HomeMy Public PortalAbout10411 OLIVE ST_Plumbing__ 76A66
005.17 12.84 APPLICATION FOR PLUMBING PERMIT
BS•17
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of TAS Angeles BULD'
NGr
WM.J. FOX, COUNTY ENGINEER ADDRESS/®
CASSATT D.GRIFFIN.SUPT OF BUILDING J
miLOCALITY
FOR APPLICANT TO FILL INTN
OWNER i d✓ GRO P ZONE READY FOR INSPECTION
MAILADDRESSAL
CITY �/ TEL.NO. PROVALPLUMBER 1.�yy y+'14-We)'r/ eftr *AINSPECTION RECORD
ADDRESS 1�C/dPa-01
CITY RV44We. TEL. NO.di!Fd
LIC N E NO. — lenX
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) wo
BATH TUB rf
SHOWER / Q
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER ySL
TOTAL NO. @ 0.80 APPROVALS
DATE INSPECTOR'S SIGNATURE
GAS SYSTEM OUTLETS @ 1.00 010 - =
r
UNDER S-Ag—WORK
WATER HEATER @ 1.00 / 100
ROUGH PLUMBING
PERMIT S 1 00
•_ GAS PIPING
TOTAL FEE GAS VENT y
[DE
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER /
D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
UMBING.
HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR GAS TEST
CENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
LIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
SCRIBED RESIDENTIAL ERTY�
NATURE
F PERMITTEE � d *'�vI — FINAL �i'.�9�% �/1. iGC �� u
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION
5 0 C 4 PlR 13 3 1 1 .0 L, In
BY
DEPUTY
WORKERS'COMPENSATION DECLARATION DPW APPLICATION FOR PLUMBING PERMIT
I he?eb�s, affirm that I have a certificate of consent to self in- 76A6667A 4/90
sure,or a certificate of Workers'Compensation Insurance,or a
certified copy thereof(Sec. 3800, Lab. C.
Policy No� `7'OV�-39 Company � /p✓��^�y COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS
(� Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM
"-' department.�} OL @ FEE LOCALITY
/
Date I 1 - 6`L Applicant - / WATER CLOSET(TOILET) NEAREST` Lry !
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. _
COMPENSATION INSURANCE OWNER ) /� nJ C 7 y 2JeES' l
(This section need not be completed if the work involved by SHOWER MAIL
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS U�/� �L-��L' Ste'•
1 certify that in the performance of the work for which this per- SINK CITY TEL. NO. cy
mit is issued, I shall not employ any person in any manner so /L�1?/� Gs � /
as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR ' G
Date Applicant CLOTHES WASHER ADDRESS ���p S. �i�� �vC
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY �Uju,�ovj �0A TEL.NO.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. ZS $��-� CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. CSSED BY
I hereby affirm that I am licensed under provisions of Chapter
I GAS SYSTEM OUTLETS I(p
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL _7 l / VL ATION }
fect. HOSE BIB DATE ` >
License Number ��Z2-�Lic. Class .3 O
FINAL V
Contractor ' Date ( 2 "�( - /fG BY
O
❑ I am exempt under Sec. V
LU
B.&P.C. for this reasonPoo. IL
Plan check fee
W
Date: PLUMBING PERMIT ISSUING FEE$ Z�L 3 L� Z
Signature TOTAL FEE
SINGLE FAMILY Plan check applicant 5 'a'ac).
HOME OWNER-BUILDER DECLARATION pP 5
1 hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and ACCUr
04
Professions Code): Address 3303 53.40
I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044, 1 ITEMS
Business and Professions Code). �s�Irjl
TOTALRL '.�3 = -
CONSTRUCTION LENDING AGENCY CKECK 53.1.0
1 hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CHARGE .013
(Sec. 3097, Civ. C.).
Lender's Name v�ti-�
nnnn-onn 1 1/30/46
Lender's Address 1556 1 Rei 90, 7
1 certify that I 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
aboventioned property for inspection purposes.
L,k')q ` _ 3 y _ C-1 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date