HomeMy Public PortalAbout9148 OLEMA ST_Plumbing__ 76A667-CEa617 6-65
APPLICATION FOR PLUMBI G PERMIT%"
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS NG
COLEMAN W. JENKINS. SUPT OF BUILDING op
LOCALITY (%
FOR APPLICANT TO FILL IN CROSS T.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER f'
WATER CLOSET 51.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL, O.
LAVATORY 1.25 CONTRACTOR
SINK 1,25 ADDRESS
DISHWASHER 1.25 CITY "e, TEL. NO.
LAUNDRY TUB 1.25 STATE LIC
LICENSE NO..�,eZ or,6 eS CLASS eV
CLOTHES R 1.25 DISTRICT NC G P 8 BY
WATER HE _ 1.50 (�fJ
GAS SYSTEM_ • OUTLETS 1.50 INDUSTMAL CIL
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WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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APPROVALS DATE INSPECTOR'S SIGNATURE
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PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
a
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICJOF
GAS VENT
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO CO
.' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULHOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANPLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATGAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEN
RESIDE IN,THE ABOVE DESCRIBED RESIDENTI P PERTY. UTILITY CO.NOTIFIED
.s SIGNATURE
OF PERMITTE �-> FINAL
i
ATION
CK. M.O. CASH
7 s 7 4E ria 3 5 u 3.50 N a
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). � CORKERS'COMPENS/L;ION DECLARATION APPLICATION FOR PLUMBING PERMIT
I ht�pa firm t hat 14kaeve a:certificate of consent'to self 76A667A
insure; r a cert ficate of Workers'Compensation Insurance, CE 817(REV. 10/81)`
or a cbrtified copy thereof{Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
cy No. Company
Certified copy is hereby furnished.❑ BUILDING I'FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS
Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM @ FEE
tion department. LOCALITY
Date Applicant WATER CLOSET Q NEAREST J
s i
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. NCA I1 l�
COMPENSATION INSURANCE OWNER r.�-
(This section need not be completed If the work involved by MAIL
SHOWER c
the permit Is for one hundred dollars($100)or less.) I Y,LAVATORY Q� ADDRESS 1
I certify that in the performance of the work for which this p
permit is issued, I shall not employ any person in any manner 9 NK CITY �( G TEL. NO.
so as to become subject to the Workers'Compensation Laws.
DISHWASHER dV
CONTRACTOR
Date -76 Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after•mak!Kg this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- //y�/J CITY 00 TEL. NO.
with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM V 1 STATE LIC.
deemed revoked. 1 WATER HEATER �I o LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION V DISTRICT NO ROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS Q([ /111
(commencing with Section 7000)of Division 3 of the Business OUTLETS.OVER S`
and Professions Codej and my license is in full force and effect. 5 PER SYSTEM 911.
DATEL ? V IDATION, 0
License Number Lic. Class �>
FINAL /� O
Contractor Date BY to U
❑ I am exempt under Sec. c 5 21 A IL
B.BP.C. for this reason Z
Plan check fee ► # o ° ° 5
Date:
PLUMBING PERMIT ISSUING FEE$ J(� ( o . 46
4 b 5
Signature
TOTAL FEE - 465076
0 465076
SINGLE FAMILY Plan check applicant
0423-86
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address
Law for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No.
I, as owner of the property, will do the work and the
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 1 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.
SEE REVERSE FOR EXPLANATORY LANGUAGE
� �-16 86
Signature of Permittee Date