HomeMy Public PortalAbout5321 NOEL DR_Plumbing__ CER,SM
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGI NEBR
BUILDING AND SAFETY DIVISION BUILD
JOHN A LANMM Co=tr ADDRESS
CASSATT D GRIFFIN Sup!of�mld�nq LocALrlY
FOR APPLICANT TO FILL IN NEABFSr
cRoss sr
NUMBER FIXTURE OR ITEM CROSOWNE8
WATER CLOSET yam,
RATE TUB ADDRESS
ssoWER
Cr TEL No ZZf3
LAVATORY CONTRACTOR
am ADDRESS
DLBRWASSSR WIT TEL. No
CONTRACTORS STATE ❑
LAUNDRY TUR REGISTRATION No COUN'L'Y
CLOTIIBS WASEER DIST7c�TN_0 GROUP 7% /
WATER NEATER /p
GAST Try I INDUSTRIAL
dor WASTE APPROVAL
INSPECTION RECORD
1 • OSF
0a-d
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ S 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
LCALIWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
FORNIA
CERTIFY THAT I AN PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
S REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
RESIDENTI P OPERTY UTILITY CO NOTIFIED
EI FINAL 1
®r
WMAT104,44 A WOOD
OR M G !!g SUPERVISING MECHANICAL.ENG R
�• 2353 X18 s A 300 n
WOrm t SATION A DPW 4/S-/ APPLICATION FOR PLUMBING PERMIT
I hereby affirm tha ertificate'%,
elf in 20 0026
tiure_or a cerfilicate orkers Compenora CE 817(REV 8/86)
certifies copy thereof(Sec 3800 Lab C
COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
Pol icy.,(do Company
tCERATE
=EXEMPTIONFROM
BUILDING O ��
FOR APPLICANT TO FILL IN(PRINT OR TYPE)
y building inspection ADDRESS
NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date WATER CLOSET(TOILET) 30100 NEAREST 1
M WORKERS
BATH TUB 3d 0
CROSS ST 1 1,Vr— S RO
COMPENSATION INSURANCE SHOWER OWNERF?JC14.A_F�12A
(This section need not be completed If the work involved by MAIL A
the permit is for one hundred dollars($100)or less) LAVATORY 06 ADDRESS
I certify that in the performance of the work for which this per SINK l7�. O CITY �' TEL
mit is issued I shall not employ any person in any man so C
as to become su ect oo the Workers Co a DISHWASHER CONTRACTOR ` 00�
Applicant CLOTHES WASHER ADD Q
NOTICE TO APPLICANT If after
T. this Certificate o Ex SWIMMING POOL RECEPTOR
emption you should become su ect to the Wor s Co en CITY ` G TEL
sation provisions of the Labor Code you mu orT comp LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall b eemed revok STATErr LIC ' /
ed WATER HEATER LICENSE NO % CLASS sqe=
LICENSED CONTRACTORS DECLARATION DISTRICT NO OCE Y
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER or
and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL �f ALID ON
fact 12 1��V 7 �_gb / /�—�
DATE d
License Number Lic Class O
FINAL Ci
a
Contractor�t M �/r �lDate� �D BY
O
F] I am exempt under Sec
B 8P C for this reason Plan check fee ► Z
Date PLUMBING PERMIT ISSUING FEE$
Signature 11-001-
SINGLE FAMILY TOTAL FEE
HOME OWNER BUILDER DECLARATION Plan check applicant t:
1 hereby affirm that I am exempt from th ntroctor s License Name
Law for the following reason (Sectio 031 5 Business and ACCT.*
Professions Code) Address
3307 1Ti 5 I
I as owner of the pr arty will do the work and the City Tel No 1 ITEMstructure is not mte dor offered for sale(Section 7044
Business and Pr ssions Code) TuTAL 155.50
CO TRUCTION LENDING AGENCY ► CHECK195.91)
I hereby affir that there is a construction lending agency for
the performance of the work for which this permit is issued CHAME .or[
(Sec 3097 Cw C )
Lender s Name 000—W01 2/26 90
Lender s Address 91M 1 AM 9:9:
1 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 II ws regulating Plumbing and hereby
authorize represents L of unty to enter upon the
above me�nhonp r action purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign u of Permittee Date