HomeMy Public PortalAbout10224 RANDWICK DR_Plumbing__ 78A687-CE#817 5-81• '
APPLICATIO V FOR PLUMBING PERMIT.
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINM
Bto.NII�G�AE CO EIVON nDH �A 2 c� l a�►B
...
WILLIAM A. JENSEN, SUP'T'OF BUILDING
LOCA= ,
FOR APPLICANT TO EM.nq NEAREST '
CROSS ST,
NUMBER FIXTURE OR ITEM
WATER CLOSET r
MAb
HATH TUB ADDRESS
CPPV TEL.NO.
SHOWER
coNrRAcroa Malley Plumbing Co.
LAVATORY'
Snm
ADDREsa W. Fleetwood P1.
DISHWASHER crrxCONTRACTOR®D ®sm =NO. Ed 51.29
LAUNDRY TUH 8 ISTBATmN�No E STATE
7 COU TY
CLOTHES WASH88DI�ST�RICT NO, GROUP ZONE CESSED BY
WATER HEATER
GAS SYSTEM MUSTS= V
WASTE APPROVAL
mmCTINI RECORD / .,/ IN
22
H
z
O 8I7LTUSE $ I /• ®, V AP,PR ALS' DATE INBPECTOR'S'SIGNATUR6
PERMIT ` $ 2190 UNDER SLAB WORK.
ROUGH PLUMBING.
TOTAL FEE" � �® pp r, r /t F :_; , "I'vo
GAS PIPING �h til i
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION t
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER Y/
PLUMBING. _
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXT-.URES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE-OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. UTILITY.C.O.-NOTIFIED
SIGNATURE
OF PERMITTE
FINAL
VALIDATION ROBERT-A.WOOD
Me 0. CASH SUPERVISING MECkANICAL ENG'R
ihl;a 7 .8 2 8% DEC 4 5 D °1 5.3 0~ Ic
wORKER'SCOMPENSATION DECLARATION 7�g p�PW 8188 APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.8800 Lab.C.) I -
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company
❑ Certified copy is hereby furnished. BUILDING
El Certified
APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS p°�.4
Certified copy is filed with the county building inspection
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date Applicant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
COMPENSATION INSURANCE BATH TUB ASSESSOR
(This section need not be completed If the work Involved by the ISHOWER MAP BOOK l/o'Q PAGE PARCEL
permit Is for one hundred dollars($100)or less.) OWNER
LAVATORY
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any man r so as to SINK ADDRESS lL
become subject to the Workers'Compensate Laws. ��'�
DISWASHER CITY �> CL TEL.NO
Date L' Applicant
CLOTHES WASHER CONTRACTOR
NOTICE fOAPPLICANT: If, after m9king this Certificate of �� v � CCs- sem
Exemption,you should become subject to he Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code,you must forthwith comply with such ADDRESS
provisions or this permit shall:be deemed revoked.. LAWN-SPRINKLER SYSTEM C%
LICENSED CONTRACTORS DECLARATION CITYTEL.NO.�� �o d
I her affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(commencing with Section 7000)of Division 8 of the Business and GAS SYSTEM 3 f r OUTLETS_ IL CENSE NO. ����- CLCJ►SS 0
Professions Code,and my license is in full force and effect.
OUTLETS OVER DISTRICT NO.. PROCESSED BY Q
LZ 5 PER SYSTEM Q
License Number Lic.ClassFINAL
_ V
DATE q _ VALIDATION w
Contractor �� Date 1`� 5 co
FINAL ACCT e s ?
' El em exempt under Sec. BY
B.&P.C.for this reason
Plan check fee 3307 39.40
Date. ES
PLUMBING PERMIT ISSUING FEE$ .J� , 1 ITEM
Signature
TOTAL FEE TOTAL .m, �
❑ SINGLE FAMILY Plan check applicant CHECK 39.30
�
HOME OWNER-BUILDER DECLARATION Name jc- ,�> CCHANGE ■00
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7081.5, Business and Professions Address
Code):
E] 1.
Tel.No. &1Cpf 0 0000-0001 1211EI9
I,as owner of the.property,will do the work and the structure
is not Intended or offered for sale(Section 7044, Business , 7141 1 AM s:40
and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the
Performance of the work for which this permit is issued(Sec.8097,
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 ordinances
and State laws regulating Plumbing, and hereby authorize
representative of this County to ter upon the above-mentioned
property for Pee
urpose SEE REVERSE FOR EXPLANATORY LANGUAGE
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