HomeMy Public PortalAbout9524 OLIVE ST_Plumbing__ 76AS67-CE#817 2-62 - TEMPLE CRT . lei-
APPLICATION. FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER.,
BUILDING AND SAFETY. DIVISION FAURESS,
DING • • ,p^�
JOHN A. LAMBIE. COUNTY ENGINEER 'G/. `WILLIAM A.JENSEN.SUP'T OF BUILDINGALITYFORAPPLICANT TO FILL IN SS ST.
NUMBER FIXTURE OR ITEM EACH FEE
'WATER CLOSET $1.25 �O OWNER
f MAIL
BATH TUB 1.25 S ADDRESS._
r SHOWER 1.25 S5' CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR
SINS . 1.25S ADDRESS
DISHWASHER. 1.25. CITY lIxTEL.NO. �-
LAUNDRY TUB 1 , 'CONTRACTOR'S STATE
REGISTRATION NO. -S7 COUNTY .p
CLOTHES WASHER 1.25 DIST ICT NO. G OUP ON PRGNFESSED BY"
WATER HEATER1.50. -0
GAS SYSTEM ?r OUTLETS 1.50 p INDUSTRIAL
WASTE.APPROVAL
OUTLETS OVER 5 PER SYSTEM .30
INSPECTION BECORD
m
An
Ah
�VALS" DATEI INSPECTOR'S SIGN66W
PERMIT S 2 00 UNDER WORK „ A
ROUGH PLUMBING ��, 4r
TOTAL FEE / //�y�
`� "v GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 1 AM PROPERLY REGISTERED ANO/OR .PLUMBING FIXTURES, ,
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE -OF •,PAS TEST
CALIFORNIA OR THAT 1.AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DE 'BED RESIDENTIAL PROPERTY. 'UTILITY CO.NOTIFIED
SIGNATURE Q
OF PERMITTEE
FINAL ✓
VALIDATION ROBERT A.WOOD
C
10! M.O. CASH SUPERVISING MECHANICAL ENG'R -
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
1
I hereby affirm that I have a certificate. of consent to self 76A667A
insure, or a certificate of Workers'Comp e ation Insurance, CE 817(REV..10/81)
or a certified copy thereof(Sec. 3800, La COUNTY OF LOS ANGELES B DING AND SAFETY
Policy No. Company
.Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUV —2 0
Certified copy is filed with the county building inspec- ADDRESS
Sytion department.. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date/� Appligant WATER CLOSET NEAREST
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($100)or less.) LAVATORY MAIL 9
ADDRESS'.
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTO
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, .after making, this Certificate of ADDRESS
Exemption; you should become subject to. the Workers' SWIMMING PObL RECEPTOR
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY'" TEL. NO.L�j!/0J
with comply with such provisions or this permit shall be STATE Or LIC..
deemed revoked. WATER HEATER LICENSE NO. �� CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED
I hereby affirm.that I am licensedunder provisions of Chapter 9 GAS SYSTEM OUTLETS
(commepcing with Section 7000)•of Division.3 of the Business OUTLETS OVER >_
and Professions.Code,and my license is in.full force and effect. 5 PER,SYSTEM FINAL1
J1 DATE VALIDATION V
License Number .�l to Lic. Class
FINAL ^ O
Contracts Date BY 7 �� r�
❑ I am exe a'o o r,, (� IL
B.&P:C. for this reason rA
Plan check fee � z
Date: PLUMBING PERMIT ISSUING FEE$
Signature .
TOTAL FEE: A/0 �,,r C-
0o j
i Plan check applicant � � a c 7.'.= o
SINGLE FAMILY u �l
HOME OWNER-BUILDER DECLARATION Name y I.C "
LA 03
"
I hereby affirm that I am exemptfl•om the Contra...ctor's License Address
Law for the following reason (Section 7631.'5, Bus..'in.ess�ancl
Professions Code): ,City Tel. No.
❑ 1, 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 �
(Sec. 3097, Civ. C.).
Lender's Name
Lender's Address
I certify that I have:read this application and state that the .fill
above information is correct. I.agree to comply with all.County
ordinances:and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes. '
SEE REVERSE FOR EXPLANATORY LANGUAGE ,
.c4. lair&��
Signature.of Permittee. Dfite