HomeMy Public PortalAbout9321 PENTLAND ST_Plumbing__ o e e n,xeM e¢Te Ix a `� _ �`• -,APPLICATION FOR PERMIT
"I3EP�RTMENT OF"BUILDING AND SAFETY ^
COUNTY OF LOS ANGELES - PLUMBING f11
WM J FOX CHIRP HNGINEER _
NATURE OF INSTALLATION DIST o o aRouw O PERMIT NO
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NHATER 1 ,CfiSBPOOL ( SEPTIC TANK AIB/ a 'FIRST INSPECTION
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A_PPLICANTzFILL IN HEAVILY OUTLINED'PORTION ONLY
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NAME -� ` _ •{" ADDR[BB / f `
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CERT No - ""`. IDIPIR[S• C NAM[ AO �/A f[l '-•� ,
LOCATIONrOF SEPTIC TANK; OR CESSPOOL
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rY NORTH It . `O
AM' THE LEGAL POSBRSSOR, OF THE ABOVE LOS
Y I- ' •, T • _ ' , ANGELES COUNTY-CERTIPICATE OF.QUALIFICATION '
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I AM THE LEGAL 0VMXXR/O�F THE PROPMTTYY DESCRIBED
ABOVE
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CORRECTIONS
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DESCRIP_TION,OF'WORH u q
E �/ BATH TUB - •RNACH J ��• . ' ,
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m OOR BINK ANDTRAP'
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WASH TRAY URINAL �' APPROVALSWATYR CLOSWr ^RINKING FOUNTAIN
DAT[ - IN�F[CTOR•MAY[
��WATKR'HEATER-, DRNTALLAVATORYa•ry 1 PLUMBING '_ i 4YODA FOUNTAIN ",I . ��
UTLIPING - Ql
CESSPOOL , "1'� U :�Y W\/�A�ll�✓
TOTAL NUM_BHR OP FDXTUREB 0 � BHPTIC TANK -
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UTILITY CO NOTIFIED F
'TOTAL FEE �� O
FINAL
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APPLICATION FOR PLUMBI G ER T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION =-rl-
F6R
v JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING
APPLICANT TO FILL tN PR NT OR TYPE TURE OR ITEM EACH FEE
WATER CLOSET 150
MAR.
( BATH TUB 1 50 D ADDAFHq
SHOWER I50 CITY r L N477-ao39 `
( LAVATORY 150 TCONTRACTOR
( SINK 1 50 D ADD '
DISHWASHER ° _ 1 50 CITY TEL NO b- Jg'3
CLOTHES WASHER• 150- STATE // _ LIC /` e
LICENSE NO �J /• CLASS G �O
SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GR ZONE P ES BY
LAWN SPRINKLER SYSTEM 2 00
NATER HEATER •1 50 D INDUSTRIAL 8
• WASTE APPROVAL lJ
GAS SYSTEM -OUTLETS t 50 15T INSPECTION RECORD
OUTLETS OVER �` 30
5 PER SYSTEM
Iti/. '/l t�,LllL'a,- z
�r
Plan check fee 25.0 of above SeereT erse '
7D
PLOA1RLNG PCRNtI'I ISSUING FEE 8
TOTAL FEE
_APPROVALS DATE IrvsPEcroR n SIGNATURE
Plan check applicantUNDER SLAB WORK
Name ROUGH PLUMBING
Address �} GAS PIPING
GAS VENT
City - - • Tel No HOT WATER HEATER 7/9" fil T&,e A(�_- '
1 HEREBY ACKNOWLEOGE`THAT 1 HAVn MAD THIS APPLICATION
AND STATE THA?THE ADOV, O,CORRECr AND AGREE"TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY OROINANC[S ANO STATE LAWS REGULATING GAS TEST
PLIIM.ING
I HEREnY CERTIFY,THAT 1 AM PROPERLY REGISTERED ANO/OR UTILITY CO'NOTIFIED
LICENSED AS REOUIR[O nY LOSS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THATO AM THE LEGAL OW ER OF AND INTEND TO
REm OE IN THE ABOYE DEBC ReIE M.10 1 PROPERTY FINAL O
I n'
