HomeMy Public PortalAbout8622 ROCCUS LN_Plumbing__ 7SA867-C ` 8017 2-62
-� '` APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS T
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST .
CROSS ST. )
NUMBER FIXTUjtE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 olc MALL
J BATH TUB 1,25 t5 ADDRESS
SHOWER 1.25 5 CITY TEL. NO.
LAVATORY 1.252/2
CONTRACTOR
SINS 1,25 5 . ADDRESS
DISHWASHER 1.25 CITY
LAUNDRY TUB. 1.25 EGISTTRRATION NO. �/VCTOR' � COUNTY STATE 0
CLOTHES WASHER 1.25 _4DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER 1.50 6Z `r
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
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APPROVALS DATE INS�CTOWS§IGNATU E
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING 27%4 M&
TOTAL FEE 4;Z6 'GAS -
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ` I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER .7_e► eS
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES Lam" 1
LICENSED A'S REQUIRED LOS ANGELES COUNTY AND STATE OF GAS TEST r
CALIFORNIA OR THAT 1 Alm LEGAL OWNER OF AND INTEND TO
RESIDE IN,THE ABOVE DES IBED RESIDENTIAL PR r Y. UTILITY CO.NOTIFIED G
SIGNATURE l r
OF PERMITTEEa6iFINAL
LIDATION ROBERT A.WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
LjiCo 3 0 2 3� AUG24 . 5 A 1625-
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}. WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate .of consent to self 76A667A
insure, or.o certificate of Workers'.Compensation Insurance, CE 817(REV. 10/81.)
or a certified co there fi( c. 38 Lab. C.) r ` COUNTY OF LOS.ANGELES BUILDING AND SAFETY
Policy No.��Co//mparfp��� �V�S'-1�1
Certified copy is..hereby furnished. i BUILDING /
I ified copy is filed with the county bui inspec- FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS C� ���-� t
'n j
tion de art ent. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Date Appli4ant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER 400
(This section need not be completed if the work Involved by MAIL
the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for'which this I
permit is issued, I shall not employ any person in any manner SINK CITY jb
NO:
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR ���1�• �'
Date Applicant "; CLOTHES WASHER
NOTICE TO APPLICANT- If, after making this Certificate of ADDRESS
Exemption, you should become subject to the Workers' i SWIMMING POOL RECEPTOR ^
Compensation provisions of the.Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY c, (� 4 TEL.NO.
with comply with such provisions or this permit shall be. STATE r� LIC.
deemed revoked. WATER HEATER LICENSE NO. GLASS
'LICENSED CONTRACTORS DECLARATION DISTRICT IVO. CESSED_Y
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS.
t(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER AL
AL
and Professions Code,anolicense is in full for and effect. 5 PE FINAL
/YS7 M , VALIDATION 0
License Nu
7Lic. Class � 7 �
er '
& ���' to '7"- �� FINAL O
BY
Contractor
❑ IL
LU
I am exempt under Sec. to
BAP.C. for this reason ►
Plan check fee
- Date: PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name �, y f Q t"
I:hereby affirm that.I am exempt from the.Contractor's License ; Address
0 0 J
-Law far the following reason (Section 7031.5, Business and
Professions Code): t c o Q
❑ I,as-owner of the property, will do the work and the i City Tel. No. 3 0 4 0 c
structure is not intended or offered for sale (Section
7044, Business and Professions Code). r
b
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. 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
ordinances and State laws regulating Plumbing, and hereby
' authorize rep sentativ ' of 's C my to enter upon the
e t' n d r y'f i s c on purposes. {{
SEE REVERSE FOR EXPLANATORY LANGUAGE
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Signature of Permittee . Date