HomeMy Public PortalAbout9584 PENTLAND ST_Plumbing__ 76 A 667—CE 817 B/68 ��
APPLICATION FOR PLUMBING P.E MIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION RUILDI s %�QJQ 2e.ltlL���!
JOHN A. LAMBIE, COUNTY ENGINEER ADDRE
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY -2 ; ,� „ (;1 tJ�
FOR APPLICANT TO FILL IN(PR NT OR TYPE) CIAREST -2
�-e
CROSS ST, i X 0 ALVC?
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET 1.50 OWNEA tied "1ores
IL
BATH TUB 1.50 ADDRESS a ori ^Dove
n
SHOWER 1.50 CITY TEL N0.2v —471
LAVATORY 1.50 CbNTRACTOR u.o La G!'aJ1arti
SINK 1.50 ADDRESS 9127 Las T una s Dr.
DISHWASHER 1.50 CITY y e,--',)Ie City TEL. N0.266-9293
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. 104CLASS C-16
SWIMh7ING POOL RECEPTOR 1.50
DISTRI13 NGR ZONE4 PR^ BY
LAWN SPRINKLER SYSTEM 2.00 `� 2� V
WATER HEATER r e'�1ac +1.50 1 50 " INDUSTRIAL
WASTE APPROVAL o
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD v
W
OUTLETS OVER .30 � ti
5 PER SYSTEM
Plan clieck fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE S 2 00
TOTAL FE, 3 5Jnn
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan cherk applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No. HOT WATER HEATER
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF '
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTLND TO
RESIDE IN,THE ABOVE DESCRIBE/D'ROESIDENTIAL P PERTY. — FINAL S j¢ N
SIGNATUPERMITTEERE 'l
OF ` /may/ JACK R. ALLEN, SUPERVISI HANICAL ENG-R.
l si�+�
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CA/-
8
A H8 1 3 5DEC 24 5 D 3.50-
�'f�L•RKERS'COMPENSATION DECLARATION
4hat I have I r. � �
4 i +,, a cettifieote of consent to self in-. 20.0026DPW4/87 APPLICATION FOR PLUMBING PERM
6hC '. ##irrtn 76A667A•
- 'sure;`ea certificate of tlVorkers'Compensation Insurance,ora ;CE 817(REV.8(86) •• `
certified copy thereof(Sec. 3800, Lab. C.),_
% �1 } COUNTY-OF LOS ANGELES DEPT. OF PUBLIC WORKS
Pblicy No. Company �
.Certified copy is hereby furnished.• `
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS
department. �d, ,
NUMBER FIXTURE OR'IT,EM @ FEE��yjKLocAUTv1ii Liv c 'Date --ZZ'P1q Applicant. •�_ .GWATERCLOSET(TOILET) . V V'.
:I . A NEAREST',.
CERTIFICATE OF.EXEMPTION FRONT WORKERS'• ii BATH TUB CROSS ST:
COMPENSATION INSURANCE �. OWNER'
(This section need not-be completed if the work involved by' SHOWER (Jo MAIL Q
the permit is for•one hundred dollars(5100)or less.) LAVATORY U J ADDRESS V o•`•'Y LA f-LD "
I certify that in the performance of-the work for which this per- SINK
mit is issued, I shall not employ any person-in any manner so CITY o �� ' TEL.NO.Z c, 73�
as,to become subject to the•WorkeW Compwisation laws. �✓�
DISHWASHER .CONTRACTOR � � W. IL
DateApplicant CLOTHES WASHER ao
NOTICE TO APPLICANT: If,'after making this Certificcite'of Ex- ADDRESS
emption,you,shoJdd become subject to the Workers'Compen- SWIMMING POOL RECEPTOR C
sation provisions.of the Labor Code,you must forthwith-comp- CITY C) ii'D• TEL.NO." / Cf
P Y- P- 'I LAWN SPRINKLER SYSTEM � �n• ��• r' ��•• _
ly wifh,such provisions o.r this•permit•shall be deemed revok- STATE /�[��7 LIC..
ed. - >• I. I• WATER HEATER i v� LICENSE.NO. ��/ t . CLASS ..'
• LICENSED CONTRACTORS DECLARATION �v
DISTRICi,NO. OCESSED BY
I hereby affirm.that I am-licensed under provisions of Chapter
' GAS SYSTEM, OUTLETS (f
9(commencing with Section 70 00)of Division 3•6f the Business „ OUTLETS OVER '
and Professions Code, and m license is1n•full,force and ef- 5 PER SYSTEM
fect. r Y 6 . I : . F..INAL•. �
J� DATE V'ALI O O
License Number �v � -tic'. Class I (�
FINAL c,
Contractor. L'bate BY' O
k-
'J
• 0 I am.exempt under Sec. -' . _-� ;j �`21 n.e �• gy
B.&P.C:for this reason `�(s(
�Pla:n check fee ►
i Date: Ij• PLUMBING PERMIT.ISSUING FEE$
Signature
j TOTAL FEE
SINGLE-FAMILY.
OWNER-BUILDER DECLARATIONPlan check applicant-
HOME
)hereby.affirm that I am exempt from.the Contractor''s'LicenseNI me t•:•' s
Law for the following reason (Section 7031.5, Business and P mak` 'F
Professions Code): Add ss FI'' ZZ L'iI
.. ` ..r..e
I . a.-I;•:as owner of the property, will do'the work and'the City Tel. No. i(=.4(L;
structure.is not intended or..offered-far sale(Section 7044, ;( �
Business and Professions-Code.). TOTAL 52.50
no ._a
CONSTRUCTION LENDING AGENCY 1 , I: C:�i;=tiE'i 52.58
I hereby affirm that thele is a construction lending agency for t
the performance of the;work,foc which'this permit.is issued ° '00
(Sec. 3097, Civ. C.).
