HomeMy Public PortalAbout9484 OLEMA ST_Plumbing__ 76 A 6.67—CE 817.8/68Jf
a# APP.LICATION FOR PLUMBING 9 E IVNQT ®//^
COUNTY OF LOS ANGELES
DEPART'OF COUNTY ENGINEER ' ?BUILDING
AND SAFETY DIVISION ADDRESS F!"
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING ' LOCALITY
FOR APPLICANT TO FILL IN(PRINT OR CDSS ST.
TYPE) KES
ROSS
NUMBER FIXTURE OR ITEM EACH FE.E - )
OWNER
WATER CLOSET 1.50 MAMB \
ATH TUB 1.50 ADDRESS
SHOVER 1.50 0 0 CITY TEL. NO.
LAVATORY 1.50 00 . CONTRACTOR
SINK 1.50 ADDRESS'
DISHWASHER 1.50 CITY TEL. NO.
CLOTHES WASHER 1,50 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50
DISTRICT 1 . GROUP ZONE PROCESSED BY
LAWN SPRINKLER SYSTEM 2.00 Q O(J' .,�� �•�/ v
WATER'HEATER 1.50 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS. 1.50t;
D ; INSPECTION RECORD
Lu
OUTLETS OVER , )� D_
5 PER SYSTEM 30 0fiAo ieh!rN-RaOM
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE .S 2 60 .
0J0J�✓
TOTAL FEE �` APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK r ) n
Name ROUGH PLUMBING jss (rTjI-k_
Address GAS PIPING
i GAS.VENT I /
City Tel. No. HOT WATER HEATER �I Y
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATIONf
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING.
GAS TEST
_
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/ORUTILITY CO.NOTIFIED ` A
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ( /•,
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTIIND TO f
RESIDE IN.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL
SIGNATURE. JACK .R. ALLEN, SUPERVISINGMECHANICAL EN
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
VALIDATION
PLAN CEIECII� C-K. M.O. CASH
WORKERS'COMPENSATION DECLARATION 76AG67A
I hereby affirm'that I have a' certificate of consent to self ce a17(z-eo) APPLICATION FOR PLUMBING PERMIT
insure,or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS dy % CX464"—
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE T
department. WATER CLOSET LOCALITY � � `2 —
Date Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER —l��, ef9 Ate' ��
(This section need not be completed if the work involved LAVATORY MAIL
ADDRESS d
by the permit is for one hundred dollars ($100) or less.) SINK0
CITY TEL.NO. (�
I certify that in the performance of the work for which this DISHWASHER
CONTRACTOR
permit is issued, I shall not employ any person in any manner tJJ$
so as to become subject to th rkers'Com ensa ion s. CLOTHES WASHER H
�' ADDRESS
Date PZ3tJ' Applicant ® a
SWIMMING POOL RECEPTOR
NOTICE TO APPLICANT: If, after making this Certif ate of CITY L.4 &1e=A1,& TEL.NO.,5W U,
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATEev LIC.
Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO.W oc3c5(. CLASS �®
with comply with such provisions or this permit shall be
deemed revoked. ! GAS SYSTEM OUTLETS DISTRICT NO. PRO EBBED BY
LICENSED CONTRACTORS DECLARATIONOUTLETS OVER 4
I hereby affirm that I am licensed under provisions of Chapter 15 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL p
ness and Professions Code, and my license is in full force and DATE ��`e'�j` k VALIDATION
effect.
License Number Lic.Class FINAL i
BY
Contracto4 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 f
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.
ness and Professions Code):
❑ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project
(Section 7044,Business and Professions Code).
'35G8F1
CONSTRUCTION LENDING AGENCY o 0 0
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.).
z - 010,00
Lender's Name
oao10,01,13
Lender's Address I y 0_8
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 Cou ty to enter upon the
above-mentioned property for inspect' n p rposes.
Signature of Permittee Date