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Home My Public Portal About9135 OLEMA ST_Plumbing__ o.S.17 sw SETS 9.45 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY' COUNTY OF LOS ANGELES PLUMBING 1 WM.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT.NO. GROUP ZONE 7 PERMIT NO. ROUGH FIXTURES COMPLETE HEATER CESSPOOL I SEPTIC TANK l RIVED HY READY FOR DATE ISSUED AT FIRST INSPECTION AS MISCELLANEOUS APPLICANT FILL IINIHEAVILY OUTLINED POEP03 ONLY JOB / E NAME ADDRESSp . ld g ADDRESS /'� . LOCALITY r NEAREST CITY ` Q CITY TEL.No. CROSS BT. .,�,A.�' COUNTY CERT.No. EXPIRES NAMEj� � LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL NORTH 30 ADDRESS CITY v TEL.No. 1 AM THE LEGAL POSSESSOR OF THE ABOVEOLOS ANGELES COUNTY CERIC E�1OF.QUAI.IFICATIO��f PLv HeR 1 AM THE LEGAL OWNER OF THE PR79RTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK a _ z BATH TUB FURNACE r SHOWER DISHWASHER AVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER L FLOOR SINK SAND TRAP --SLOP SINK FLOOR DRAIN \ WASH'TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING. I I ETES GAS oun SODA FOUNTAIN GAS PIPING I I GAS VENT I CESSPOOL I' I TOTAL NUMBER OF FIXTURES I SEPTIC TANK , �rE88P00SEPTIC TANK SEWER I TOTAL FEE i OQ UTILITY CO.NOTIFIED FIN L ! V BAm-CEou &58 APPLICATION FOR P.LUMB.ING PER IT 1 COUNTY OF'LOS ANGELES + ` DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DNMON CIN A. LAN31L Coontr Eaglnees ADDREWD RM TT D.GEWW.Snp t of BufIdIngRU LDUICI L OCALITY: FOR APPLICANT TO FILL IN RNUMBER FIXTURE OR ITEM WWATER CLOSETATt.BATH TUB DDRESSHOWER PlY TEL.NO. r LAVATORY CONTRACTOR SINK ADDRESS 7 DISHWASHER CITY TEL.N �r d CONTRACTOWS STATB LAUNDRY T� REGISTRATION NO. COUNTY D CLOnvj WARM DISTRICT TNNO.(�i 'GROUP ZONE SED BY WATER HEATER.,de . i a `_ I. GAS SYSTEM USTRIAL WASTE APPROVAL INSPECTION RECORD CA 7 APPROVALS Q jg Ogm%Rg ( DATE INSPECTOR'S SIGNATURE • UNDER SLAB WORK PERMIT $ 2 00 ROUGH PLUMBING TOTAL FEE v GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE-ABOVE IS CORRECT AND AGREE TO COMPLY 140T'WATER HEATER S JD B WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING li PLUMBING. . .PLUMBING FIXTURES I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR GAS TEST LICENSED.AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF , CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL PROPS . SIGNATURE ^ kl� OFPF.RMi-rrEkL FINAL ROBERT A.WOOD. B. ALWATION SUPERVISING MECHANICAL ENG'R CK. H.0. CASH 1'1 �. �,7 :1 _5 7 3-EP 2 5 D ;.Gr '�' �" WORKERS'COMPENSATION DECLARATION 78p887A I hereby affirm that I have a' certificate of conAnt to self ce 817'(X-.80) :APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation"Inguran6e,or a certified copy.Mheteof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE ADDRESS department. WATER CLOSET LOCALITY Date Applicant V NEAREST ' BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' ly COMPENSATION INSURANCE SHOWER OWNER (/t. (This section need not be completed if the work involved. LAVATORY MAIL ADDRESS o r by the permit is for one hundred dollars ($100) or less.) SINK CL CITY TEL.NO. I certify that in the performance of the work for which this / DISHWASHER U permit is issued, I shall not employ any person in any manner r CONTRACTOR W so as to become subject to the Workers'Compensation Laws. CLOTHES WASHERO ADDRESS Date Applicant SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. W W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM CL Compensation provisions of the Labor Code.,you must forth- STATE LIC. with comply with such provisions or this permit shall be WATER HEATER LICENSE NO. CLASS deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION r1!510yOUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL °� '�(;�`r�/j