Plumbing, and hereby' authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. /f ,p SEE REVERSE FOR EXPLANATORY LANGUAGE lam✓/!��• r°��''�� !�"�/ Signature of Permittee Date