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HomeMy Public PortalAbout10665 LOWER AZUSA RD_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer DISTRICT NO. GRO P ZON . FOR APPLICANT TO FILL IN PIUMSE.R VALLEY Iif l/A RECEIVED BY READY FOR DATE ISSUED �"Ag rl FIRST INSPECTION ADDRESS R300 �LiCT //1 CS/ //.® _ . ` ADDRESS 4&Q66a/,97 k L P.L:VD. BUILDING CITY �F F TEL.Na. _ COUNTY .LOCALITY C�+ INCENSE NO. EXPIRES 630 - NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNERa, MAIL _ MAIL WATER CLOSET(TOILET)' 0.50 S _ADDREBS BATH TUB @ O.SO CITY TEL. Na. SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE- READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. ' . I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY a 0.50 ANGELES COUNTY LICENSE, OR. 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED AB❑ E. GAS SYSTEM__3_OT ULETB 6 0.50 ✓ SIGNATURE OF WATER HEATER @ 0.50 PERMITTE SLOP SINK @ 0.50 INSPECTION RECORD LJI FLOOR SINK (l 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN 0.50 URINAL 0.50 J Q HOUSE SEWER 0.50 . _Z MISCELLANEOUS O.' 0 APPROVALS D TE/7 INSPE OR'S NAME ROUGH PLUMBING lCoA i /J ege__l GFS PIPING GAS VENT CESSPOOL @ 1..00 CESSPOOL ' SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER /,r'� /� •. PERMIT 1.013 OAS TEST UTILITY CO.NOTIFIED TOTAL FEE FINAL 76A667 DBS#17 6-52 76A667'(CE-817)-4/72 APPLICATION FOR- PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION NSG MAKE CHECKS PAYABLE TO: LDI ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER / L'OCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM @ FEE OWN ER g . IL.(�J�/t�i /✓�� O WATER CLOSET 1.75 MAIL Q nn BATH TUB 1.75 ADDRESS SHOWER j,75 CITYne;gg ,,.o i TEL. NO 240 LAVATORY 1.75 CONTRACTOR a SINK 1.75 �7. ADDRESS DISHWASHER 1.75 v� CITY TEL. NO? !K 13"1 CLOTHES WASHER 1.75 STATE //'�� LIC LICENSE NO. 1(O 3 I CLASS / SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP ZONE CESSED BY LAWN SPRINKLER SYSTEM 1.75 ^ 0 Q �_ WATER HEATER 1.75 INDUSTRIAL C� WASTE APPROVAL cy' GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD C.7 OUTLETS OVER 5 PER SYSTEM .30 0 . W a Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INS PE TOR'S SIGNATURE Plan'check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND.STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. • GASTEST ' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQU I RED BY LOS ANGELES COUNTY AND STATE OF CALI FORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DES CRIB D RESIDENTIAL PR PERTY. FINAL ` tiJ SIGNATURE /%•, OF PERMITT REE Evim! PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH LAco 0 5 65 .� JAN 1.5 5: D 821'5CIO WORKERS"COMPENSATION DECLARATION 7en6e7a /� ®pt I hereby affirm,that: I have,-a certificate of,consent to;self ' CE s» (z=s'o) A P `�I C.A T:I O N FOR PLUMBING PERN1IT 'insure, or a certificate of Workers •Comperljation Insurance,or a.certified copy thereof(Sec:3800 Lab C.) • BUILDING AND SAFETY COUNTY OF LOS ANGEJAS Policy No. Company ' O, Certified copy is hereby'furnished. FO'R APPLICANT TO'FILL IN(PRINT OR-TYPE) BUILDING ,., C ;Certified copy is filed with the' ounty building inspection,' NUMBER FIXTURE OR ITEM FEE Re arfinent, TY � -� ADDRE 1/Ld� p f WATER CLOSET LOCALI Date Applicant NEAREST 'BATH TUB CROSSST. � CERTIFICATEOF,EXEMPTION FROMRKERS'' , COMPENSATION.INSURANCE:WO `; �-,, SHOWER: OWNER, °` �V44'7j ^/j ' P LAVATORY MAIL (This section need not' tie�`com leted if the'awork._involved' -.� .. - - �` ss j©�6�- •V' lam', !'Q'•�:/��a'� ' O -by,the 'pe it is for one hundred 'dollars`($1,00)•-or less.),,. SINK - CITY TEL.NO" () .. • "... ---'' 1122 .pi Certifythat in the .performance-of the work for which this DISHWASHER' - Permit is issued,:I:shall-not employ any`person.in any.manner /std ./��_ i"i Q. CONTRACTOR so as to become subject to the.Workers Compensation'Laws, CLOTH ES,WASHER ¢ ADDRESS / V Date APP scant, = SWIMMING POOL RECEPTOR W NOTICE TO APPLICANT::'If,.after mCe aking,this rtificate of CITY, TEL NO d LAWN.SP lINKLE'R SYSTEM z -Exemption, you should:become sub)ect'`to the Workers' – STATE LIC — Cor pensation,pr`ovision,s of'thbla'bor Code,, you'musf'forth– LICENSE NO :CLASS With -comply with such' provisions or this _perm it',shall be R HE deemed`revoked. _ WATER ATER , a GAS SYSTEM 'OUTLETS ^ DIST.Ft.ICT NO. OE�SSED BY LICENSED CONTRACTORS;DECLARATION OUT LETS'OVERl� (' !- I hereby affirm"that I am,licensed under provisions of Chapter SPER SYSTEM 9" (commencing with Section 7000) of Division 3 of-the Busi a.y , �N 'ness'and Professions,Code, and,my license is in full force and e�f " FINAL �•,,,_. '° ' � VAL'IDAT1 DATE effect License Number Lic FINAL . ^ Class BY' EM Contractor' Date. f G� ' I am'exempt•from the licensing' requirements'as I am a Plan Check fee ' licensed architect-or a.registered,professional engineer, - PLUMBING PERMIT ISSUING FEE$ acting in, my, professional capacity•(Section:705'1, Bus- iness and Professions Code). TOTAL FEE , Lic.or Reg.No. -Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name. Address I .hereby affirm-"that 'I'am,exempt:from the 'Contractor's License Law for the following reason, (Section 703i.'5_Busi_ Cz-v Tel No. ness d Professions Code) I, as'owner;of',the property, am exclusively contracting With licensed contractors to'construct the` project z, (Section'.7044,,,•Business'and Professions Co'de). `z 8 CONSTRUCTION`LENDING,AGENCY # °< 0.5 Ihereby affirm that there is a constructioir;lending:'agency. = '" for'"the'performance of.the Work for which!this permit is 2 ° O2 - 2..0'.0 issued(Sec: 309 i .Civ,C:) Lender's Name o o . k lenders Address 8 2 7 - 8 0. x t I certify that J have read,this application and state that the. " above information is correct:Lagree to comply with'all County- ' SEE REVERSE FOR EXP.LANATORY,.L'ANGUAGE• ordinances and State' laws regu ng:-Plumbing,- an - hereby authorize representatives of t County to; enter' pon e' me lone p r fo inspectionpure v. 1_ . t�V Signature f Per y ee Da