HomeMy Public PortalAbout10506 LYNROSE ST_Plumbing__ 76A667 (CE-817) - 5/73 / 7-r /
APPLICATION FOR-PLUMBINGPERMIT
COUNTY'OF LOS ANGELES J
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
MAKE CHECKS PAYABLE TO `ADDRESS
HARVEY T. BRANDY, COUNTY ENGINEERi,� LOCALITY ,
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
NUMBER FIXTURE OR ITEM r, CROSS ST /r
@ FEE
OWNER, /C Td IV
WATER CLOSET 1.75 _
MAIL, SLA
BATH TUB 1.75 " ADDRESS
SHOWER 1.75 CITY v TEL NO
LAVATORY 1.75 CcpAVtF4C INSTAr� •,".t. '
SINK 1,75 AD O E. GRAND A
DISHWASHER 1.75 CI ; J J ,.-I ALtF,NO'N
CLOTHES WASHER 1.75 I
LICENSE NO ('/"•�"%^gti CLASS"'
SWIMMING POOL RECEPTOR 1.75
DISTRICT NO GROUP CESSED BY
LAWN SPRINKLER SYSTEM 1.75
WATER HEATER 1.75 �� INDUSTRIAL
WASTE APPROVAL y
GAS SYSTEM OUTLETS 1.75d
1 INSPECTION RECORD O
OUTLETS OVER
U
5 PER SYSTEM .30 0
CD
C-:)
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Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
' TOTAL FEE �J
APPROVALS DATE INSPECTOR S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel No '
GAS VENT
� r sa:n
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER 9�-1d1 A9w
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES r
WITH ALL COUNTY ORDINANCES' AND 'STATE LAWS REGULATING
PLUMBING GAS TEST \
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSEDAS, REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RES IDE IN THE ABOVE DES/CRIBEO RESID N,T(I�A�L P�ROPERfTY FINAL
SIGNATURE r
OF PERMITTEE •
PERMIT VALIDATION cK M.O. CASH
PLAN CHECK VALIDATION
CK M.o CASH
4 ,8'.5TZA R• 11 5 D 4,7.5
'
t � �
76A667 CE#817 5-61
i-jTY OF I MPLE
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING'L S 050(
ADD
JOHN A. LAMSIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY -1 p
FOR APPLICANT TO FILL IN —NEAREST
CROSS ST. 1,
NUMBER FIXTURE OR ITEM
OWNERv.
'c Land D;:.
WATER CLOSET MAIL
BATH TUB ADDRESS
SHOWER CITY TEL NO.
CONTRACTOR
LAVATORY
SINK
ADDRESS
- -----
DISHWASHER CITY TEL. NO.
CONTRAO
LAUNDRY TUB REGIBMCTTIOWS N STATE
NO 1971F,,'-! COUNTY
--CLOTHES WASHER DISTRICT NO.- GROUP NE PROCESSED By
WATER BEATER
GAS SYSTEM WASTE APPROVAL u
INSPECTION RECORD
0
Lu
IL
0 $1.00 PER ITEM
OR FIXTURE APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT sl p 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
A N D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
HOT WATER HEATER
PLUMBING.
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES____
L'CENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA
ALIFORNIA 0 R THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TEST
DESCRIBED RESIDENTIAL PROPE TY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
I FINAL F"
VALIDATION ROBERT A. WOOD
M.0. CASH SUPERVISING MECHANICAL ENG'R
L
;ArRKERS'COMPENSATION DECLARATION APPLICATION/� TION FOR PLUMBING
PERMIT �7
T hereby'affirm that I have a certificate of consent to self in- 20-0026 67PW 4/87 Mr r M 'r f IC '�/' V PERMIT / 1
sure, or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) `1U1
certified copy thereof (Sec. 3600, Lab. C. n
�n(� � S y4 A, ��� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy:No. an
0 .Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING D G
Certified copy is filed with the county building inspection ADDRESS Ir-" 's {'1/ If S t?
department. NUMBER FIXTURE OR ITEM @ FEE ���
LOCALITY
WATER CLOSET(TOILET) 0
Date -'7_;&j Applicant _1i CROSSNEAREST.
CERTIFICATE OF EXEMPTION OM WORKERS' f BATH TUB / I �7
COMPENSATION INSURANCE SHOWER OWNER r �T kJ ! �C ( D rJ
(This section need not-be completed if the work involved by �) MAIL
� l/
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS IQ.'S_d ( r V 'Q_i'
I certify that in the performance of the work for which this per- SINK
mit is issued, I shall not employ any person in any manner so CITY. TEL. NO. �j n
as to become subject to the Workers'Compensation Laws. DISHWASHER
Dat Applicant (/� 6 - SWIMMING POOL RECEPTOR ADDRES CLOTHES WASHER '
p
NOTICE TO APPLICANT: If, after ma g this Certific e of ExY � - . S o /`
emption,you should become subject to the Workers'
CITY TEL. N
sation.provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM 1 �
ly with such provisions or this permit.shall be deemed revok- STATE UC. rlz:> ,
ed. WATER HEATER LICENSE NO. O CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROC ED BY
I hereby affirm that I am licensed under provisions of Chapter GAS.SYSTEM OUTLETS (/
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 8
fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL ✓� VALID ION �
//� / DATE L
License Numbert��C04 Lic. Class; l V
RR /� r FINA
/J r l.t P-77 BY �. / O
Contractor Date pp
I am exempt under Sec. _,.y.., w
B.&P.C. for this reasontH
T
Plan check fee ► TP_.�•E.3 g
Date: 1. :.[ _
PLUMBING PERMIT ISSUING FEE$ TOTAL
E€!AI 4-0 s 5
.Signature 49 10
TOTAL FEE
SINGLE FAMILY. HLOC-l{
HOME OWNER-BUILDER DECLARATION Plan check applicant q ME �y
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and
Professions Code): Address
I, as owner'of the property, will do the work and-the City Tel. No. tG_ y �iF (•J=55
Business
isnot 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 representatives of this County to enter upon the
ab o -mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Si of Permittee Date