HomeMy Public PortalAbout9950 MILOANN ST_Plumbing__ 76A667 (FE-817)-8-71
APPLICATION OR PLU INC PERMIT
COUNTY OF LOS ANGELES �J
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS J(�
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE). NEAREST.
NUMBER' FIXTURE OR ITEM ® FEE --
CROSS .
ST
yyi
WATER CLOSET 1.75 OWNER
MAIL
BATH TUB 1.75 ADDRESS
SHOWER 1.75 CITY TEL. NO.
LAVATORY 1.75 C ONTRAC TO
SINK 1.75 ADDRESS 0
DISHWASHER 1.75 CITY TEL. N /
CLOTHES WASHER 1.75 STATE LIC
LICENSE NO (,� CLASS
SWIMMING POOL RECEPTOR 135
DI $ICT GROUP �D E PR ESSE BY
LAWN SPRINKLER SYSTEM 1.75
WATER HEATER' 1.75 v •/pp��qq
WASTETAPPROVAL 12.
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD V
OUTLETS OVER 30 Z
5 PER SYSTEM
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Plan check fee See reverse.
PLUMBING PERMIT ISSUING FEE 8
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO. GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS
CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED ANGE OUNTY AND STATE OF
CALIFORNIA OR THAT AM THE LEG OWN'E OF' AND INTEND TO
RESIDE IN THE AB U.ESCRIBED SIDENT OPERTY. FINAL
r
SIGNATUREd'
OF PERMI T
VVIa
PERMIT VALIDATION CK. M.O. sH
PLAN I I AKILMI rC01 xPEY'oASF"A'i"RON
6 0 8-OCT 1.9 5 D 7.5 0 e;;6
POLICYHOLDER: �V%� e2o�
POLICY NUMBER° „ ,, j
f
;c APPLICATION FOR PLUMBING PERMIT
KERS'COMPENSATION DECLARATION
I hereby trm'AaP.,9 have a certificate of consent to self 76A667A ,
Insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Polley No. to Company
Certified copy is hereby furnished. BUILDING IUD
�.f y , C
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS � /a 4/ • s I�N��� +r
Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM @ FEE
tion department. LOCALITY`fJrItiP1,W C
qJ
Date Appli4ant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB. CROSS ST. -Mae(_0 Lit
COMPENSATION INSURANCE SHOWER OWNER 'L j� l
(This section need not be completed if the work involved by
the permit is for one hundred dollars $100 or less. MAIL CfC�rfp Ali,L /¢O
P ( ) LAVATORY ADDRESS / J0 ��Y
I certify'that in the performance of the work for which this
permit is issued, I shall not employ person in any manner SINK CITY (ally TEL NO..
so as to become subject to therk s'Co nsati n Laws. DISHWASHER CONTRACTOR Z07 j
J i
Date Applican CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after mak g this Certificate of SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers' CITY �_ TEL. NO.
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. �/ PJMESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 6
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER v g
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALID ION O
• DATE A . �
License Number Lic. Class e5
FINAL
Contractor Date BY 10 U
I am exempt under Sec.
B.&P.C. for this reason ►
Plan check fee
Date:
• PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE 1�
SINGLE FAMILY
Plan check applicant 1— �,,� -)1T1.�•L6z�
HOME OWNER-BUILDER DECLARATION Name C-9,e7. 6 dT-f4 L.-
I hereby affirm that I am exempt from the Contractor's License e LO
16
Law for the following reason (Section 7031.5, Business and Address V P-51 67 A
Professions Code): City L— A CJ Tel. No.3 (9�• JJ4J�� 0 0 0 0 0
p o 0
ICS, I, as owner of the property, will do the work and the o 0 0 3 I�I,5 0 5
structure is not intended or offered for sale (Section ,
7044,.Business and Professions Code). o7.31 -86
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 o✓
Lender's Address
I certify that I have read this application and state that the Poo
information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
auth a representatives of this County to enter upon the
a• ve- entioned r erty r inspection pulgu rp ses.
SEE REVERSE FOR EXPLANATORY LANGUAGE
V�
51gnature o Permittee Date