TI
SIGNATURE1 a.(�/ - JACK R ALLEN, SUPERVISING CHANICAL
OF PERMITTIEE _
P}' =_j7AY SnA TNf1N CK M O CASH i`IT
PLAN CHECK VALIDATION CK M O CASH -
1pr;,4,6 3 9R X23 5• 0 1 1 .0 Or _p
• / u
WORKER'S COMPENSATION of consent
Bf� APPLICATION FOR PLUMBING PERMIT
JBASa7A
I hereby affirm that I have a certKmste of consent io sell In6ure ,,
or a cerhhrpte of Worker s Compensation Insurance or a certified—
copy
ertifiedcopy thereof(Sec 3800 Lab C)
�'y�qy�� � COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV
Policy No LCL 7k/ CompenY��� '��rJ - _ z t -
Certdied copy is hereby furnished I 1
'f FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING f
L7 Cenrhed copy is filed with the county building lding inspection f
dament�� � rsr �t NUMBER , FIXTURE OR ITEM � FEE LOCALITY �7
Dale (�_Apphcant IOM WATER CLOSET r
( NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB r CROSS ST
COMPENSATION INSURANCE ASSESSOR t 1
(This section need not be completed If the work Involved by the 1 SHOWER _ MAP BOOK �� ' Q PAGE PARCEL( ,
permit Is for one hundred dollars($100)or leas) ) / LAVATORY ' D OWNER
I certrfy that in the performance of the work for which this permit n
MAIL
is issued I shall not employ any person in any manner so as to $INK ADORES$ Z1 (.
become subject to the Workers Compensation Laws r
_ AdUlo
DISWASHER CfTY TEL NO
Dale Applicant CLOTHES WASHER CONTRACTOFtr-�
NOTICE TO-APPLICANT It after making this Certificate of
Exemption you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR _ ADDRESS
provisions of the Labor Code you must forthwith comply with such
provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITYr� TEL NO 27 d
I hereby affirm that I am licensed under provisions of Chapter B WATER HEATER
(commencing with Section 7000) of Division 3 of the GAS SYSTEM OUTLETS LICENSE NO CLASS Business and STATE LIC
Professions Code 'and my license is in Lull IOrCO end affect OUTLETS OVER - _ DISTRICT NO PROeC�'`,j�i/SE--D..BY' __ cc
5 PER SYSTEM - - O - 0
License Number"ll Lic ClassFINAL w
�M I t _ DATE 3 Zf,71 VALIDATION
OL
Ccnlractor lvs-• f � _ Dat __ I AL fn
L Z
❑ I am exempt under Sec By
B 8P C for this reason VVVV
ate
Plan check fee ,
Sgnatura PLUMBING PERMIT ISSUING FEE$ OU
❑ + TOTAL FEE Q I
r
Plan check applicant c
SINGLE FAMILY
HOME OWNER BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor s Lore nee Law ' _ f
for the following reason (Section 7031 5 Business end Professmne Address ?117 �ql
Code) _
EM_
❑
I as owner of the property well do the work and the structure city Tel No I TI
f
' is not intended or offered for sale (Section 7044 Business 1 TML _c c 0 a _ 0
and Professions Code) j Poo.CONSTRUCTION LENDING AGENCY ' ` I HEC r U UI I
I hereby affirm that there is a construction lending agency for the ( CHANGE ,IILI
performance of the work for which this permit Ie issued (Sec 3097
Civ C)
t OLI]I)-I]QI]1
Lender s Name � `9/- 7/C0�
2752 1, AN10:91
Lender Address
I certify that I have reed this application and state that the above
information Is correct I agree to comply with all County ordinances , r 1
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 1 " +