HomeMy Public PortalAbout9071 OLIVE ST_Plumbing__ 76ABd7-CEift710-60
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APPLICATION. FOR. PL.iJMBING PERMIT," �
-'COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION BUILDING J
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY `
FOR APPLICANT TO FILL IN ��ST
CROSS.'ST. �� Ta n
NUMBER FIXTURE OR ITEM
WATER CLOSET y OWNEB _P s
MAIL
BATH TUB y,^ ADDRESS'
i, CITY TEL.NO. '
SHOWER
LAVATORY 57CONTRACTOR R"� p COi
SUM s ADDRESS
DISHWASHER CITY p TEL.Ncc-11
CO CTO ATE
LAUNDRY TUB' BEGISTRATION•NO. d� COUNTY.
CLOTHES WASHER 'S DISTRICT NO... GROUP ZONE PROCESSED 8Y
WATER HEATER 7? S O� R-/ I
GAS SYSTEM ii INDUSTRIAL
WASTE APPROVAL
Y. INSPECTION RECORD y� ,
O
S $1.00 PER ITEM _
OR FIXTURE :I_ f3 APPROVALS - DATE INSPECT R'S•SI'GNAiURE
PERMIT $ 2100. UNDER SLAB WORK f7 ��* �y # f�•
TOTAL FEE p ROUGH PLUMBINGEl
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS APPLICATION d• ,
AND STATE THAT THE ABOVE IS CORRECT AND AGREE'TC COMPLY GAS VENT .
WITH•ALL COUNTY ORDINANCES AND STATE- LAWS REGULATING
PLUMBING. HOT WATER HEATER
_ '
'1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES.
LINSED AS REQUIRED BY LOS ANGELES COUNTY'+AND STATE OF GAS TEST U V(
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL ROPERTY. - UTILITY CO.NOTIFIED
e.. SIGNATURE \-1 ,n J 1 •' i'rr'7%-1•) .4/ '
OF PERMITTE -FINAL
VALIDATION ROBERT A. W'y1o6b V ,
CK.
M.0. CAH SUPERVISING IYIECHANICAL ENG'R
L .11b3� JUL 5 5 Q 1.5.0 ON
WQIZKERS'COMPENSATION DECLARATION 7GA667A
I hereby affirm that I have a' certificate of consent to self CE 817(?.-go) APPLICATION FOR PLUMBING PERMIT
insure,or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR ADDRESSR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ,[
D7� G• 0���� �•
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE le ���
department. WATER CLOSET LOCALITY
Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER � OWNER IL47 D
MAI L }
(This section need not be completed if the work involved LAVATORY ADDRESS f �. O-
by the permit is for one hundred dollars ($100) or less.) SINK op/a 0
�� CITY �➢L. TEL.NO.,:9 U
I certify that in the performance of the work for which this DISHWASHER ,A > /
permit is issued, I shall not employ any person in any manner CONTRACTOR t e v O IF
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS �4�� W
Date Applicant
NOTICE TO APPLICANT: If, after making this Certificate of ( SWIMMING POOL RECEPTOR CITY �4yj e- TEL.NO. a
� N
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLAS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. GSE SED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER �J� � `s
I hereby affirm that I am licensed under provisions of Chapter 5PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect.
FINAL
License Number Lic.Class BY �
Contractor Date !
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus- ll
iness and Professions-Code). TOTAL FEE
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address ,
License Law for the follwing reason c ' )7031.5, Busi- City Tel.No.
ness and Professions Code):/� �! -
n.
��
I, as owner of the prdarty, contracting I
with licensed contractorse project
(Section 7044,Busines Professions Code). 2 1 2.2 A
CONSTRUCTION LENDING AGENCY # o 0 0 o o 5
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.). - 2500
Lender's Name o o 0 2!0 0 5
Lender's Address
021 2-8C
I certify that I have read this application and state that the
above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
auth ize representatives of this County to enter upon the
above- entioned property for inspection purposes.
'
Signature of Permittee Date