HomeMy Public PortalAbout10118 LYNROSE ST_Plumbing__ 76A667 DBB 17 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER PLUMBING
DIBTRICT
FOR APPLICANT TO FILL IN (\ _ .. 17a o/ 3 ?-
PVALLEY LUMBER PLUMBING RECEIVED BY READY FOR DATE ISSUED
PLUMBER FIRST INSPECTION
0 EAST VALLEY BLVD.
ADDRESS
BUILDING
CITY AD TEL, No. A 1T _, ADDRESS xto
COUNTY LOCALITY
LICENSE NC. EXPIRES 6-30,57
NEAREST
PERMIT FEES cRosB
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) 0.50 >a
0 ADDRESS �� v
BATH TUB Q 0.50 40
' CITY T;EL No.
SHOWER (� 0.50 1 HEREBY ACPCTHAT 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.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB
LAUNDRY TUB R TRAY Q 0.50 ,SL ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OAS SYSTEM OUTLETS 0.50 ^ OF THE REBIDENTIA PROPERTY DESCRIBED ABOV
S./ SIGNATURE Of
WATER HEA ER @ 0.50 PERMITTEE
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR BINK @ 0.50
FLOOR DRAIN D.60
DISHWASHER 0.60
DRINKING FOUNTAIN 0.50
URINAL 0.50 J
Q
HOUSE SEWER 0.60 _Z
MISCELLANEOUS D
O
APPROVALS
DATE INBPEOTOR'S NAME
ROUGH PLUMBING /I
OAS PIPING A pv i
� v
GAS VENT ,
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 1 SEWER
PERMIT .
I 1.00 GAS TEST
TOTAL FEE UTILITY CO. NOTiFIIED� �
FINAL
WORKER'S COMPENSATION
certificate
DECLARATof consent to 76A667 DPW 9/89 APPLICATION FOR PLOMBING PERMIT u
76A667A `
I hereby affirm that I have a certificate of consent,to self insure, ,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec 3800 Lab C) r I - •• i -
COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No Company
❑ Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) DDDING
SS
EJCertified copy is filed with the•county budARE
ding inspection' -
department NUMBER FIXTURE OR ITEM Q FEE LOCALITY
Date ApplicantWATER CLOSET
NEAREST -
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST 1
COMPENSATION INSURANCE i ASSESSOR
(This section need not be completed If the work involved by the SHOWER MAP BOOK PAGE PARCEL
permit Is for one hundred dollars($100)or leas) OWNER
I certify that in the performance of the work for which this permit LAVATORY
is issued, I shall not employ any person in any manner so as to SINK MAIL
become subject to the Workers' Compensation Laws -- ADDRESS
/J 1 DISWASHER CITY - - TEL NO
Date/4—v�
Applicant CLOTHES WASHER I
NOTICE TO APPLICANT If, r eking t is Certificate of r CONTRACTOR ���
1
Exemption,you should become subj to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS G
provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY C ' N ,
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER IL
(commencing with Section 7000) of Division 3 of the Business and STATE LIC ,per
Professions Code, and my license is in full force and effect GAS SYSTEM OUTLETS LICENSE NO b CLASS C_
OUTLETS OVER DISTRICT NO PROCESSED BY O
_ N _ 5 PER SYSTEM
License Number V Lic Class n
U
FINAL 2 C VALIDATION W
CL
------^^^/���^ ].� yam) q DATE
Contractor7, 65 65 F / i r !'•�/ ate
Elam exempt under Sec - BY } Z
B&P C for this reason /
Plan check fee
Date
L
Signature PLUMBING PERMIT ISSUING FEE$
- '
❑ �' TOTAL FEE
\ f
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Namer_t-T■r
I hereby affirm that I am exempt from the Contractor's License Law ..
for the following reason (Section 7031 5, Business and Professions Address 3307 .`t3■ �)
Code)
❑ City Tel No 1-ITE{ '
I,as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business TOTAL .530
and Professions Code) 001, _
CHECK =q,L,li
CONSTRUCTION LENDING AGENCY c!
I hereby affirm that there is a construction lending agency-for the CHANGE Cl[{
performance of the work for which this permit is issued (Sec 3097,
Civ C) a y i i�7!
Lender's Name �(J�/ / 1313111313-101001 12 M
7204 1 AMI1e55
Lender's Address Z
1 certify that I have read this apphcati and state that the above ,
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
prop(�inspectio urposes . 1_ SEE REVERSE FOR EXPLANATORY LANGUAGE
a ure of Permittee Date