Loading...
HomeMy Public PortalAbout9077 OLIVE ST_Plumbing__ 76A667-CE#817 6-65 Al - �a APPLIC T ON FOR PLUMBIN. PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCAL FOR APPLICANT TO FILL Di NEAREST CAOSS ST. NUMBER FIXTURE OR ITEM EACH FEE - OWNER WATER CLOSET 51.25 MAIL BATH TUB 1.25 ADDRESS p C ` TEL. D 7 f� SHOWER 1.25 LAVATORY 1.25 CONTRACTO t. SINS 1.25 ADDRES _,, (� DISHWASHER 1.25 .NO ® U STATE LIC /� LAUNDRY TUB 1.25 'LICENSE NO. Q CLASS 4 LS-3 CLOTHES WASHER 1.25 DISTRICT NO. GROUP E PROCESSED BY WATER HEATER 1.50 (f 14wz- 17, 7 1:50 INDUSTRIAL CL GAS SYSTEM OUTLETS °- WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM 80 INSPECTION RECORD U DOC U 1 .• W a , N Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 00 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 WITH ALL LINTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING 1 HE RE CERTIF THAT M PROP REGISTERED`AND/O LJJMSING FIXTURES LICENS AS EQ 1 ED BY A GE S O TY A 'TEST CALIFOR A A O T RESIDE I BOV RIBED SID NTIAL PROP t UTILITY CO.NOTIFIEQ SIGNAT 1 OF PE 1 FINAL DATION `' CK. m.a. - CASH LAC0 2 .2 9 9 m MR12 0 5 D cj.0 0M 7GA667A(CES17A) - 6/715 4 APPLICATIO OR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: ADIDRESS O E. Olive St. HARVEY T. BRAND•T, COUNTY ENGINEER Lo Ess LITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST Stilt NUMBER FIXTURE OR ITEM � FEE CROSS ST. WATER CLOSET OWNER Rolf L. Henriks. BATH TUB. MAILADDRESS9077 E. Olive St / SHOWER ✓ CITY im le City TEL. NO. 289-840 LAVATORY CONTRACTOR Owner SINK ADDRESS DISHWASHER CITY TEL. NO. CLOTHES WASHER -r STATE. - LIC 61 LICENSE NO. CLASS SWIMMING POOL RECEPTOR DISTRICT NO. GROUP N OCES D BY' LAWN SPRINKLER SYSTEM .o p _i. \ WATER HEATER INDUSTRIAL .O WASTE PPROVAL / GAS SYSTEM OUTLETS INSPECTION RECORD OUTLETS OVER O 5 PER SYSTEM u CL A - rn z Plancheck fee See Reverse PLUMBING PERMIT ISSUING FEE. 5 TOTAL FEE APPROVALS DATE INSEE TOR•5 SIGNATURE Plan check applicant UNDER SLAB WORK f Name owner ROUGH PLUMBING' -+�Z Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER 1 HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING_FIXTURES WITH ALL COUNTY.'ORDINANCES AND STATE LAWS REGULATING GAS TEST ', PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT.I AM. THE LEGAL OWNER OF, AND INTEND TO b RESIDE IN THE ABOVE E RIB RESIDEN I L PROPERTY. FINAL SIG'NATU RE vr OF PERMITTEE -4�� PERMIT VALIDATION M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 9 0. 5-MI 22 5 :9 2 2-5 p Abu RS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT tTiat I have a certificate of consent to self 76A667A a certificate of Workers'Compensation Insurance, CE 817(REV. 10AI) F714o.—Compan ertified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS.ANGELES ,BUILDING AND SAFETY PY Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYRE) Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appligant / WATER CLOSET r NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB .� CROSS ST. c7V� COMPENSATION INSURANCE OWNER ��. !GS (This section need not be completed if the work Involved by SHOWER c.i- the permit is for one.hundred dollars($100)or less.) MAIL LAVATORY 1 ADDRESS 061VI I certify that in the performance.of the work for which this permit is issued, I shall not employ an, person in an manner SINK r CITY TEL.NO. P P. Y Y P Y I C/ / so.as to become subject to the Workers'Compensation Laws: N DISHWASHER r• CONTRACTOR. r Date Applicant CLOTHES WASHER, ADDRESS NOTICE TO APPLICANT: if, after making this Certificate of Exemption, you,should become subject to the Workers' SWIMMING POOL.RECEPTOR Compensation provisions of the.Labor Code, you must forth- CITY '� TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this Permit shall be STATE LIC: deemed revoked. WATER HEATER,- LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT No. ESSEU BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division.3 of the Business OUTLETS OVER �O o y and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINADATE `!' .�L VALID40—N V License Number Lic.. Closs Qe FINAL O Contractor Date BY II­ ❑ I am exempt under Sec. B.&P.C. for this reason. Plan check fee ► s.l 5 7 A Date. PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE S # o 0 0 0 0.5 , Plan check applicant I o o 461 5 0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name .o 0046505 •1 hereby affirm that I am exempt'from the Contractor's License Address Law for the following reason (Sr (.Section 7031.5, Business and _ 0 2 2.5'—8 5 Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ► 7044, 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' II (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,andhereby authorize .representatives of this County to enter upon the above-mentioned jpropertyjor inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nu 09--)<. Signatur o erm'itt Date P 11e� WORKERS'COMPEN&ATION DECLAR _TIION. %s+•. APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of,consent fo;,self 76461 t1 n s} insure, or a certificate of Workers'Compens6Mn Insur"ancet CE 817(REV. 1.0/81) or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF L03 ANGELES /7 ,1 (2v' BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN PRINT OR TYPE BUDDING /�0�� © Certified copy is filed with the.courity building inspec ( ) ADDRESS 7 �'f See tion department. NUMBER FIXTURE OR ITEM @ FEE ,� LOCALITY ��� �� G.) Date Appligant ' WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE. (This section need not be completed If the work.Involved by SHOWER OWNER L+ • Cry&I iS the permit is for.one hundred dollars(.$100)or less.) LAVATORY ADDRESS -17 0L1 VIE 5T I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY fiPZE C)j— ' TEL. NO,� � ok SO as to become subject to the Workers'Compensation Laws. / * DISHWASHER CONTRACTOR 3 . Date qApplicant CLOTHES WASHER ' NOTICE TO PLICANT: If, after making this Certificate of ADDRESS ,Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CIN TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE. LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO: P. CESSED'BY I hereby off irm.that I am licensed.under provisions of Chapter 9 r GAS SYSTEM 1 OUTLETS (.commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ��d and Professions Code,and my license Win.full force and effect. 5 PER SYSTEM FINAL VALIDATION O License Number Lic- Class DATE 7 „g V FINAL O Contractor Date BY V ❑ 1 am exempt Under Sec. H B.$P.C. for this.reason. Plan check fee' Date: Signature PLUMBING PERMIT ISSUING FEE$ ` „ LTO- TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name = C r 7.2 A I hereby affirm that I am exempt from the Contractor's License Address ;% 0 0 0 o 5Law for the following reason (Section 7031.5, Business and o Professions Code): City Tel. No. Z'o'o 3 I1'5 Q LJ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ,'o'.o (L �;n Q 7044,.Business-and Professions Code). CONSTRUCTION LENDING AGENCY ° Q 50 G —8!! 1'hereby off irm 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 1 certify thof 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 pop authorize representatives of this County to enter upon the %ave-me'nt�ionedpro y for inspection purposes. ;I SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dcfie