HomeMy Public PortalAbout10634 SPARKLETT ST_Plumbing__ COUNTY OF LOB ANGELES APPLICATION FOR PERMIT
Department F of County EngineerFPLUMBING
DIVISION OF FOX, DING & SAFETY
WILLIAM J FOX, CaonO, EEpinex
FOR APPLICANT TO FILL IN / 4_ 7"2g4--
PLUMBER VALLEY BOULEVARD RE IVSD SY READY FOR DATE ISSUED
ADDRESS 8300 EAST VALLEY FIRST INSPECTION 2—30_c.13
DIT, ROS�E^MEAD TEL No wnoREee
COUNTYL,ICNSE NOPI LOCALITY
NEAREST PPP
PERMIT FEES CROSS ST
NUMBER TYPE of FI% =OR ITW FEE OWNER C _
MAIL
WATER CLOSET(T01LWO a 050 B O ADDRESS
BATH TUB 0 Oso CITY TEL No
SHOWER O M50 1 HERESY AOKNOWLCOGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) a 050 APPLICATION AND STATE THAT THE ABOVE 13 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK d 030 S�O AND (TATE LAWS REGUI-ATING PLUMBING
TT I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY @ 050 V ANGELES COUNTY LICENSE, OR I AM THE L GAL OWNER
OF THE RKQIDKNrIAJ, PROPERTY DEBGRIBL ABOVE
GAH BY3T[ UTLCTS 9 MISS zGO SIGNATURE OF
WATER HEATER m MSG B d PERMITTC
SLOP BINK @ 030 INSPECTION RECORIV
FLOOR BINK a GOD
FLOOR DRAIN d 050
DISHWASHER 0 0313
DRINKING FOUNTAIN D SO
URINAL 050 Q
HOUSE SEWER Y 030 Z
MISCELLANEOUS
APPROVALS
DATE INBPEOTOR B SAM
ROUGH PLUMBING
OAS PIPING I
BAB VENT WL
CESSPOOL ® Ina CESSPOOL
SEPTIO TANK SEPTIC TANK
DRAIN ( ) PIT ( ) 1 Doi I BEWER
PERMIT 100 GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE B
FIN
70A66T DBS#17 0-32
WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT - -
1 hereby affirm that I have a certificate of consent to self 74Abe7A
insure or a certificate of Workers Compensation Insurance, CE 617(REV I0i61)
«a certified copy thereof(Sec 3600 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company
Pol
Certified copy Is hereby fumnhed BUILDING
FOR APPLICANT TO FILL IN(PRIM OR TYPE)
Certified copy is filed with the c ry bml mg irlspac- ADDRESS
tion department 1116MBER FIXTURE OR lrEM ® FEE
Date ' `36!y�pllSant WATER CLOSET LOCALITY
NEAREST
CERTIFICATE OF EXEMPT16N FROM WORKERS BATH TUB CROSS ST
COMPENSATION INSURANCE SHOWER OWNER CjBa�
(This section need not be completed If the work Involved by
the permit Is for one hundred dollars($100)or less ) LAVATORY MAIL yet
I certify that in the performance of the work for which the
permit is Issued, I shall not employ any person in any manner SINK CITY `� TEL NO/f -/Lx/ 0
so as to become subject to the Workers Compensation Lows
DISHWASHER CONTRACTOR
Date ane CLOTHES WASHER
NOTICE TO APPLICANTT If If cher making this of SWIMMING POOL RECEPTOR
Exemption you should become subject to the
the W Worrkers e'6144,(4
Compensation provisions of the Lab«Code, you must forth- LAWN SPRIW(LER SYSTEM Ays
CX_ TEL
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO L) OASS
LICENSED CONTRACTORS DECLARATION DISTRICT NP, BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 701 of Divnion 3 of the Business
OUTLETS OVER 'L d
and Professions Code and my licence is In lull force and effect 5 PER SYSTEM ' DAN E / VALIDATI t0.!
License Number OL¢ Clair,
la So
FI 0
Contractor a ' BY U
E] I
in exempt under Sec 14 4.3 A V,
B 8P C for this reason Plan check fee # • • is • • 5 ?
Dote
Signature PLUMBING PERMIT ISSUING FEE$ 1 Z40 WO ( • is 3 0 5 0
TOTAL FEE '3U
• • • 3050
Plan check applicant 0 1.30-85
SINGLE FAMILY
HOME OWNER BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor s License Address
Law for the fallowing reason (Section 7031 5, Business and
Profession Code) City Tel No
❑ 1, as owner of the property will do the work and the
structure is not Intended or offered for sole (Section pool
Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby offnm 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 mformalion is correct I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above m ntion party for action purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
sire 5f Permit Dote