Loading...
HomeMy Public PortalAbout10543 OLIVE ST_Plumbing__ 76A867_-CE*817 5/69 ` �)P .l. Ty ` APPLICATION FOR :PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT.OF COUNTY ENGINEER FOR BUILDINGL AND SAFETY DMSION .d 3 L. Ob V� JOHNA. AMBIE. COUNTY ENGINEER +WILLIAM A.JENSEN,SUPT OF.BUILDING Ca CFOR APPLICANT TO FILL IN 1:3 NUMBER FIXTURE OR ITEM EACH FEE OWNER T�. v L n g. WATER CLOSET $1:25 MAIL RATH TUR, 1.25 ' ADDRESS [ SHOWER .1.15 J.s; •CITY TEL. NO. LAVATORY 1,25CONTRACTOR�. Lm .` . . SINK 1.25 ADDRESS 14 DISHWASHER 1.25 CITY TEL.NO.ED �fc� LAUNDRY TUB 1.?S CONTRACTOR'S. �+ STATE %.REG.ISTRATION NO. I��. �``Q COUNTY CLOTHES WASHER 1.25 DISTRICT PO. GROUP ZONE PROCESSED BY / WATER HEATER 1.50 5-08 " l� f GAS SYSTEM OUTLETS 1.50 0 INDUSTRIAL RLAL D' WASTE APPROVAL � OUTLETS'OVER PER SYSTEM• .30 INSPECTION SECOND o: 0 ..� W _ a N Z ®� APPRO LS' DATE INSPEcjr R'S MINIATURE PERMIT 5 2 00 UNDER SLAB,WORK J. iROUGH PLUMBING. TOTAL FEE !tJ` C GAS PIPING 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 . CALIFORNIA OR THAT I AM THE.LEGAL OWNER OF, GAS TEST AND INTEND TO . L DE IN,THE.ABOVE DE RIBED RESIDENTIAL PROPERTY. UTILITY CO.NOT•IF.IEDNATURE JPERMITTEE FINAL � i VALIDATION ROBERT A..WOOD CK. M.O; CASH SUPERVISING.MECHANICAL NG'R. LILO 42 9 9 SEP 28 5 D 15.00- • WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- �6A667A PW a/87 sure,ora certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86) ertified p..thereof (S .,3800, Lab. C.) 'fl —02-�/9gq�—� � �� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Rol'icy No. Company(rAwmo9m�� p&l .[a'-Certified copy is hereby furnished. Certified co is filed with the count buildin p FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING © v copy y g inspection NUMBER FIXTURE.OR ITEM @ FEE ADDRESS bur- department. LOCALITY 7y�• p WATER CLOSET(TOILET) Date Applicant l.TI •�/`�S�is✓C 9e ,� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB, CROSS ST. COMPENSATION INSURANCE." ' • SHOWER OWNER (This section need not be completed If the work involved by MAIL �1 the permit is for one hundred dollars ($100)or less.) LAVATORY D ADDRESS �/ I certify that in the performance of the work for which this per- SINK mit is issued, 1 shall not employ any person.in any manner so CITY TEL. NO.1P1 7 as.to become subject to the Workers'Compensation Laws. • DISHWASHER CONTRACTOR At jtEr Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SyIIMIVIING POOL RECEPTOR emption;you should become subject to the Workers.'Com pen- CITY TEL. NO. sation provisions of the Labor'Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. 1 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS . 0(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and.my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. DATE . CIL License Number Lc. Class_�_ V _ FINAL C ntfact r. Ca' Date BY O ❑ V I am ;e3�.der Sec. W 8.8P. re n �oZ ► U1 Plan check fee Date PLUMBING PERMIT ISSUING FEE$ ! 0-0 Signa re J TOTAL FEE SINGLE FAMILY lan'eheck applicant HOME OWNER.BUILDER DECLARATION P5 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address ;'�I f 35 e 51 I, as owner of the property, will do the work and the City Tel. No. T; i _NS structure is not intended or offered for sale(Section 7044, i Business and Professions Code). TOTAL 35 51 Lt CONSTRUCTION LENDING AGENCY CHECK 35,jl j I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued > CHANGE e!lil (Sec. 3047, Civ. C.). y Lender's Name lyij�'• t+-1]IJ�i r f 26 1 Lender's Address , 82245 i All10 I certify.t I pve ret7d this ap ication and state that the , above i ormati is G• rect. I agr a to comply with all County ordina c,-s—a . re ul ting Plumbing, and hereby autho ize rep sen i es o t s unty to enter upon the abov -menti o erfy in pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa•ure Permittee Dal