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Home My Public Portal About10415 OLIVE ST_Plumbing__ 76AGO'l APPLICATION FOR PLUMBING PERMIT CE 817 8-50BU=ING AND SAFETY DMSION Department of County Engineer . �D a County of Los Angeles BUILDINGO JOHN A.LAMBIE.COUNTY ENGINEER ADDRESS a�7 CASSATT D.GRIFFIN.SuP,T OF BUILDING • LOCALITY z. FOR APPLICANT TO MI IN NEAREST CROSS ST. OWNER DISTT.� NO. oftioup I ONE I AEAGY FOR INN SPECTIO MAILAlADDRESS _ INDUSTRIAL ' CITY TEL.NO. WASTE APPROVAL PLUMBER iy a INSPECTION RECORD �! ADDRESS J CITY TEL.NO. 3 e. Z"" LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE e7, WATER CLOSET (TOILET) @ $1.00 $ D Q BATH TUB @ $.1.00 16U SHOWER @ $1.00 6 O dr LAVATORY (WASH BASIN) @ $1.00 O G t KITCHEN SINK @ $1.00 rl DISHWASHER 0 $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ $1.00 O WATER HEATER @ $1.00 . O GAS SYSTEM @ $1.00 000 APPROVALS DATE INSPECTORS SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE OO GAS VENT 7 _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WL�TER HEATER g G ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY )� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING pLUMBINGFIXTURE8 PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR. GAS TEST i. LICENSED AS REQUIRED BY LOS .ANGELES COUNTY AND STATE OF > CALIFORNIA OR THAT I AM THE LEGAL OWNER THE VE UTILITY CO.NOTIFIED .. DESCRIBED RESIDENTIAL PROPE SIGNATURE OF PERMItTEE FINAL ROBERT A.WOOD. JOHN A.LAMBIE.COUNTY ENGINEER ATION SUPERVISING MECHANICALENG'R L 2 CFAE.,2 7; SEA 5 3 - 11 .00 . 2 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76A667A 11 JI "or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING OL4 i 1 t J Certified copy is filed with the county building inspec- ADDRESS L-- �+ rp- tion dApartment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY „ Date Applicant WATER CLOSET NEAREST �1' �, �� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. ��/L.�( COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR e3 I—(J 641—(p/IL Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS IS1 )/- Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR A Compensation provisions of the Labor Code, you must forth- CITY LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROC D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL ALIDATION L7 /— DATE 6 r C ,' License Number Lic. Classes ( FINAL Contractor L7.5��+ Date �` L47 BY C �C� ❑ 1 am exempt under Sec. t.. B.BP.C. for this reason G Plan check fee ® Cr Dat . 3 PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY CHEM 14085 HOME OWNER-BUILDER DECLARATION Name �{ 1 hereby affirm that I am exempt from the Contractor's License IA,`} om Law for the following reason (Section 7031.5, Business and Address �� my Professions Code): City Tel.No. a . ❑ I, as owner of the property, will do the work and the LiLIJ3 tlr, 5 9/1 / structure is not intended or offered for sale (Section n T.7044, Business and Professions Code). � T. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for � iv the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address I 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 rppQ entatives of tbK County to ter upon t above- do d operty f inspe n oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sioe nature of Permittee Date