HomeMy Public PortalAbout9236 PENTLAND ST_Plumbing__ 7SA"7 DBB n 11-50 APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY PLUMBING
COUNTY OFF LOS LOS ANGELES
WILLIAM J FOX, cHlEr [NGIN[eR
FOR APPLICANT TO FILL INjo R LIVEDBY READY IDRDATE 1
ADDRESS 'rjIRBT INSPECTION �/ L
CITY TEL N�� ��• o ADDRESS
COUNTY (/ 1� j0 ,J LOCALITY
LICENSE NO EXPIRES
NEAREST
PERMIT FEES cpoae Br
MDMBGI TYPE Or rlS Rr DR ITEM FEE DIVNER
MAIL
WATER CLOSET(TOILET) @ 050 B ADDRESS
BATH TUB @ 050 CITY TEL
SHOWER @ 050 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 050 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK @ 050 AND STATE LAWS REGULATING PLUMBING
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY @ 050 ANGELES COUNTY LICENSE(.OORRYII AM THE
THE LEGAL OWNER
GAS SYSTEM OUTLETS ® 05D TH[ RESIDENTIAL Py OPG'_ _-6
BUr IRIBLD AHO
SIGNATURE
WATER HEATER @ 050 PERMIT.-
-SLOP BINK @ 050 INSPECTION RECORD
MOOR BINK @ DSC
FLOOR DRAIN @ 050
DISHWASHER @ 050
DRINKING FOUNTAIN @ 050
URINAL @ 050 J
Q
HOUSE SEWER @ Ono Z
MI EL ECUS 0
D
0
I
APPROVALS
DATE IMBPc CR• MAME
ROUGH PLUMBING
GAS PIPING
GAB VENT
CESSPOOL @ 100 CESSPOOL
SEPTIC TANK SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1 00 I I SEWER
PERMIT 1 GO GAB TEST
UTILITY CO NOTIFIED
TOTAL FEE 6 SO
FINAL,
WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT
I hereby; offir.%i that I have a certificate'of consent to self in; 76A667A
sure,'or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified copy thereof (Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES - DEPT. OF PUBLIC WORKS
Policy No., Company.
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING / (�f �✓
Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date Applicant WATER CLOSET(TOILET) NEAREST „/ !
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. R 4T U S R f w
COMPENSATION INSURANCE SHOWER OWNER f �G_ 6-
(This(This
section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 521{ten ee 4,e` r4 3P�
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person i.n-cry'manner so SINK U v CITY TEL. NO.
as t9 become subject to the Work rs— ompen ation Laws. DISHWASHER v
. // CONTRACTOR
L" DO}e / Applicant �' CLOTHES WASHER ADDRESS '
NOTICE TO AP LICAN, :'If,'after making this Certi cote of Fx-
7 SWIMMING POOL RECEPTOR /
emption, you should become subject to the Workers'.Comp n- CITY / TEL. NO.
sation,provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. CESSED BY
I hereby affirm that I am licensed under provisions of Chapter ' GAS SYSTEM OUTLETS 60 cl)Ll
9(commencing-with Section 7000)of Division 3 of the Business OUTLETS OVER W)allAco
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINALVAL TION
feet. ( �� DATE � �� 0
License Number Lic. Class U
FINAL a
Contractor Date BY ' O
t—
I am exempt under Sec.
OL/V
B.BP.C. for-this reason Plan check fee ► g
Dater PLUMBING PERMIT ISSUING FEE$ 10 60
Signature
- TOTALFEE
SINGLE FAMILY ' w�
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and
Professions Code): Address
+ i
r rr
-
I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). _
CONSTRUCTION LENDING AGENCY ( ': '�E �'
I hereby affirm that there is a construction lending agency for 5_: L:r=,`,0
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.). .. _
Lender's Name
• .,_ "�_'�.`•. _.. ..>;%jet''
Lender's Address
1 certify that I have read this application and state that the - ' �2'
above information is correct. I agree to comply with all County ►
ordinances and State laws regulating Plumbing, and hereby
authorizerepresentaa.ives of this @bunty to enter upon the
aiaoue-a-4r+ property for irv&ection purposes• -
�, SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permute ate