Lender's.Name- f� ,. L_ '•'-,' s -I./ ry/39,
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.
ordindnces andAtafe laws regyI ting'Plumbing, and hereby
authorize represent Iles Kis County to enter upon the I If
ab,gve-mentioned ro ,f urposes. J
I SEE,REVERSE FOR EXPLANATORY LANGUAGE
07
IC Signature of Permittee Date
:I `� % ,
EDEPARTBIEW OF COU= ENGINEER PLUMBING I
-I51VISION OF BUILDING AND SAFETY PERMIT APPLICATOON
COUNTY OF LOS ANGELES BUILDING �fj—� _1 ;/� I 1
WILLIAM J. FOX, COUNTY EN13INEER ADDRESS / �J (�
FOR APPLICANT TO FILL IN LOCALITY �Qic,l(�rS��
ADDRESS 7.J`� Cl? nam CUILDING ROSS ST.EAREST ,���
DISTRICT NO. GROUP ZUNE/ PERMIT N0.
LOCALITY `7— d
NEAREST �r
CROSS ST. t i 0 RECEIVED BY Ready for Inspection L/ DATEISSUED
OWNER ( , //,a�1�''-+�.�1: p't. 7� J T
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY (� TEL.NO. INSPECTION RECORD
PLUMBER uj fsA&Aad % ��4 Z�
ADDRESS e�CtnA K7o$R ^ -`3 3 C .O ,, sP.6 f1
CITY � { � TEL.NO. JE HClr�f Ckf, ��
��yy
❑STATE A/-`A� t/,-,,w7`"Fi /It, i
LICENSE NO. X-T ❑COUNTY
PERMIT FEES ` `"�m ' v n af' Q
NUMBER TYPE OF FIXTURE OR ITEM FEE6. �� Z
i - /. I 19
2- WATER CLOSET(TOILET) 0.80 d �O �r' �'tl �°~ ` O
BATH TUB @ 0.80 �o � A 1/, /;'_O c�_sl..�o A AJ O
SHOWER @ 0.80 SU /1 A.0 T'rf L _P--' lCPlle __/._r1_,
LAVATORY(WASH BASIN) @ 0.80 S` 3 �0.4,40_—
KITCHEN SINK @ 0.80 Z,r ' A
A _ LAUNDRY TUB OR TRAY @p 0.80
7"�Tnn
SLOP SINK @ 0.80
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEMA........OUTLETS @ 1.00 0 0
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDERSLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING]
TOTAL FEE y' ((o GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THI§ APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER /
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- r
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERM ITTEE..-_....- _.........._..___.......4pu= -�....
FINAL
76A667 DBS 17 1/53 -
a YVRKERS'COMPENSATION DECLARATION ` APPLICATION FOR PLUMBING PERMIT
,� 76A666 DPW 4/87
Lhf.�aY, c,f#irM that I have a certificate of consent to self in- 76A667A
"sure,fa(6 certificate,of Workers'Compensation Insurance,ora CE 817(REV.8/86)
certified copy"thereof(Sec. 3800, Lab. C.)
No. _Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy Company �A \Ui:�'Q.
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING -r
E] Certified copy is filed with the county building inspection ADDRESS E,WTL-k"
NUMBER FIXTURE OR ITEM FEE LOCALITY.
department. @ —T—m- -% L,� C
^f - � WATER CLOSET(TOILET) (�
Date_ "Z`'"L. Applicant NEAREST.
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. F at �,� �j
COMPENSATION INSURANCE SHOWER �o OWNER E Nl e S rti� t?L uev'
(This section need not be completed if the work Involved by MAIL
the permit is for one hundred dollars($100)or less.) LAVATORY 12- 00 ADDRESS
I certify that in the performance of-the work for which this per- SINK
mit is issued, I shall not employ any person in any manner so CITY C, TEL. NO.Z�A773as to become subject to the Workers'Compensation Laws. DISHWASHER uCONTRACTOR ppy
Date Applicant ' CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of Ex- w
ADDRESS? �I� �Otl
emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR C/
CITY jw�p_ TEL. NO. (6/
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM '
ly with such.provisions or this permit shall be deemed revok-
ed. LICENSE NO. Sb 04+70 CLASS
WATER HEATER
LICENSED CONTRACTORS DECLARATION �U DISTRICT NO. OCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS (} ,`
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER (�
and Professions Code, and'my license is in full force and ef- 5 PER SYSTEM FINAL VALI O
fect. ti
�D 4-) 6 DATE - O
License Number Lic. Class (�
��//' /� FINAL
Contractor t/ r/ dte ^ BY A
V
I am exempt under Sec. �`Z� A� � • �
B.&P.C,for this reason pop. '(( W
Pian check fee
Date: i PLUMBING PERMIT ISSUING FEE$
Signature
i TOTAL FEE �Z
SINGLE FAMILY _
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): Ed ss ___-• _11
I, as owner of the property, will do the work and the Tel. No. y �`13
structure is not intended or offered for sale(Section 7044, _
Business and Professions Code.). , +.!-`-y �52 �0
CONSTRUCTION LENDING AGENCY `_t,+srt
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 i '' f_ _:I ' =s �i'q.�`
Lender's Address - --- l
I certify that I have read this application and state that the
above information is correct. I agree to comply with all.County I ►
ordinances and State laws re ulating Plumbing, and hereby
Jqv.e-me
horize represents ives_ �1is County to enter upon the
ntio dIFfrro6r' s urposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date I