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Home My Public Portal About10234 RANDWICK DR_Plumbing__ ,76A66]—CE 817468 4 APPLICATION FOR PLUMBI G PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING 2 JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1.50 IL BATH TUB 1.50 ADDRESS \I SHOWER 1.50 CITY TEL. LA VAT ORY 1.50 CONTRACTOR SINK 1.50 ADDRESS DISHWASHER 1.50 CITY TEL. .:j CLOTHES WASHER 1.50 STATE LIC LICENSE NO. �y CLASS SWIMMING POOL RECEPTOR 1.50SEE � DISTRICT NO. GR P ZONE PRO D BY 16 LAWN SPRINKLER SYSTEM 2.00 S O WATER HEATER 1.50 INDUSTRIAL WASTE APPROVAL Z GAS SYSTEM OUTLETS 1.50 �� ,,s INSPECTION RECORD C� 0. OUT5 P LETS SYSTVMR .30 /'�`'1 �y 7S �f zy,r/ b '�- a Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 2 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING' GAS VENT LHE Tel. No. HOT WATER HEATER EBY ACKNOWLBDOE THAT I HAVE READ THIS APPLICATION ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES LL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST G.EBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF NIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO IN.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINALURE JACK R. ALLEN, SUPERVISIN�?'OECANICALENO'R. ERMITTEE PERMIT VALIDATION M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH L.Aro112 8% JUL 2 4 5 D 6.5 1, Vt 76A667-CE#617 5.51• APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGMM DEPARTMENT OF COUNTY ENGRiM BUlI.DING AND SAFETY DIVISION FAMODEESS ` JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDINGFOR APPLICANT TO FILL IN CROSS ST. NUMBER FIXTURE OR ITEM - OWN88 `y WATER CLOSED mm BATS TOB ADDRESS CITY TEL NO. SHOWER CONTEACYm Val Yey P;"umUing CO. LAVATORY ADDRESS -442 W. Fleetwood P1. DR;HWMMM CITY Glendora oy TM NO. Ed 5®1293 NTRACTOTE LAUNDRY TOB REG ONNt a COUNTY CLOTHES WASHER DISTRICT NO. I GROUP I ZONE PR SED BY WATER HEATER e .O GAS SYSTEM INnvsTRrAL 0 WASTE APPROVAL INSPECTION RECORD th OE FDCm I /. � or- s APPROVALS DATE INSPECTOR'SSIGNATURR' PERMIT N 2 00 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING ��f I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 4 Of g LICENSED AS REQUIRED BY LOS,ANGELES COUNTY AND STATE OF GAS TEST y 'CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTE FINAL VALIDATION ROBERT A.WOOD t M.0. CASH SUPERVISING MECHANICAL ENG'R LAGO 7 8 1 3 Qt DEC 4 5 0 "1 6.5 5N a r '*WWKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT t hereby affirm that I have a ceUlficate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING F-1Certified 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 IF Or- Date Appligant WATER CLOSET NEAREST ` CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER t (This soetion need not bo complot f the work Involved by SHOWER the permit Is for one hundred a ($100)or less.) LAVATORY MAIL ADDRES I certify that in the performs e o the w rk for whit permit is issued, I shall not a plo any p son in any an r SINK CITY TEL. NO. ~ so as to become subject to a kers' ompensati6nLdws. DISHWASHER CONTRACTOR Dat I' t CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: I , after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL.NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P ESSE $Y I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS t (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER y. and Professions Code,and my license is in full force and effect. 5 PER JYSTEM FINAL _ VALI TION t DATE ` O License Number Lic. Class k) FINAL 0 Contractor. Date BY 2 2 3,0 A � ❑ I am exempt under Sec. # 0 0 0 0 0 5 IL B.&P.C. for this reason Plan check fee 1 - 2250 Date: PLUMBING PERMIT ISSUING FEE$ Signature 000225050 TOTAL FEE o b 0610-85 SINGLE FAMILY Plan check applicant 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 P,r essions Code): City Tel. No. 1 I, as owner of the property, will do the work and the 1 structure is not intended or offered for sale (Section 7044, Business 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 v (Sec. 3097,Civ. C.). Lender's Name y Lender's Address 1 cer .y that I have read this application and state that the abo information is correct. I agree to comply with all County or once s and State la gulating Plumbing, and hereby a orize presentati s this County to enter upon the ve-m ritione r ert for inspection urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o ermittee Date (/