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Home My Public Portal About9076 RANCHO REAL RD_Plumbing_1974-09-25 76A667 (CE-817)- 6/73 APPLICATION F R PLUMBING PERMIT COUNTY OF LOS ANGELES IJ DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING / rj �� ,9L • ADDRESS �o G AA HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY ,p,G4C FOR APPLICANT TO FILL IN (PRINT OR TYPE) CROSS NEARESTT. e NUMBER FIXTURE OR ITEM @ FEE- . �Q A WATER CLOSET 1.75 OWNER 1611 y All l MAIL `D BATH TUB T.75 ADDRESS ® �� '�/� SHOWER 1.75 CITY NO. LAVATORY 1,75 CONTRACTOR ��L� SINK 1.75 ADDRESS DISHWASHER 1.75 CITY &T7-/TEL. N04V,�-,-le;D CLOTHES WASHER 1.75 STATE /J�/�f/,� LIC LICENSE NO. OC /G J CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT NO.. JQ1JP NE FRC)CESSEP BY LAWN SPRINKLER SYSTEM 1.75 0 WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.75INSPECTION RECORD v OUTLETS OVER .30 0 5 PER SYSTEM H v c�. Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE 7� APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Nagle ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER � AND STATE THAT THEABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND./OR UTILITY CO. NOTIFIED LICEN SEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER PF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RES[DENTIA�o ROPER TY.Al FINAL -SIGNATURE. Zir 9&OV - OF PERMITTEE 4ERMALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASHSEN �.,. 4.7 5-e�z : r �,� WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT rr°' {yhernbyy,,affirm that I have a certificate of consent to self 7gAB87A "insure, dr d.certificote of Workers'Compensation Insurance, CE 817(REV.8/86) or a 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 Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUBell Q CROSS ST. ,5 e vn aim COMPENSATION INSURANCE OWNER d (This section need not be completed If the work involved by SHOWER the permit is for one hundred dollars($100)or less.) LAVATORY MAIL nom' ADDRESS b W I certify that in the performance of the work for which this permit is issued, I shall not emplin any manner SINK CITY ,,e 1 TEL.NO �.. 21.� so as to become subject to the a satin ws. DISHWASHER ✓ C CONTRACTOR Dote J Applicant= CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL.NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NQ, PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ,fir, (�J/ (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER — and Professions Code,and my license is in full force and effect. 5 PER SYSTEMIt FINAL ¢ VALIDATION' License Number Lic. Class DATEv FIN Q Contractor Date B °Vi ;26 9 ❑ I am exempt under Sec. 9J # 0 0 0 916 B.BP.C. for this reason o 0 5 0 Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Ito - 0 5 5 0 H_ Signature ' TOTAL FEE o 5,O 4-8 7 Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and 6 9�� A Professions Code): City Tel. No. I, as owner of the property, will do the work and the # 0 0 0 0 0 5 structure is not Intended or offered for sale (Section ® ( 0 o 2 a 5 O 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY o 0 0 2 a 5 O 0 1hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issuedo504 -87 (Sec. 3097, Civ. 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 rdinances and State laws regulating Plumbing, and hereby uthorize representatives of this County to enter upon the bove- ntioned)p5erty for inspection purposes. �i SEE REVERSE FOR EXPLANATORY LANGUAGE �' 77 Signature o ermittee Date I AA p' C pw WORKERS'COMPENSATION DECLARATION APPLICATION' FOR PLUMBING PERMIT I helaffirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76A667A or'a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING // 'r� �► ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE:OR ITEM @ FEE LOCALITY ' Date Appl igont WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BAT}t TUB CROSS ST. , COMPENSATION INSURANCE OWNER (This section need not be completed if the work Involved by MAIL SHOWER -tp the permit is for one hundred dollars($100)or loss.) LAVATORY ADDRESS C1 6 b ,n Y�"L I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any manner SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHERn CONTRACTOR Date Applicant — CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS L�-Z� / V (N UCS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY Gam, TEL. NO. '33'7..3,' with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. I CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 1 GAS SYSTEM r OUTLETS O (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Codec,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION O License Number S3 � Lic. Class 3 L DATE 11/ T Q FINAL Contractor �" Date ( ( BY c` - ❑ I am exempt under Sec. W B.&P.C, for this reason Plan check fee Cn Date: PLUMBING PERMIT ISSUING FEE$ O Signature TOTAL FEE Plan check applicant -i SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License 3307 Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the TO";-AL 26 a 1D structure is not intended or offered for sale (Section 7044, Business and Professions Code). :i LL.� CONSTRUCTION LENDING AGENCY dip i hereby affirm that there is a construction lending agency for CHAll 4iGiE o z the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name � �-i; t • I i��is n-,-, .4 d 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 Poo ordinances 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 Signature of Permittee Date