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Home My Public Portal About10118 NADINE ST_Plumbing__ 711A667-CE817-8-W �C3 . APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTNIENT OF COUNTY ENGUOM BM�pL�DING AND SAFETY DMSION BU DING� � Ci0 A. LAMM County 8n�nees D. of TT D GS1FFIIp,Snp t �aldv� LOCALITY FOR APPLICANT TO Fa.L IN N ST ems' NUMBER FIXTURE OR ITEM OWNER WATER CLOSET HATS TUB ADD8E88 SHOW= A CITY TEL NO LAVATORY CONTRACTOR sm ADDRESS Z DISSWASSER CITY L,- l TEL NOl rr I/p LAUNDRY TUB CONTRACTOR S STATE ❑ REGISTRATION NO a Z— COUNTY CLOTHES WASHER DISTR GROUP ZQNE P OCESSED B WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD APPROVALS DATE INSPECTOR S SIGNATURE UNDER BLAH WORK PERMIT 3 2 00 ROUGH PLUMBING TOTAL FEE AS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT ANBD AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES 1 HEREBY CERTIFY RIL—PROPERLY REGISTERED AND/OGAgLICENSED AS REQUIREE ES COUNTY D STATECALIFORNIA OR THATAL 0 THE AS UTILITY CO NOTIFIED DESCRIBED RESIDENTIA SIGNATURE OF PERMITTE FINAL 8 r ^� ✓� ROBERT A WOOD ®p CK OMATION SUPERVISING MECHANICAL ENG R Y 0 CASH 3 6 3 4 8% OCT 'l_. 5 A 3.0 0 76A6 17 f0 8B B7 DBB APPLICATION FOR PLUMBING PERMIT 1 DMSION OF BUMDMG AND SAFETY Deportment of County Engtaeas Cour of Loa An lea JOHN A LAMBIE COUNTY ENGINEER ADDRESS f0 CASSATT D GRIFFINS SUP T OF BUILDING ' LOCALITY FOR APPLICANT TO FILL IN NEAREST ��)) CROSS ST OWNER a i(i(J.lJ�� DISTRICT NO GROUP SONE READY FOR INSPECTION AMAIL DDRE S 4W30 CIT TEL .0-r INDUSTRIAL If WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS �14417 � �1 0y CITY AIS TELNOl -l�•2 LICENSE NO s36 NUMBER TYPE OF FIXTURE OR ITEM FEE ,10 WATER CLOSET (TOILET) @ $100 $ BATH TUB @ $1 00 J SHOWER @ $100 ptA LAVATORY (WASH BASIN) @ $100 KITCHEN SINK @ $100 I DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ $100 I CLOTHES WASHER @ $1 00 WATER HEATER @ $100 AS SYSTEM @ $1 00 ray /z APPROVALS DATE INSPECTOR S SIGNATURE UND WORK �I/ 1 00 PERMIT ROUGH PLUMBING ✓ $ 1 00 GAS PIPING TOTAL FEE Ion !� GAS VENT � 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT t� ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES y Pl. BING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICEI+SED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF S CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED DESChIBED RESIDENTIAL OPERTY SIGNATURE7 OF PERMITTEE �"v" FINAL y JAI J JOHN A LAMBIE COUNTY ENGINEER /VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR �K M 0 3 6 4 5 oEc 24 3 13.0 0 in WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self in 6A667A 4/87 [� sure or a certificate of Workers Compemsopofl Insuronce or a CE 817(REV 8/86) U ce;tified copy thereof(Sec 3800 Lab C ) Policy No�Company Z✓•G• �^ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS 19 Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � Certified copy is filed with the county building inspection ADDRESS C department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date —).- — Applicant . WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit Is for one hundred dollars($100)or less) LAVATORY ADDRESS I certify that in the performance of the work for which this per SINK CITY TEL NO mit is issued I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of Ex SWIMMING POOL RECEPTOR emption,you should become subject to the Workers Compen CITY TEL NO sation provisions of the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok STATE LIC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATIONDIS ICT NO OCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fend Professions Code and my license is in full force and of 5 PER SYSTEM FINAL V LIDATION d Q� q DATEct O License Numbers 7 Lic Class V ,p //�� FINAL cc Contractor f.K 64,LV OL&S Date1 z^24 11 BY O F- F] I am exempt under Sec W B&P C for this reason ► Z Plan check fee Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER BUILDER DECLARATION �T�A I hereby affirm that I am exempt from the Contractor s License Name Law for the following reason (Section 7031 5 Business and 3307 1116.511 Professions Code) Address 1 ITEMS F1 I as owner of the property will do the work and the City Tel No structure is not intended or offered for sale(Section 7044 TOTAL 28.50 Business and Professions Code) , LK aJ c CONSTRUCTION LENDING AGENCY C 01l j 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 ) oWO-moi J2i22/89 Lender s Name 7719 1 AM $:51 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 above mentioned property for inspection purposes /1—2 1 •- 9?_ SEE REVERSE FOR EXPLANATORY,LANGUAGE Signature of Permillfife Date