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Home My Public Portal About10557 OLIVE ST_Plumbing__ 78AG87-CE#817 12-84 APPLICATION FOR PLUMBI G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER sU1I:DING BUII.DING AND SAFETY DIVISION ADDRESS JOHN A.LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS,SUPT OF BUILDING, LOCALITY FOR APPLICANT TO FILL IN CgoSg T. NUMBER FIXTURE OR IT EACH FEE OWNER WATER CLOSET $1.25 O MAIL BATH TUB 1.25 ADDRESS f� C' TEL. NO. SHOWER 1.25 LAVATORY 1,25 CONYRACTOR eZ S0. SINS 1.25 aS ADDRESS DISHWASHER 1.25 CITY.. TEL. NO.26 LAUNDRY TUB 1,25 CONTRACTOR'S STA ❑ REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 J DISTRICT NO. GROUP ZONE PROCE D BY WATER HEATER 1.50 GAS SYSTEM��OUTLETS 1.50 P30 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD ROS 09 O ' H v .. W IL co Z APPROVALS DATE CTOR'S SIGNATURE PERMIT $ 2 O0 UNDER SLAB WORK / �� ROUGH PLUMBING �} TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 11, 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 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND .INTEND TO. IF RESIDE IN,THE ABOVE 124SCRIBED RESIDENTIA rROPERTY. UTILITY CO.NOTIFIED SIGNATURE •/ S OF PERMITTEE FINAL VALIDATIO*e_� ROBERT A.WOOD CK. M.O. (CASH SUPERVISING MECHANICAL ENG'R LA60 0 1 5w tit 3 5 D 15.00- V • ,WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT .t'hereby, offirm,4hat I have a certificate of consent to self in- 20-0026 DPW 4/87 f� suite,or a certificate of Workers'Compensation CE 817 ensation Insurance,ora CE 817 A ,UI (REV.8/86) certified co thereof(Sec. 3800, Lob. C.) L COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Polic o, 75� CompanyJw Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) O Certified copy is filed with the c my buildi gin tion NUMBER FIXTURE OR ITEM ADDRESS department. @ FEE LOCALIT Date Applic t WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXE TION FRO ERS' BATHTUB DROSS ST. COMPENSAT ON INSUR C SHOWER OWNER (This section need not be a mpleted i the work Involved by MAIL the permit Is for one hund d doll ($100)or less.) LAVATORY ADDRESS 1r?i I certify that in the performan the work for which this per- SINK Q CITY yam.' TEL. NO. mit is issued, I shall not employ any person In any manner so W as to become subject to the Workers'Compensation Laws., DISHWASHER :::ACONTRACT R Date Applicant' CLOTHES WASHER #-z_ NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS T emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY TEL. NOg i sation provisions of the Labor Code,you must forthwith comp- LAWN.SPRINKLER SYSTEM O �� . ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. , , WATER HEATER LICENSE NO. rjZ CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS ,r'i 9•1-commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. DATE 3 ": a Li ense Number Lic. Class TI–_> — O C) rr -�� FINAL -C nTr' ' Date BY "k O I am exempt under Sec. B.BP.C. for this reason Plan check fee 3307 q•5`fyi VA Date: PLUMBING PERMIT ISSUING FEE$ �. � i Signature I a i �i + a "i.1- TOTAL FEE SINGLE FAMILY' Plan check a licant CHECK 45.6133 HOME OWNER-BUILDER DECLARATION PP I hereby affirm that I am exempt from the Contractor's License Name CHANGE Law for the following ieason (Section 7031.5, Business and Professions Code): Address o. i] n;i Ijl1 1 0/313/91- 0 Cit ' I, as owner of the property, will.do the work and the y Tel. N � structure is not intended or offered for sale(Section 7044, 9261 9:5o 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 Name Lender's Address I certify that I have-read.this application and state that the , above information is orrect. I e to omply with all County or n ces and Sto laws atin lumbing, and hereby a.Lori pre tiv this C my to enter upon.the a - entio r ins. ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa 'r f ittee Date ,,.,�+✓WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT �I''Itc�Teby affirm that I have"a certificate of consent to self 76A667A �� ,, !.r"kre, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) ``�' oT a certified copy thereof(Sec.3800, Lab. C.) COUNTY OF LOS ANGELES / �' BUILDING AND SAFETY "Policy-No. Company Certified copy is hereby furnished. BUILDING E] FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the.county building inspec- ADDRESS U tion department. NUMBER FIXTUWOR ITEM ® FEE L. LOCALI r, Date Appligant WATER CLOSET NEAREST 0 / CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.. COMPENSATION INSURANCE OWNER (This section need not be completed If the work involved by SHOWER the permit is for one hundred dollars($100)or less.) LAVATORY D IL RfiF5S � r7 D t I certify that in the performance of the work for which this permit is issued,'1 shall not employ an person in an manner SINK CI TEL.NO.. P P. Y Y P Y Qetc., 1 L- so as to b come bject'to the Workers'Compensation La s. DISHWASHER LCONTRACTOR Date 'V pplicant CLOTHES.WASHER ADDRESS NOTICE TOA LICANT: If, afte ma Ing this Certificate of SWIMMING POOL RECEPTOR Exemption,,you should becom ject to the Workers' CITY TEL.NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit .shall be STATE: LIC. deemed•revoked. WATER HEATER LICENSE-NO. 'CLASS.. LICENSED CONTRACTORS DECLARATION DISTRICT NO. P ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS O (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions.Code,and my license.is in full force'and'•effect. 5 PER SYSTEM FINAL DATE VALIDATION U License Number Lic. Class ad FINAL: O Contractor. Date BY s° ❑ I'am exempt under Sec. B.BP.C. for this reason , - Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Q SO Signature TOTAL FEE 4p S( Plan check applicant �. SINGLE FAMILY 3 1 12 A HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License 4 # o o 'o,o 0 5 Law for the following reason (Section 7031.5, Business and Address Professions Code): E 2 0 o 1 b 5 0 ). City Tel. No. ❑ I, �A as owner of the property, will do the work and the , .o o. o 1 6 5'0 cza structure is not intended or offered for sole (Section 7044, Business and Professions Code). 0624-83 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 (See. 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..)agree.to comply with-all County ordinances and State'laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the. bove-mentioned property for inspection p rposes. . + SEE REVERSE FOR EXPLANATORY LANGUAGE bLl jvp, Sig Lure of Permittee D e