HomeMy Public PortalAbout10539 LYNROSE ST_Plumbing__ 18A667-CE#917.5-611
'yAPPLICATION FOR ' PLUMBI.NG 'PERMIT -•- I
COUNTY OF LOS ANGELES
DEPARTMENT.OF COUNTY EN "E1116-1111
BHNNGAMB ETY E ®N SUILDING
LCOUNTY vaiNE10539 -Lv=ose '
WILLIAM A..JENSEN,.SUP•T OF BUILDING • .
LOCALITY Tem le .Cit ' -
. FOR APPLICANT TO FII.L.IN cm ai. Pal Mal.
NUMBER FIXTURE OR ITEM
•Meeker. Land Dev: =. `
2 WATER•CLOSE!
>e.
BATH TUB -ADDRESS..1
CITY TEL.NO. �
1. SHOWER'
2 LAVATORY co -n owe
Brd6 o Plumbin
ADDRESS525 N.- Baldwin Ave. -
f DISHWASH88 cITY Fl: Monte- TEL.No: GI-37644-
C
1_3761 -4M.
ALAUNDRY m• REGISTRATIONNO. '1 . 18 COUNCLOnm WASHER DIBTRICr NO. GROUP' NE P E
WATER HEATER 'Q
IIVDURTRIAL
1 . GAS SYSTE@B WAST&APPROVAL
- VIBMCTION RECORD
-rr
�OLA. �'.�i;•.ti/l�ito�-may
V.
$1.00.PEa rrEK'
10 OR FD:TUaE : �" I I0.60 ~
APPROVALS q SAT I�ISPB R18 S1�3f1ATUR6
PERMIT S. A].00 UNDER SLAB WORK 7 0+�. a
:TOTAL FEE 12000- ROUGH.PLUMBING.
GAS•PIPING " • r
I HEREBY ACKNOWLEDGE THAT'1 HAVE READ THIS APPLICATION .!p
AND STAYS THAT THE ABOVE IS'CORRECT AND •AG*E6 TO COMPLY GAS VENT
WITH ALL OOUNTY .ORDINANCES AND STATE,LAWS REGULATING -
PLUMBING. '.:. - HOT WATER HEATERdA� /y
I HEREBY CERTIFY THAT 1. AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES I-I
LICENSED A8 REQUIRED.BY S. ANGELES•COUNTY AND STATE OF GAS TEST . r 11.1 r d
CALIFORNIA .OR THAT 1 AM'THE LEGAL B
,OWNER OF THE. ABOVE .
..
DESCRIBED RESIDENTIAL PROPERTY. - UTILITY CO.NOTIFIED
SIGNATURE ti
OF PERMITTE , .4 6119
FINAL /P+e
//"�VALMAnON. ROBERT-A!WOOD ,
�K,//•. .
M.0. �H SUPERVISING MECHANICAL ENG'R':
,8 5 6'-801
FEB.' FEB.1_ - •5 .0 1 2.00. .
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
affirm that'I have a certificate of consent to self 76A667A
ONZ
isure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81)
a certifie coR .ttherreof(Sec. 3800• Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.0 ��1�L L�CompaZ
--Q—Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ,)
Certified copy is filed with the county buildiri ins c- ADDRESS 'C
tion department. NUMBER FIXTURE OR ITEM @ FEE
�� LOGALI
)D��'
Date APpl i4a;;�9A_ WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS SL.
COMPENSATION INSURANCE OWNER
(This section need not be completed if the work Involved by SHOWER
the permit is for one hundred dollars($100)or less.) LAVATORY MAILRESS.
ADDL �6
I certify that in the performance of the work for which this
permit is issued, I shall not employ an erson in any manner SINK CITY_ TEL. NO. '
P P Y YP- Y ( Xr f
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant. CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If; after making this Certificate of 0���� �• �
Exemption, you should become subject to the Workers' SWIMMING POOL.RECEPTOR
Compensation provisions of the.Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY!vv /\r r r
MTa TEL. NO,. 6���6
with comply, with such provisions or this permit shall be STATE /� LIC. ,Q
deemed revoked. WATER HEATER LICENSE NO. F1,_J 7. CLASS.
LICENSED CONTRACTORS DECLARATION DISTRICLNO. ROCESSED BY
I hereby affirm that I am licensed Under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license'is in full force and effect. 5 PER SYSTEM FINAL _
DATE VALIDATION
License Numbert v Lit. Cl..
Confracto bible
r'I�&l die
f �
❑ I am exempt under See. G
B.BP.C. for this reason
'Plan check fee
Date: , A o 0 o b F
PLUMBING PERMIT ISSUING FEE$' � .
Signature
TOTAL FEE 3 I ''o 3 5.
Plan check applicant •� o o Q, (,
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name I C c.%—P.J
I hereby affirm that I am exempt from.the Contractor's License Address
Law for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No.
❑ I, as owner of the property, will do the work and 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 represen tiv of this. ounty to enter upon the
ab2Xp.3n nti .ed o ty fo in ection purposes.
,�� SEE REVERSE FOR EXPLANATORY LANGUAGE
r�'br1"j
Signature of Permittee Date.