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Home My Public Portal About9602 LOWER AZUSA RD_Plumbing__ 76A667 17 26M SETS 7-48 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES WILLIAM J FOX, CHIEF ENGINEER DISTRICT NO GROUP I ZONE PERMIT N13 FrNR APPLICANT TO§aFILLNPLUMBERREADY FORRECEIVED BY FIRST INSPECTION 4ATE �9UED ADDRE91 /��(/C `/CITY % TEQ JOB d" ADDRESS COUNTY LICENSE NO z A EXPIRES LOCALITY OR I CERTIFY THAT 1 POSSESS TH OVE VALID LOS NEAREST ANGELES COUNTY LICENSE CROSS ST OWNER MAIL PLUMBER ADDRESS PERMIT FEE IS $1 00 FOR THE FIRST FIXTURE OR CITY I TEL NO ITEM LISTED BELOW PLUS 90O FOR EACH ADDITIONAL I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- ITEM FOR EACH SEPTIC TANK AND PIT OR DRAINFIELD ERTY DESCRIBED ABOVE $1 00 MINIMUM FEE FOR ANY PERMIT $1 00 EACH OAS SYSTEM IS A SEPARATE ITEM NUMBER TYPE OF FIXTURE OR ITEM OWNER WATER CLOSET (TOILET) CORRECTIONS BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK LAUNDRY TUB OR TRAY GAS SYSTEM—/—OUTLETS WATER HEATER SLOP SINK Q FLOOR SINK Z FLOOR DRAIN C1 DISHWASHER 0 DRINKING FOUNTAIN URINAL MISCELLANEOUS APPROVALS DATE INSPECTORS NAME ROUGH PLUMBING GAS PIPING OAS VENT CESSPOOL SEPTIC TANK DRAIN ( ) PIT ( ) $ SEPTIC TANK CESSPOOL $ SEWER HOUSE SEWER $ OAS TEST TOTAL FEE $ UTILITY CO NOTIFIED FINAL - I ION WOR at I have of consent to 7BA667 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 78A887A I hereby tt*f rm that I have a certificate of consent to self insure or a certific�e of Worker s Compensation Insurance or a certified copy thereol"(Sec 8800 Lab C Policy No Company �Y'l) rGt4,W COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is fled with the county building inspection / ADDRESS Z department v NUMBER FIXTURE OR ITEM ® FEE LOCALITY /�� Date `F / Applicant WATER CLOSET 61; NEAREST 1 L CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK AGE PARCEL permit is for one hundred dollars($100)or lose) LAVATORY OWNER I certify that in the performance of the work for which this permit MAIL is issued I shall not employ any person in any manner so as to OI become subject to the Workers Compensation Laws SINK �a ADDRESS DISWASHER CITY TEL NO Date Applicant CLOTHES WASHER CONTRACTOR r A NOTICE TO APPLICANT If after making this Certificate of V Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER Q, (commencing with Section 7000)of Division 3 of the Business and STATE LIC CdQ12kU 8 Professions Code and my license Is in full force and effect Q GAS SYSTEM OUTLETS LICENSE NO CLASS OUTLETS OVER DISTRICT NO PROCESSED BY It 5 PER SYSTEM ,{ License Number Lic Class d d V FINAL DATE 5 _13 VALIDATION a ,. Contractor Z&&&K Date El _ / I am exempt undZ er Sec FINAL BY j[/ ACC' p g B&P C for this reason d Date �.65 Plan check fee 3307 � 1 ITEt'� Signature PLUMBING PERMIT ISSUING FEE$ �'� �j c F1 TOTAL FEE lm5 TOTAL 55 a 6;:5 tt SINGLE FAMILY Plan check applicant � E(y, 55.6.5 HOME OWNER BUILDER DECLARATION Name CWNGE ■04 I hereby affirm that 1 am exempt from the Contractors License Law for the following reason(Section 7031 5 Business and Professions Address Code) ❑ City Tel No aow—(Mol 5/ 4/9., I as owner of the property will do the work and the structure is not intended or offered for sale(Section 7044 Business 9!35 1 AM11.1, 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 a Address I certify that I have read this application and state that the above PON.Information is correct I agree to comply with all County ordinances and State laws regulating Plumbing and hereby authorize representatives of this County o enter upon the above mentioned pro inspection purpo s SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A - insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certified c y t ereof(Sec 3800 LabC ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N — Company i Pol T' Certified copy is hereby furnished BUILDING / FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS (A Certified copy is filed with the county building inspec tion department NUMBER FIXTURE OR ITEM Q FEE �^ LOCALITY j WATER CLOSET J �� Date Appli4ant NEAREST CROSS ST I CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB j COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars $100 or less MAIL P ( � ) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTO N (S L V, Date Applicant CLOTHES WASHER 41 r ADDRESS 1 N NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forth CITY --I—,e C TEL NO s 3 LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE , /./�O LIC /y deemed revoked WATER HEATER LICENSE NO `-f fi' CLASS C� — LICENSED CONTRACTORS DECLARATION / DISTRICT NO PR ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS S (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER - } and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL r '- " VALIDATION IL License Number 4V-yb1F_Lic Class V 3 ro DATE �'�(.a q � V )j. FINAL OC Contractor V"N lk tcc I Date 7'��^� BY •6 u ❑ I am exempt under Sec7 1/ IW IL to B&P C for this reason Plan check fee ► Z Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 3f334A SINGLE FAMILY Plan check applicant y • • • • • HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s license Address t • • 1 b 5 0 Law for the following reason (Section 7031 5 Business and Professions Code) City Tel No a 6 • i + 5 0 3 ❑ I as owner of the property will do the work and the r O_ structure is not intended or offered for sale (Section 83 00.7044 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 11110.above information is correct I agree to comply with all County ordinances and State jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes /� r E'4� 7 F� SEE REVERSE FOR EXPLANATORY LANGUAGE ( y 6— - gnature of Permittee I Date