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Home My Public Portal About10412 OLIVE ST_Plumbing__ 75A557-CE#517 10.52 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES - DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDINGD //j JOHN A.LAMBIE, COUNTY ENGINEER ADDRESS OGi WILLIAM A.JENSEN,SUP'T OF BUILDING f LOCALITY 1117. FOR APPLICANT TO FILL IN• NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS / SHOWER 1.25 CITY TEL. NO. ` LAVATORY 1.25 CONTRACTOR SINS 1.25 ADDRESSgel - DISHWASHER '1.25 CITY TEL. N ir LAUNDRY TUB 1.25 CONTRACTOR'S /9 e CO TUB 0 REGISTRATION NO. ! v CLOTHES WASHER 1.25 DISTRICT NO. [GROUP ZONE PROEI?B WATER HEATER 1.50 11 GAS SYSTEM OUTLETS 1.50 INDUSTRIJEL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM to• �, � INSPECTION RECORD W& u 09 APPROVALS _DDAT� INSPECTJOR'S SIG!SkT-m E PERMIT $ 2 00 UNDER SLAB WORK ,� i ROUGH PLUMBING � Jp^,• e' �?..�'.p"' TOTAL FEE GAS PIPING / !•� rey=7R I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. - 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST 16AL3 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBE RESIDENTIAL'PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF'PERMITTEE FINAL s`'I S--�y XAIJDATION ROBERT A.WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R - L i l�0 4 0 4 7 UIPit 3 0 5 D 1 5.0 U y WORKERS'CQMPENSATION DECLARAT?01`0 'rt * AUPP ICAT8®N FOR PLUMBING 7 G PER 17 I hereby%ffiFm that I have a certificate of consent to sailo�4010026 EdPW 6/87 insurep or a certificate of Workers'Compensation Insurance, 76AG67A ' 5r a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS .Policy No. Company fL�J Certified copy is hereby furnished.❑ ( I BUILDING ' C) 1 Q`,ve sr FOR APPLICANT TO FILL IN PRINT OR TYPE 1 Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Date Appliqant WATER CLOSET • NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB , .— CROSS ST. • '�� COMPENSATION INSURANCE SHOWER ' OWNER S0Re96QA A%C (This section need not b3 completed If tha work involved by 1. MAIL sr the permit Is for one hundred dollars($100)or less.) LAVATORY• 1 ADDRESS q► �y A� I certify that in the performance of he work for which this SINK ` CITY TEL.NO. g� /��.7 permit is issued, I shall not em oy a person in any anner so as to become subject to e k Co ensatja�i Laws. tm DISHWASHER ' CONTRACTOR Date ppli CLOTHES WASHER , ADDRESS NOTICE O APPLI ANT: If, after king this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become bject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION �D`ISTRICT N PR ESSED BY I hereby affirm that I am licensed under provisions of Chapter91 GAS SYSTEM OUTLETS 10 (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL r ( � / ALIDATION CL DATE (o License Number Lic. Class h 2Z' ) (� FINAL Contractor Date BY I am exempt under Sec. lot B.BP.C. for this reason ® Cn Plan check fee Cn Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 140[50 Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name �e.p I hereby affirm that I am exempt from the Contractor's License Address ACC f o J Law for the following reason (Section 7031.5, Business and Professions Code): 11 City Tel. No. I, as owner of the property, will do the work and the t structure is not intended or offered for sale (Section 7044, Business and Professions Code). TWO- 70 n 50 CONSTRUCTION LENDING AGENCY CCV. 70.50 1 hereby affirm that there is a construction lending agency for /y jAt r the performance of the work for which this permit is issued CRIAM .W,ry� l (Sec. 3097, Civ. C.). Lender's Name ca-3-6531 9/ 1/89 Lender's Address 1 AN 8oP 1 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 Cthorl sentativ s of this County to enter upon the d pro sy for inspection urp se SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ur.of rmHtee Date