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Home My Public Portal About9430 PENTLAND ST_Plumbing__ 76A667,- CEB17 5/70 APPLICATION FOR PLUMBING PE IT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONDav JOHN A. LAMBIE COUNTY ENGINEER COLEMAN W.JENKINS SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN KPR NT OR TV PE �T ST NUMBER FIXTURE OR ITEM EACH FEE / OWIKER WATER CLOSET 150 MA¢ BATH TUB 1 50 ADDRESS SHOWER 150 CITC TEL NO LAVATORY 150 CONTRACTOR _ SINK 150 ADDRESB DISHWASHER I50 CRT /f TEL N CLOTHES WASHER 1 50 STATE LIC LICENSE NO CLASS SWIMAUNG POOL RECEPTOR 150 OIURICT NO GROUT NE ESBED BY LAWN SPRINKLER SYSTEM 2 00 5. 0>,F / WATER HEATER 150 BIDUSTRUIL 1 WASTE APPROVAL 8 GAS SYST EM OUTLETS 150 D®PCCTIC ;VRD (� OUTLETS OVER 30 fir , Z ST 5 PER SYEM Plan check fee 25% of above See reverse PLUMBING PERMIT ISSUING FEE S 00 TOTAL FEE APPROVALS DATE IHSFECTOR E EIGHwruRE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Addres GAS PIPING GAS VENT GIIY GT Tel No HOT WATER HEATER I MEREwY ACKN"ULOGE THAT I HAVE READ THIS AF LICATIOH AND ErATE THAT THE ABOW IR CORRECT Arm AGIQ{ TO COMFLY PLUMBING FIXTURES WrtN ALL COUNTY ORDINAN AND RATE LAWS MCULATINO GASTEST T MUM0ING 1 H 1 Hu®Y CERTIFY THAT I AM F FERLY REGIETCIQO AD/. UTILITY COINOTIFIED ULIFDRNIA• R[GU TTI AM TN[ LEGAL OWNS. OF AND INTEND TO 0,'BY LOS ANIELIES COUIMYY AND STAM OF ' �roR R_,_ IN TH E DEYCRISED RUIRNTIAL FRO"INYY FINAL \ ' SIGNATURE JACK R. ALLEN, SUPERVISI ECHANICAL ENG R OF PERM !! PERMWYALHJATION c' fM-o CASH V PLAN CHEC CK M O CASH - KIel3 ^Ar, 1 4 3 2 ti JUL 1 4 5 D 8 2 5 I '1"667 17 36M.18 7 4E APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING ' +' COUNTY OF LOS ANGELES WM J FOX CHIEF ENGINEER TUR O S O P /�/O ROUGH FIXTURES COMPLETB '�/ /4–/ 2 HEATER H. CESSPOOL —I B�TIC TANK RKCHIYED BY READY FOR DATE ISSUED Z514i / FIRST INSPECTION �Q SCEL A ✓ 'T' / APPLICANT FILL IN HEAVILY OUTLINED PORTION O Y JOB NAM ADDRESS B ADDRKSS LOCALI NEAREST CITY TEL No CROSS ST COUNTY i LICENSE NO I mIPTRES C NAME LOCATION OF SEPTIC TANK, OR CESS OOL = MAIL ADDRESS NORTH 0 CITY • TEL No 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION i FLYYwaI 1 AM THE LEGAL 94NZR OF THE PROPERTY DESCRIBED ABOVE OWNOI CORRECTIONS BourH J DESCRIPTION OF WORK _i ATN TUB FURNACE 13 ROWER —DISHWASHER D LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER OOR BINK BAND TRAP LOP BINK ______FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE IM/F/CTOw 6M6Yi WATER MEATIER DENTAL LAVATORY ROUGH PLUMBING / ETER-3—GAS SODA FOUNTAIN GAB PIPING C OUTL GAB VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK Cesspool SEPTICTANK SEWER S G/ �" UTILITY CO NOTIFIED /1 TOTAL FEE 4 �^ FINAL -7 �✓� WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 'I hereby oftirm that I have a certificate of consent to self 20 D026 DPW 6/87 insure or a certificate of Workers Compensation Insurance 76A667A or o certified copy thereof (Sec 3800, LAab�.�C )`• 1y� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No Company !� n2ylm 'F•T-t Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRIM OR TYPE) BUILDIN F'nb Certified copy is filed with the county building Inspec ADDRES �/ tion department NUMBER FIXTURE OR ITEM ® FEE OCAUTY T/ DoteLAppIlSant LTS S7'll .� IK IPbI/� 1 WATER CLOSET / NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST O COMPENSATION INSURANCE OWNER (This section need not he completed if the work involved by SHOWER the permit Is for one hundred dollors($100)or lass ) I LAVATORY MAIL RESS ADD04{ I certify that in the performance of the work for which this � permit Is issued I shall not employ any person in anyy manner SINK Cliv TEL t0O l/ so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS T 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 LAWN SPRINKLER SYSTEM CITU TEL NO�� with comply with such provisions or this permit shall be STATE UC deemed revoked WATER HEATER LICENSE NO L� C1.455 LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS D (commencing with Section 7000 of Division 3 of the Business r ( 9 I OUTLETS OVER and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION S I / DATE tj License Number, Llc Clang i' C.1 a FINAL C Contractor ateL BY 7 O ❑ I am exempt under Sec (( + U -1. �.s lsJ B 8P C for this reason — � Gi ELI Plan check fee S� l i �_ ! N Date Z PLUMBING PERMIT ISSUING FEE f p2. 1 1110,2 Signature r TOTAL FEE IleQ 117 FAL 126 - 60 Plan check applicant (tHEu. 12,-AFI SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name CHAN j� ,(Ill I hereby affirm that I am exempt from the Contractor s Ucense Address Law for the fallowing reason (Section 7031 5 Business and Professions Code) Cit Tel No }—t ❑ Y IIQIJI_ ll illi :/ 1(•y I, as owner of the property will do the work and the 11191 t Arl 7�4i structure is not intended or offered for sale (Section 7040 Business and Professions Code) pop CONSTRUCTION LENDING AGENCY I hereby affirm that there iso construction lending agency for the performance of the work for which this permit Is issued Sec 3097 Gv 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 jaws regulating Plumbing and hereby authorize reprelentatrves of this County to enter upon the above mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Data