HomeMy Public PortalAbout10116 OLIVE ST_Plumbing__ MM67--CE617-8-58
APPLICATION FOR , PERMIT.
COUNTY-OF LOS ANGELES "
DEPARTIVJF.NT .OF COUNTY ENGINEER
BUILDING AND: SAFETY DIVISION BUILDING
J�� � ADDRESS
CASSSAATT D.G8 FIN SWI of f.-a m LOCALITY '
FOR APPLICANT TO FILL IN NEJUIESTCROSS om.
NUMBER FIXTURE OR ITEM
OWNER
WATER CLOSET
BATE TUB -
AADDDRESS r
SHOWER CITY ' TEL. NO.
LAVATORY CONTRACTOR
sm ADDRESS
DISHWASHER CITY TEL.NO. r
COSTATE_ ❑
LAUNDRY TUB REGISTRATION NO. COUNTY .❑
CLOTHES WASHER DISTRICT NO. GRO ZONE P CESSED BY
WATER HERTEB ' .24 ot
GAS SYSTEM. INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
1Ta� pg 0F R n 1 DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 2100 ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND.STATE THAT THE ABOVE IS CORRECT. AN0,AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR GjLg TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE U'CILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY..
SIGNATURE
OFPERMI ' FINAL
TTE
ROBERT A.WOOD.
OF VALIDATION' SUPERVISING MECHANICAL ENG'R
'
T07 1 6 4Erl
140V 9 5 A 3
ION
• f WORKER'have a certificate
of consent
to 7BBAS67APWe/ae APPLICATION FOR PLUMBING PERMIT
• I hereby affirm that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab.C.)
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company
❑ Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS ��� `�
El copy Is filed with the county building inspection � n k
department. NUMBER FIXTURE OR ITEM- @ FEE LOCALITY Q[�
Date Applicant r. WATER CLOSET E'er
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' ' BATH TUB CROSS ST: ,f Uk
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the work involved by the SHOWER MAP BOOK C/✓ PAGE��. P.ARCEL( �
permit is for one hundred dollars($100)or less.) LAVATORY OWNER t` J
1 certify that In the performance of the work for which this permitAIL
is Issued, I shall not employ any person In any manner so as to SINK ADDRESS
become subject to the Workers'Compensatio
DISWASHER CITY �e �� TEL.N
Date ��+ Applicant CLOTHES WASHER CONTRACTOR C• ^'
NOTICE TO APPLICANT: If, after making this Certificate of 'YJ1�
Exemption,you should become subject to the Workers'Compensation •„B-, SWIMMING POOL RECEPTOR
provisions of the Labor Code,you must forthwith comply with such ADDRESS w4l 6
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY `6� L o. a
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER 1�"TATEa J
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO: rj-1159 I CLAS L
Professions Code,and my license is in full force and effect. 3
5OUTLETS,OVER PER SYSTEM DISTRICT NO. PROCESSED BY Q
License Number rjlk�l Lic.ClassFINAL. ���
1.5
DATE '�_Z S~I SLIDATION a
Contractor l Date ACCT-`T z
❑ I am exempt under Se BY AL i
B.&P.C.for this reason S 1 —
Plan check fee , 1 ITEM"
Date:
Signature PLUMBING PERMIT ISSUING FEE$ TOTAL 145.65
❑ TOTAL FEE e CHECKS 145.0
SINGLE FAMILY Plan check applicant CHANGE .00
'
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Address
ry_ i {f.7
Code): DODO-0001 j
❑ Alf 11�w7`
I,as owner of the property,will do the work and the structure City Tel.No. �191488 1
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 Nam
Lender's Address I
I certify that I have read this application and state that the above oil.Information is correct. I agree to comply with all County ordinances
and State laws regulating Plumbing, and hereby authorize
repro tativea o this County to enter upon the above-mentioned
prop rty r insp I ur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Armittoa at6