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Home My Public Portal About5630-5632-5634 NOEL DR_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT — Department of County Engineer PLUMBING DIVISIONIONOOF BUILDING 8c SAFETY WILLIAM J FOX. County Engineer R APPLICANT TO FILL IN DISTRI U O . [AjVDREM ,7 1 .- 591219 READY FOR RECEIVED Blf DATE I�D InRST INSPECTION em .� 1 s ' BUILDING TEL,No ADDRESS COUNTY �+ LOCALITY , LICENSE NO EXPIRE `s7 NEAREST PERMIT FEES CROSS ST NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) 41 050 111 ,21110 ADDRESS BATH TUB ! 0 SO CITY TEL NO Q SHOWER ® ago I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS J LAVATORY (WASH SABIN) O 50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK 1350 AND STATE LAWS REGULA G PLUMBING I CERTIFY THAT 1 EBS THE ABOVE VALID LOB LAUNDRY TUB O TR Y 1350 O ANGELES COUNTYOR i AM THE LEGAL OWNER GAS SYSTEM�OUTLETB O SO O OF THE RESIDENT RTY DESCRIBED OVE WATER HEATER 1350 SIGNATURE OF PERMITT 09 SLOP SINK ago SPECTION RE RD I FLOOR SINK 050 3 FLOOR DRAIN 050 DISHWASHER 050 1 r -)V „ DRINKING FOUNTAIN 030 URINAL 050 ��tllV T HOUSE SEWER O 513 MISCELLANEOUS G: �.� 7• yr O t i 't` 1 L..raT6e� Sg.r2•o�ctE. A..Io+T e.A.� APPROVALS D E INSPEQ R'S NAME R UGH PLUMBING BAB PIPING i� GAL VENT CESSPOOL a 700 CES OOL SEPTIC TANK SEPTI TANK DRAIN ( ) PIT ( ) S) 100 SEWER PERMIT t DD GAS TEST TOTAL FEE N�� UTILITY CO NOTIFIED / FINAL 76A667 DBS#17 6-58 WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20 0026 DPW 6/87 insure or a certificate of Workers Compensation Insurance 7GA667A or a certified copy thereof(Sec 3800 Lab C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy Nd�_�Company Certified copy is hereby furnished BUILDING ggrr FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS J O 1v •fie► Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM FEE tion department ��y LOCALITY Date 3 Appli4ans'ai5 41,whi,A WATER CLOSET NEAREST � _J¢ L CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST QQ COMPENSATION INSURANCE SHOWER OWNER �..eQ/ ��66rf (This section need not be completed if the work involved by �'• the permit is for one hundred dollars($100)or less) LAVATORY ADDRESS .6-64-- A/ MAIL I certify that in the performance of the work for which this permit is issued I shall not employ any person in SINK CITY TEL NO any manner L� /I a— 4f4(r'6sks' so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS i`T 7�n4 a /off L NOTICE TO APPLICANT If after making this Certificate of Exemption, you should become subject to the Workers SWIMMING POOL RECEPTOR f� Compensation.provisions of the Labor Code you must forth- LAWN SPRINKLER SYSTEM CITY _3 AAd 0 TEL NO3��' "� with comply with such provisions or this permit shall be STATE �/ LIC 6 deemed revoked t WATER HEATER A51 GG LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS •A/ (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ��.. and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION License Number L�c Class d 9.J6 DATE S T t FINA 06V 4�UJn 6iI /—�^�s BY Contractor Date ` ❑ 1 am exempt under Sec B 8P C for this reason Plan check fee Date StgnotuPLUMBING PERMIT ISSUING FEE$ 4 ~ re TOTAL FEE 44r SINGLE FAMILY Plan check applicant �• HOME OWNER BUILDER DECLARATION Name --- - AC CTS* I hereby affirm that 1 am exempt from the Contractor s License Address Law for the following reason (Section 7031 5, Business and 3W 40■65 Professions Code) City Tel No _ -- - ❑ _ 1 ITER$ I, as owner of the property will do the work and the TOTAL 40 6S structure is not intended or offered for sale (Section - +� e 7044, Business and Professions Code) _ _ e65 CONSTRUCTION LENDING AGENCY _ : C*CK 4065 I hereby affirm that there is a construction lending agency for - 4GE • the performance of the work for which this permit is issued - — - - (Sec 3097 Civ C ) 4 OQQ4-OW 1 3/29/93 Lender's Name y 892$ 1 PM 12:35 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 Poo ordinances and State laws regulating Plumbing and hereby a o e reprelentatrves of this County to enter upon the ove Anti ed property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE .0 .3•asy Signature of Permittee Date