VALIDATION ness and Professions Code,and my license is in full force and DATE "',Y(��' effect. FINAL License Number Lic.Class BY Contractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic,or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following.reason (Section 7031.5, Busi- City Tel.No. 2 6 1 a 3 A , ness and Professions Code): 1 0 0 0 Do 5 1, as owner of the property, am exclusively contracting with licensed contractors to constructthe project 2 0 - 32,50 (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCYo o*0 3 2 5 0 v 1 hereby affirm that there is a construction lending agency ` 0 913-82 for the performance of the work for which this permit is i issued(Sec.3097,Civ.C.). Lender's Name 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the Iabove-mentiooned property for inspection purposes. Y 6U�.c.Y.t.�� ac.�—�cry✓ , ftee Datere of Permitt WORKERS'COMPENSATION DECLARATION 7GA667A I hergby af." that I have a' certificate of consent to self da s,� weo) APPLICATION FOR PLUMBING PERMIT insure,ora certificate of Workers'Compensation Insurance,or �- /� a certified copy thereof(Sec.3800,Lab.C.) / .` /S �� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nd. Coripany 0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) [ADDRESS ILDING Certified copy is filed with the county building Inspection NUMBER FIXTURE OR ITEM' FEE�ff /� WATER CLOSET CALITY'Dated t ApplicantC4L14 ez/r!�'tEy'�r�I' ARESTBATH TUBOSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE ` SHOWER OWNER /i'Je5 �A-L�St7� MAIL (This section need not be completed if the.work involved LAVATORY ADDRESS by the permit is for one hundred dollars; ($100) or less.) SINK O J I CITY •' �� TEL.NO. �..-87?y (.) I certify that in the performance of the work:for which this DISHWASHER • CC permit is issued, I shall not,employ any person.in any manner CONTRACTOR ��1�� ., ,4Gse!:�l.. j ,., so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS Data ' Applicant. SWIMMING POOL RECEPTOR ;N.OTICE TO APPLICANT: If, after making this Certificate of CITY �i�ri�Js�'/Z. TEL.NO. .N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Z Compensation provisions of the Labor Code,you must forth- LICENSE NO. /�� GLASS �Z,6 c7 C� with comply with such provisions or this. permit 'shall be WATER HEATER. deemed revoked. GAS SYSTEM UTLETS DISTRICT NO. PROCESSED' Y LICENSED CONTRACTORS DECLARATION OUTLETS OVER s:Oa .I hereby affirm that I am licensed under provisions of.Chapter 5 PER.SYSTEM 9 (commencing with Section 7.000)of Division.3 of the Busi- FINAL VALIDATION ness and Professions Code,and my license is in full-force and DATE effect. - (� - License Numbe� /,O/ Lie..Class t 2 FINALBY Contracto1W n4'� 4----bate I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer rName NG PERMIT ISSUING FEE$ 7,!� acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE V Lie.or Reg.No. Date plicant HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contrdctor's Address License Law for the following reason (Section,'7031.9., Busi- City Tel.No. 3 2 4, 1. A ness and Professions,Code): ❑ I, as owner of the property, am exclusively,contracting C L ,(f 010 o 0 o 5 with licensed contractors to construct the project (Section 7044,Business and Professions Code). 2 0 o 1 a 0 0 CONSTRUCTION LENDING AGENCY o 0 0 1 0.Q 0.10 I hereby affirm that there is a'construction lending:agency for the performance of the work for which this permit is 1,2 8—8.0: issued(Sec.3097,Civ.C.). Lender's Name Lender's Address i I certify.that I have read this application and state that the above information.is correct.I agree to.comply with all County SEE REVERSE.FOR EXPLANATORY LANGUAGE ordinances and.State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection.purposes. Signature of Permittee Date