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Home My Public Portal About5575 NOEL DR_Plumbing__ 76A667-CE817&N APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER MEM BUILDING AND SAFETY DIVISION BUILD]NG 1OHN A LAN DIE County gees ADDRESS 0 CASSATT D GRIFFIN Supt of$usldmg LOCALITY ` FOR APPLICANT TO FILL IN NEAREST caoss ST NUMBER FIXTURE OR ITEM OWNER Aules d'.01 WATER CLOSET MAIL -7 BATH TUB ADDRESS S' L SHOWES CITY s • TEL.NO LAVATORY CONTRACTOR �,• B� ansa ADD de ✓ DISHWASHER C TBI.. NOdv CO TSSTATE LAUNDRY TUB REGISTRATION NO COUNTY CLOTHES WASHER DISTRICT NO GROUPONE P "WED BY WATER HEATER �J GAS SYSTEM INDUSTRIAL WASTE APPROVAL n4MCTiON RECORD B OR FDnvn $PER 17"l O APPROVALS DATE INSPECTOR S SIGNATURE PERMIT 51 Z oo UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXT�U/R�ES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST //I CALIFORNIA OR i 1 AM LEG OWNER 0 THE ABOVE DESCRIBED RE EM L P70T UTILITY CO NOTIFIED 1SIGNATURE OFFINAL ®r VAIJDATIO�ROBERT WOOD, o[ p CASE SUPE 8 RVISI 6 MECHANICAL ENG R _ Tn7 9 7 4POS NOV 23 5 A 400 I / Zl r DEPARTMENT OF COUNTY ENGINEER PLUMBING / DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING -�t-7�— QCG WILLIAM J FOX. CouNTv ENoINEER ADDRESS FOR APPLICANT TO FILL IN NEAREST LOCALITY . �. BUILDING s w CROSS I ADDRESS �. n DISTRICT NOGROUP ZONE PERMIT NO LOCALITY 4. - _x �s NEAREST CROSS ST R CD Ready for laepeetlon DATE ISJUED OWNER )v MAIL INDUSTRIA ADDRESS WASTE APPROVAL CITY TEL NO INSPECTION RECORD PLUMBER Z 9 r G. :;� ADORE88fw G & CITY T !� TEL NO FO p 7 7 S* F—WWI ATE LICENSE NO COUNTY W PERMIT FEES a v NUMBER TYPE or riXTURE OR ITEM rEE WATER CLOSET(TOILET) 0 080 : n BATHTUB 0 080 �' G SHOWER 0 080 LAVATORY(WASH BASIN) 04 080 KITCHEN SINK ! 080 LAUNDRY TUB OR TRAY G 080 Q SLOP SINK a 080 FLOOR SINK 0 080 FLOOR DRAIN 49 080 DISHWASHER da 080 DRINKING FOUNTAIN ! 080 URINAL 60 080 GAS SYSTEM V OUTLETS @ 100 1 lop WATER HEATER 1 00 D D MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 !FINAL GH PLUMBING Z -- TOTAL FEE PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI VENT CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING MBING FIXTURES w 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY TEST 3 AND STATE OF CALIFORN OR AT 1 AM THE LEGAL OWN ER OF THE ABOVE DE BED IDENTIAL PROPERTY ITY CO NOTIFIED SIGNATURE OF PERMITTEE _ _ _ _ �� S 76A68T DBS If 3158 ORKERS CQMPENSATION DECLARATION 20 DPW,4/87 APPLICATION FOR PLUMBING PERMIT r� 667 1 hereby affirm that i have a certificate of content to self m 76A667A sure Sr a certificate of Workers Compensation Insurance or a CE 817(REV 8/86) certified copy thereof(Sec 3800 Lab C ) COUNTY OF LOS ANGELES DEPT'NOF PUBLIC WORKS '' Policy No Company 'fl ❑ Certified copy is hereby furnished - BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE)❑ z+ C 75' A/0 b/ C - D Certified copy is filed with the county building inspection ADDRESS _7 V � Q� department NUMBER FIXTURE OR ITEM @ FEE r / LOCALITY WATER CLOSET(TOILET) Date Applicant CROSS 5NEARET 3R 0.4o+v/!F y CERTIFICATE OF EXEMPTION FROM WORKERS j BATH TUB COMPENSATION INSURANCE SHOWER OWNER O"D A-IV C O/V 7Z (This section need not be completed if the work involved by MAILr the permit is for one hundred dollars($100)or less) Z LAVATORY ADDRESS J i, I certify that in the performance of the work for which this per SINK Mit is issued I shall not employ any person in any manner so CITY �'�/y p(f Cary TEL NO Zg 7 8327 as t ecome subject to the War a Compens tion ws DISHWASHER CONTRACTOR 0 >InI A/LC R Date Applicant CLOTHES WASHER ^ NOFonT P LICANT If after m g this Certificate of Ex ADDRESS T-5-74- NOiEL O R, em o should become subj t o the Workers Compen SWIMMING POOL RECEPTOR CITY L TEL NO 2-6 7832 7 sation provisions of the Labor Cod ou must forthwith comp LAWN SPRINKLER SYSTEM ly with such provisions or this per it shall be deemed revok STATE LIC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRI!y a PR ED B I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS S 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL VALI TIO >. fect DATE d License Number Lic Cla OW O V FINAL ;10145A Contractor Date BY O I am exempt under SecLU P, IL B 8P C for this reason Plan check fee y�Z`�� '( o • 4 Q 5 0 Z Date PLUMBING PERMIT ISSUING FEE$ • C ® 4 Q 5 053 Signature TOTAL FEE 4P6 i 6 SINGLE FAMILY 012-88 HOME OWNER BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor s License Name Law for the following reason (Section 7031 5 Business and Professions Code) Address ❑ 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 Business and Professions Code) ► 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 Lender s Address I certify that I have read this apple ation and state that the above information is correct I agreX comply with all County , ordinances and State laws regulating Plumbing and hereby authorize representatives of this Count to enter upon the ab mentions r rty for mspectic urposes / SEE REVERSE FOR EXPLANATORY LANGUAGE Si lure of Permiee ate