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Home My Public Portal About10714 MILOANN ST_Plumbing__ 76AG67C (CE-61713) -9/75 `•7 L y � `e-�0 (-� APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS I ��f 1n WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. S SHOWER OWNER LAVATORYMAI L ADDRESS Gt SINK CITY �^ r TEL. NO. li DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM CITY STATE TEL. NO. LIC WATER HEATER LICENSE NO. CLASS a 3 DISTRICT NO. I GROUP WNE ROC SED BY vGAS SYSTEM OUTLETS . I OUTLETS OVER O� C 5 PER SYSTEMv INDUSTRIAL WASTE APPROVAL y� o_ INSPECTION RECORD Plan check fee PLUMBING PERMIT ISSUING FEE $ (' TOTAL FEE S Q Plan check applicant Name APPROVALS DATE INSPECTORS SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING J: CitLTel. NO. GAS PIPING r i v/y'-j '' _ ✓.* EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT O TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 0- D AS REQUIRED BY L S ANGELES COUNTY AND STATE OF GAS TEST NIA OR THAT I AM T LEGAL OWNER OF AND INTEND TO N THE ABOVE DESCRI D RE SIDEN�rIAL P oPERrY. UTILITY CO. NOTIFIED U RE ERMITTE FINAL •��r'tJ��.f'� =�•+ PLAN CHECK VALIDATI CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH A 2 8 1 SSFP 22, 5 ?•5 COUNTY OF LBB ANBELEN ApPyMTM FOR PERKU DMSION OF SIIILDIIIG 8c SAFETY WILLIAM J. FOX. Ceooyr Eftlow PLUMBING -1 FOR APPLICANT TO FILL IN IT A NY DATE ISSUED PLU BER RECEIVED- " / FIRST INSPECTIONADDRESS w. .� . i i `/ �•. ■UILDINN CITYFI�� TEL.No. ADDRESS o wol COUNTY �.��..IEXPIRES i, s LOCALITY NEAREST IF FERMT FEES ORDER BT. HUMMIL TYP!OF FU1711m ON rrm F'Ei OWNER WATER CLOSET(TOILKT) • C.BO • ADDRESS BATH TUN • C.60 CITY TEL. No. SHOWER • 0.110 1 HERESY ACKNOWLEDNE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) • O.BO ; APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND ASREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN BINK • C.6C AND STAT! LAWS REMULATINN PLUMMINN. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LAN LAUNDRY TUN OR TRAY • 0.11O i ANMELES COUNTY LICENSE" OR 1 AN THE LENAL OWNER NAS SYBT! UTLETS • C.dO OF THE RESIDENTIAL ROPERTY DESCRIBED Ag 6 WATER HGTlR • 0.60 1011NrE OF PERM R SLOP BINK • d60 PECOR Z=RD FLOOR BINK • C.EO FLOOR DRAIN • 0.60 1 DISHWASHER • Calci DRINKINN FOUNTAIN • C.BO URINAL • 13.50 t HOUR! SEWER • 0.110 Z MISCELLANEOUS O APMOYAM DATE INVLQ-MN-0! MANS tUERWOOL LUMMINN INN 11 ICT 16.1 T CESSPOOL • umLSEPTIC TANKI ANKDRAIN ( PIT I • �.00PERMIT t.0T OO.NOTIFIEDTOTAL REB • "ANT DSS#if e-IM S WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I have ar certificate of consent to self ICE 017 (2-e0) APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab..C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 1 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS �ttJL0Q%AJ#k S Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM i FEE department. t WATER CLOSET @® LOCALII'4�� r/ r Date Applicant NEAREST BATH TUB v9p CROSS ST. S CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE , SHOWER d'A9 OWNER r ei (� LAVATORY MAIL (This section need not be completed if the work involved ADDRESS by the permit is for one hundred dollars ($100) or less.) - SINKT�0'��103 a CITY TEL.NO. O 1 certify that in the performance of t work fo which tis DISHWASHER permit is issued, I shall not employ person ' an a er CONTRACTOR so as co a subject to the r rs' m s ti WS. CLOTHES WASHER ADDRESS O Date 'rr Applican SWIMMING POOL RECEPTOR U NOTICE TO APPLICA : If, afte making this Certificate of CITY TEL.NO. W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. N Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code,and my license is in full force and DATE �� '.� �/ effect. r FINAL License Number Lie.Class BY Contractor Date F1 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ®� acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE i� Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am ekempt from the Contractor's Address License Law for the following reason (Section 7031.5, Busi- City Tel.No. ,pes,rand Professions Code): I as owner of the property, am exclusively contracting -r'51 4,9 A with licensed contractors to construct the project (Section 7044,Business and Professions Code). I r 0.0.0.0 0 5 CONSTRUCTION LENDING AGENCY 2 o o 1 9. 00 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is o 0 0 issued(Sec.3097,Civ.C.). Lender's Name C507-81 Lender's Address I certify that I have read this application and state that the above informiagplon is correct.I agree to comply With all County SEE REVERSE FOR EXPLANATORY LANGUAGE Ord' d State laws regulating Plumbing, and hereby authoriz resentaties of t 's County to enter upon the above- a lone ro er y f nsppction purposes i Sfgnatu of Permittee Date I I