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Home My Public Portal About9238 OLIVE ST_Plumbing__ 76AS67A / GE 1317(R111yV.6/78) fy r APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY r FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS `JL i NUMBER FIXTURE OR ITEM. ® FEE ` LOCALITY WATER CLOSET NEAREST BATH TUB CROSS ST. )S SHOWER OWNEffMAIL 2`F LAVATORY ADDRESS �+ (LIV� SINK CITY" TEL.NO. ` 5—, DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL.NO. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT .HOT WATER HEATER PLUMBING FIXTURES GAS TEST '�/ / i%. ��ca 4ft Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ 17 r= FINAL TOTAL FEE 1131. Plan check applicant / �d- Jd1 �3�� Name � A 0 C � 'L. - �/G'®� l�t�/�+w'l,�c'�I Address q Q;9 E. 6 Utv` /�/3/f7 9 CItY` e m p L f- Ci+Y Tel.No. 9n(L I HEREBY A KNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 5 3 61 A AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS # O O p O O 5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. 2 - - 1300 SIGNATURE 3 O O O '� ,(�C r.l OFPERMITTEE v v r DISTRI.T .� PRO ED BY 071 o-79 INDUSTRIAL WASTE APPROVAL _ r a "',a r si7 �J.-WORKEM-SOMPENSAJON DECLARATION /APPLICATION FOR PLUMBING PERMIT -�I her laffirm that I'have a certificate of consent to self 76A887A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.8/86) or a certified copy thereof(Sec. 3800, Lab. C.) Ol700d3tompany 1 &214U7 -S Policy No2AIA, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) ©� s t ❑�ertified copy is filed with the count'building inspec- ADDRESS .7- v t° tion department. �f��,Q NUMBER FIXTURE OR ITEM @ FEE LOCALITY T7' l`'? o� "" WATER CLOSET a / l P Date Appli4antlg'—' ' 7 NEAREST , CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB U CROSS ST. 0 GL COMPENSATION INSURANCE SHOWER V hh OWNER �� (This section need not be completed if the work involved by / v MAIL q f A/ the permit is for one hundred dollars($100)or less.) LAVATORY p ADDRESS -/0 0" ��S- K/✓�.s I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY �_1LJ,04C TEL.NO.,Zg'�cj so as to become subject to the Workers'Compensation Laws. 1 DISHWASHER CONTRACTOR��'��''r`� - Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of �/ �2 SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- CITY � >� TEL. NO. �� LAWN SPRINKLER SYSTEM �`O�� 115 with comply with such provisions or this permit shall be STATE �/,(� LIC. deemed revoked. WATER HEATER LICENSE NO.I /� CLASS C--,?10 LICENSED CONTRACTORS DECLARATION / DISTRACT ND PROLE ED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS c� oo S U (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER _ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL, T� VALIDA ONS Liua y to DATE / License Number r 7 o o I Lir. Class� 1 FI Contractor ❑ I am exempt under Sec. 9L B.BP.C. for this reason Plan check fee lop 2 Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE s Plan check applicant SINGLE FAMILY -2 7 5 7,5 A HOME OWNER-BUILDER DECLARATION Name 0 0 0 0 0 I hereby affirm that I am exempt from the Contractor's License Address 00 8 7Law for.the following reason (Section 7031.5, Business and Professions Code): City Tel. No. 'd I, as owner of the property, will do the work and the 0 7 3 8 7 13 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 (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 represe v s f this County to enter upon the above- ntioned for Inspection purposes. SEE REVERSE FOR.EXPLANATORY LANGUAGE nature of Permittee Date