HomeMy Public PortalAbout10046 LYNROSE ST_Plumbing__ 76A667 oea 17 11-50 - APPLICATION FOR.PERMIT
DEPARTMENT OF BUILDING AND SAFETY
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COUNTY OF LOS ANGELES O� WILLIAM J. FOX, CHIEF ENGINEER
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DISTRICT O. GROUP I ZONE
FOR APPLICANT TO FILL IN 1 —3(
VhLLtY RU PLUMBING CO. J READY FOR
PLUMBER REC ED BY FIRST INSPECTION DATE ISSUED
ADDRESS
3 A S VALLPY BLVD.RE)S
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L' Yi BUILDING AT. 2-2719 ADDRESS93 hi
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CITY TEL No. -
COUNTY
LICENSE NO. EXPIRES 6-30 - LOCALITY
NEAREST
PERMIT FEES cROSS ST.
NUMBER TYPE CF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) @ '0.50 0/010 ADDRESS
BATH TUB @ 0.50 ® CITY EL NOS `7
SHOWER @ 0.50 I HEREBY ACK OWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WARN BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 5 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS 'THE ABOVE VALID LOS'
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, -OR I AM THE LEGAL OWNER
OF THE RESIDENTIALPRDPERlrY DESCRIBED ABOVE.-
GAS SYSTEM OUTLETS @ 0.50
SIGNATURE OF
WATER HEATER @ 0.50 PERMITTE
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50 -
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50 -
URINAL @ 0.50 J
Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS 2
O
APPROVALS
DATE IFIBPECTOR•S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1:00 CESSPOOL
SEPTIC TANK: —SEPTIC TANK
DRAIN. ) PIT ) @ 1.00 SEWER
PERMIT .
I 1.0o GAB TEST
/ UTILITY CO. NOTIFIED •/ Y"� _"t'a -cfl
TOTAL FEE
GGG FINAL
,76A667•-CE#81,3 5163 t
,4I'PLIC¢ITIOIV FOR Po_.UM788 &GP MIT F
COUNTY OF LOS ANGELES
DEPARTMENT, OF COUNTY ENGINEER NG
Bd11nI
BUILDING AND. SAFETY DIVISION BUILDING
s,; 10046 Eo `L ose
JOHN"A�LAMBIE, COUNTY.ENGINEER
WILLIAM A. JENSEN, SUPT of BUILDING: LOCALITY IP ,�
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.,
NUMBER" - FIXTURE'OR ITEM .EACH FEE
OWNER W.'
. Mariotte.
WATER CLOSET $1.25 MAIL
BATHTUB 1.25 ADDRESS same
SHOWER 1.25 CITY TEL. NO. At.75-543
LAVATORY 1.25 corrraacroB.' ;pacific Installers
SINK 1.25 ADDRESS = 10920 Eo Grand
DISHWASHER 1.25CITY.Templ•e City TEL. NO. 442-1234
CONTRACTOR'Sp p STATE (Z
LAUNDRY•TUB 1.25 'REGISTRATION NO. 211898 COUNTY ❑
CLOTHES WASHER " 1.25 DI7TRlf NO. GROUP 'ZONE P ESSED BY '
WATER HEATER "1:5050
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL e' 1 CL '
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM . • .30 INSPECTION RECORD U
Q
renH
yl a n-p.rnprtw
a
N
Z
APPROVALS DATE; INSPECTOR'S SIGNATURE
PERMIT $ 2 OO UNDER SLAB"WORK
-ROUGH PLUMBING "
TOTAL FEE' 3.5C, 0 O r
7 _GAS_PIPING-.
I HEREBY ACKNOWLEDGE THAT I HAVE READTHIS APPLICATION �
AND STATE THATTHEABOVE IS CORRECT AND 'AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE .LAWS REGULATING HOT WATER
PLUMBING. �'- (.L/
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY' REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 'STATE OF _
CALIFORNIA.OR THAT 1'AM THE LEGAL'OWNER OF,AND INTEND TO GAS TEST -
'RESIDE IN,THE ABOVE DE4CRfBD RESIDENTIAL'PRO TY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
IIDATION ROBERT A:WOOD
_ - - CK. M 0.'*'! ,CASH SUPERVISING MECHAN"ICAC ENG'R
zi FEB 4 5 D
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
f•hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87
insure, or a►cettificat& of Workers' Compensation.Insurance, 76A667A luf
or a certified copy thereof (Sec. 3800,Lab. C.) r COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Paolicy/No.Sw CJl/..r 9Company .S7lIP�
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is`filed with the county building inspec-
tion ADDRESS
NUMBER FIXTURE OR ITEM @ FEE
department. � _ O
_ / LOCALITY
Date Applicant V / WATER CLOSET=
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB. CROSS ST.
lo
COMPE-NSATION:INSU RANCE OWNER
SHOWER
(This section need not be completed if the work involved by MAIL '
the permit is for one hundred dollars (6100)or less.) LAVATORY. ADDRESS.IOL4446. ® S 21__
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 CIT �GE T QTEL NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR'
Date Applicant CLOTHES WASHER ADDRESS �177
NOTICE TO'APPLICANT: If, after making this Certificate of X
Exemption, you ,should become subject to the Workers' SWIMMING POOL RECEPTOR / 7 S
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY G Q ��) 6;� Vff TEL. N0.7 3Q _SVl�
with comply with such provisions or this permit shall be STATE / w v r� LIC.
deemed revoked. WATER HEATER LICENSE NO. s0,(-�6 / CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm•thot I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �O i
(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 / VALIDATION
License Number `5 ��Lic. Class DATE l'L� (� Z� U,
/� � BY
Contractor .-. ate
L?'L, 7 �T�/y�}/( AL
y ®,
I am exempt under Sec. - 1
B.BP.C. for this reasonIL
• PLUMBING PERMIT ISSUING FEE$ 7 ; •""` � � -r
Signature '
TOTAL FEE ai H - =
_- Plan check applicant iti�ir'IV o)''• 3
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name '
I hereby affirm that I am exempt from the Contractor's License Addresst'i 1 e 1' a
Law for the following reason (Section 7031.5, Business and _I_1
Professions Code): City Tel. No.
a ` 1,as-owner of the property, Will do the work oncl the
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
above information is correct. I agree to comply with'all County
ordinances_ and State laws regulating Plumbing, and hereby
authorize representotiJes of this County to enter upon the
20'"E,of
mntione roperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
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SignoturCISTPermittee Date