Loading...
HomeMy Public PortalAbout10114 NADINE ST_Plumbing__ 76A807 DOS 17 10 SS c APPLICATION FOR PLUMBING PERMIT 7 ]RIMSION OF BUILDING AND SAFETY 1 Deportment of Colmty Engineer Canty of Loa Angele8 BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN.SUP T OF BUILDING LOCALITY FOR APPLICANT TO M IN ' NEAREST CROSS ST OWNERJam✓ LIJ�MAIL DISTRICT NO ROUP yIZONE READY FOR INSPECTION ADDRESS d a30 6 INDUSTRIAL CITY TEL OAT 1371 WASTEAPPROVAL PLUMBER / I/ INSPECTION RECORD ADDRESS / / If 44L- Ll AA y CITY AL TEL NO LICENSENO �53� NUMBER TYPE OF FIXTURE OR ITEM FEE SL WATER CLOSET (TOILET) @ $100 C� BATH TUB @ $100 O V' SHOWER @ $100 Q LAVATORY (WASH BASIN) @ $100 KITCHEN SINK @ $1 00 I DISHWASHER @ $f 00 LAUNDRY TUB OR TRAY @ $100 1 CLOTHES WASHER @ $100 'If WATER HEATER @ $100 B el f GAS SYSTEM @ $100 APPROVALS oO DATE INSPECTOR S SIGN TURF UNDER ShAS WORK PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING Z� TOTAL FEE 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES 'tr 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED j DESCRIBED RESIDENTIAL ROY SIGNATUREvx- OF PERMITTEE FINAL Ell JOHN A LAMBIE,COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR M 0 CASH LAfo 4 16 ear, JAN 15 3 13-00 11 ' 'WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ' J he4by affirm that I have,a certificate of consent to self 20 0026 DPW 6/87 ensure or a certificate of Workers Compensation Insurance 76A667A or a Ger if copy thereof f(Sac 3800 Lab C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS �Policy —Company 15"GATE &WD ❑ y Certified copy is hereby furnished BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county build g inspecInliq - tion department NUMBER FIXTURE OR ITEM ® FEE Esq LOCALITY 7n=p1L..� Date Z"'s/ Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FRO ORKERS BATH TUB CROSS ST Cf COMPENSATION INSUR E HOWER OWNER �-g (This section need not be completed if the work Involved by MAIL the permit Is for one hundred dollars($100)or less) LAVATORY ADDRESS Ei I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTO ` &P .1fi7 Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of ADDRESS Jsdiis& Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth v CITY ,2� _ TEL NO with comply with such provisions or this LAWN SPRINKLER SYSTEM STATE LIC p y p permit shall be deemed revoked WATER HEATER LICENSE NO Z CLASS LICENSED CONTRACTORS DECLARATION GAS SYSTEM OUTLETS DISTR��NO� ESSED B( I hereby affirm that I am licensed under provisions of Chapter 9 ✓LLJ V (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �. and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION O: License Number -3� 7�' 97 —r Class o s DATE �� Q FINA Contractor Date ❑ I am exempt under Sec B 8P C for this reason Plan check fee Date 00. Z Signature PLUMBING PERMIT ISSUING FEE$ TOTAL FEE 'Z SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address G C ACCT■T Low for the following reason (Section 7031 5, Business and w© Professions Code) CityN J3 &I& Tel No3307 22.50 ❑ I as owner of the property will do the work and the Zey 1 ITEMS structure is not intended or offered for sale (Section TOTAL � O 7044, Business and Professions Code) t CONSTRUCTION LENDING AGENCY CAM 22.50 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued OED (Sac(Sec 3097 Civ C ) Lender s Name , 0�-M1 8/22/89 Lender s Address 5214 1 AM1Q�� 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 above mentionedproperty f nspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 40-2 Sign ure P matte Date