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Home My Public Portal About9612 LOWER AZUSA RD_Plumbing__ D,%M-1'25M arm w" APPLICATION FOR PERJUT NT of F LOS AG AND AL 1� TN COUNTY OF LOS ANGELES 7� VVu.J.FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. ORO It - Pwmrr . ROUGH RIXTUREB COMPLETE 5- C _ 8,29g HEATER CESSPOOL SEPTIC TANK I POR R EIV BY FIRST INSPECTIONU GAS- --..APPLICANT FILL IN HEAVILY UTLINED PORTIGO�N} My— JOB NAME �� o ADDRESS 0 C O id a� / ADDRBGJ V"[jj LOCALITYNEAREST = CITY L TEL.No. 5QA-V11 CRO89 ST. 41 COUNTY A ®UIR L(Ar. CERT.NO. 4 NAME LOCATION OF SEPTIC TANS, OR ESSI'OOL MAILADDRESS NORTH O CITY TEL.NO. I AN THZVLRQAL POOSMOQk OF THE ABOVE LOB ANGELES COUNTY CERTIFICA )rIPICATI IsLumom 1 AM THE LEGAL OWNER OF HE PROPERTY ESCRIBED ABOVE. OWN= CORRECTIONS O Ilea- SOUTH SOUTH J DESCRIPTION OF WORK x ATH TUB RNwcs 0a MOWER 'v r+ISHWASHER G VATORY -REFRIGERATOR KITCHEN SINK WATER SOFTENER -JrLOOR SINK SAND TRAP LOP BINK -FLOOR DRAIN WASH TRAY 'tom, URINAL APPROVALS WATER CLOSET f/ DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING ETE SODA FOUNTAIN OAS PIPING S OUTL GAS VENT /�j CESSPOOL TOTAL NUMBER OF FIXTURES v O SEPTIC TANK CESSPOOL SEPTIC TANK SEWER S TOTAL FEE D O UTILITY CC NOTIFIED N °J3A6" SM SICTS '~° APPLICATION FOR PERWr E1 :PARTU T OF BUILDING AND SAFETY i COP��B�N� 'f � COUNTY OF LOS ANGELES WM.J. PDX.CHIRP ENGINEER NATURE O INSTALLATION C 2 PERMIT ROUGH !K• COMPLETE 2 � 72 2-- HEATER PIXTUREB' tillm HEATER CESSPOOL SEPTIC TANK RECE BY READY FOR PATH ISs __ ,Pia. FIRST INSPECTION ' �! M1 C N 8 APPL CANT FlX4 IN HEVILY OUTLINED PORTION ONLY ` roe NAME DDREid ADDRESS ITY j 6 CITY TEL No. CROSSNEAREST ST., COUNTY CERT.No =PIRES �' NAME LOCATION OF SEPTIC TANS, O CEWOOL MAIL ADDREM /la (JA NORTH O CITY TEL.No. 1 AM THE LE Possusimm OF THE ANGE.EB Coui ICA UALIFI r � PLYwsm 1 AM THE LEGAL OWNER OF THE PROPERTY DEBCRIBED ABOVE. OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK z ATH TUB FURNACE O tr ROWER DISHWASHER O VATORY REFRIGERATOR ITCHEN SINK WATER SOFTENER -FLOOR SINK NAND TRAP LOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPEeroR's NArE WATER HEkTER DENTAL LAVATORY ROUGH PLUMBING Y 6T6R.. -a" SDA FOUNTAIN GAS PIPING OUTL OAS VENT ' CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK CESBPOOI SEPTIC TANK SEWER S UTILITY CO.NOTIFIED TOTAL PEE RIN 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) �-- n or a cert co th reof(Sec 3800, Lob C ) COUNTY OF LOS ANGELES f ` BUILDING AND SAFETY Policy N Company Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS I LO w� J/S Certified copy is filed with the county building inspec- G[ tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY G' WATER CLOSET Date Appli4ant CROSS NEAREST C CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit Is for one hundred dollars($100)or less) LAVATORY MAIL ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRALTO D Date A-plicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM g- 3.-Q with comply with such provisions or this permit shall be STATE ��cc LIC /� / deemed revoked WATER HEATER LICENSE No u CLASS l� -b LICENSED CONTRACTORS DECLARATION DISTRICT NO BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS O V (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER Q } and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL ryryrr VALIDATION 0. Q� /� 34 JDATE 7'i+.?"�,� O License Number.-4V Ot7I v lic Class 4 V K 1 o�C/ FINAL 0 Contractor Date BY �OJ, ❑ I am exempt under Sec O 7/ d B 8P C for this reason Z Plan check fee SignaturDate PLUMBING PERMIT ISSUING FEE$ b Sd 38 3"%' A e TOTAL FEE � �` 1° • • • • r Plan check applicant [ - 1650 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o (, 5 C I hereby affirm that I am exempt from the Contractor's License Address -120-83 � Law for the following reason (Section 7031 5, Business and ( 1 2 0—8�,r Professions Code) City Tel No ❑ I, as owner of the property, will do the work and the 011,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 tender's Address I certrfy that I have read this application and state that the 100above 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-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date