HomeMy Public PortalAbout9437 PENTLAND ST_Plumbing__ 7aA6jCE8I;
APPUNTYLICATION
g FOR PLUMBING PERMIT
DEPAMENTNT SF COUNTY ENGINEER
BUMDINC AND SAFETY DMSION WcTy/
iJOHN A MBIE COUNTY ENGINEER C..WILLIAMA JENSEN SUPTOFBUILDING
FOR APPLICANT TO FILL. IN rNUMBER FIXTURE OR ITEMWATER CLOSET HATH TDBCITY—jf� TEL NOSHOWERRLAVATORY
Sm ADDRESS
DISHWABI�HL(�C� , TEL NO
CONTRACTOR A '
LAUNDRY TDB REGISTRATION NO oG_ COUNTY
CLOTHES WARTIER DISTRICT O GROUP ZONE E'D BY
WATER EMAXEH 'T
GAB SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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o
i m
� ER ITEM
R op 00 PEcrUxE I E �O
APPROVALS DATE INSPECTOR 931GX`ATURE
PERMIT 4 2 OG UNDER SLAB WORK n
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TX18 APPLICATION GAS VENT
AHD STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING "f� G
PLUMBING HOT WATER HEATER
1 HEREBY CfiRTI FY THA M PRO RL IDTERED ANO/OR PLUMBING FIXTURES'
LICENSED AS REQUIRED LOS ANGEL OU Y A STATE OF GAS TEST
CALIFORNIA OR THAT AM THE LH 0 TX[ ABOYH
DESCRIBED RESIDENT L PR ERTT i UTILITY CO NOTIFIED N
SIGNATURE
OF PERMITTE FINAL ?
mr VALIDATION ROBERT A WOOD
y M.G cArB SUPERVISING MECHANICAL.ENG R
LAC00641% iLw22 5 u 3.50- q
-� WORKERS COMPENSATION DECLARATION y,,- APPLICATION FOR PLUMBING PERMIT - Y
200026 DPW 4/B7,
I thereby, afflrtri that I have a certificate of'corisent to self in- 7yxaa7A _ '
sure or a ceraficale`of Workers Compensation Insurance ora • ICE 817(REV.B/B6) ; •
hed'co 'thereof (Sec 3800 Lab' � t ,.,
Y �r , .,�• COUNTY OF LOS ANGELES DEPT OF,PUBLIC WORKi ,-
;m,
licy No / Company` + v _ , - y - - — ° _ • yC _
'� Cerhfted copy is hereby,furnuhed - n r y`„ - p
i A •FOR APPLICANT TO FILL IN(PRINT OR TYPE1 BUILDING r
�Cvlified copy is filed with the cou ty building Inspection ADDRESS 3 ,
t t b department c . r NUMBER FIXTURE OR ITEM_ @ _FEE -
x ^y• LOCALITY
Date 2 ' Applicant � '6LI� WATER CLOSET(TOILET) '
� x PP NEAREST
c7 tA)
�ravt CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB - s CROSS ST ' -
COMPENSATION,INSURANCE - 'f SHOWER'{ ' y} +° OWNER - A mASo�
section need n �not be completed-if the work involved by 'MIL ( / a
the permit'for,one hundred dollar --($100) 0r lest`) . 1 ' LAVATORY' • r 6 - + ADDRESS Lf -
certify that n the performan
d ce of the work for which this per t , p
.mit is Issued shall not employ any person in any'm'a nner so SINK, CITY TELA NO,
���)( `�
' as to becomeiw
ublect to the Workers Compensation Las'
' • F r fy - ,d• a•yr DISHWASHER
t CONTRACTOR,it
Dajte Apphtont
l�c.se
` + .. CLOTHES WASHER
NOTICEJO APPLICANT'IP-aftenmaking this Certificate of En r-• ADDRESS �' �6 f S'� d ^ s 1
n SWIMMING POOL RECEPTOR
empnon you should become subject to the Workers Compen CITY f�-54d TEL NO
1, sahan,pr oymons o6the Labor Code you must forthwith comp LAWN SPRINKLER'SVSTEM K,�6 '
+ly with such provisions or this permit shall be deemed revok STATE TIC / - t
'led_'TT '^ t:, r% .. . ^ . WATER HEATER+ • O LICENSE N0�7 A CLASS
{ LICENSED CONTRACTORS DECLARATION r / _ DIST RI^T NOO P SSED BY t
I hereby affirm That I am licensed under provisions of Chapter GAS SYSTEM OUTLETS +. ad
✓1 L
9(commencing wtlh Section 7000)of Division 3 of the Business OUTLETS OVER `
Pfe d P ,ofessionI Code and 1, I nI is mIfull fo e and of .. 5 PER SYSTEM _ t DAN EL —Q VALID ION a
.License Numftaar ' y ' Lic Class - - - r _ t r ° O
r/IW ^� /i1!•15� y r. FINAL
Contractor / Doter „y " � _ O
am exemptn.under Sec t ° - ^ c ,77
2 0'% 2'] Q W
Y i • _ - 4 i . . -
B 8P C for this reasonN
Plan check fee - • V e j.'. e • 5 i
` '' Date 1
°T 'PLUMBING PERMIT ISSUING FEE $ - - ( re e 5 a 5 0
S gnolwe , _ -
- _ TOTACFEE ,
>. - SINGLE FAMILY `
HOME OWNER BUILDER DECLARATION t . ' ' Plan check cpplimnt " ' r - ` to •re 5 a 5 0�
I hereby affirm thotd am exempt from the Contractor s License Name a - -' •! ' ." • +ti J
"Law for the fallowing reason (Section 7031 5 Business and ° - o9 2`2 —8 8r.
Professions Code) C r Address .. . i
`I as cwner',of-the property wdl,do the work and the Gry - Tel'No
�� structure is not intended or offered for sole(Section 7044
u
Biness and Professions Code) • x i_ _rf . 1 + - , ► z °, „ ,. m d °
CONSTRUCTION LENDING AGENCY
'* I hereby affirm,thot there is a construction lending agency for
the performance of the work for which ihis'�permit is issued `
(Sec;3097, Civ C ) " 'rV ,
w - -
` Lander is Name
,Lender s Address
+ I certify that I have read this opplicatmnpcmd state that the - r r
"above informati c rrect I'ograe to comply with all Couriry - r q ` ' ' ►
ordmon�es a Sto lows re lacing Plumbing and hereby
authorize pres totrve is County to enter-upon the
above no m pr inspection purposes
SEE,REVERSE FOR EXPLANATORY LANGUAGE,
Signa t arm tee vt A Date n• 1> ^ i - ' - ' - ' - - " '