HomeMy Public PortalAbout9247 SPARKLETT ST_Plumbing__ 7SAEf9 RBn I, 11-M r' APPLICATION FOR PERJ=
DEPARTMENT OFJG AND SAFETY U BIB B
COUNTY LOS ANGELES
WILLIAM J..OF
LOS FOX, OHI[► ENGINEER
/FOR APPLICANT TO FILL IN01INTRICT NO. ZONE PERMIT NU.
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p— alp
PLUMBER` 1 1 p . R�Q��VED �Y READY FDR O
ADO11[Be/ / / �• Ate' /A. / nRBT INSPECTION DATE 1
�i G _ ,Q BUILDING
CITY '�C TEL N 6-j �O ADDRESS 7
COUNTY C V Y 6 .JO J—W LOCALITY
NGR[Si
PERMIT FEES cROBS BT
NUMEER TYR Of FURURE OR REM FEE OWNER
IL
WATER CLOSET(TOILET) @ OBD B ADDRESS
BATH TUB @ [LBO CITY TEL Nc , '7-fr 3
SHOWER @ OBD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ DSO APPLICATION AND STATE THAT THE ABOVE IB CORRECT
ANDAGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK O O SO AND STAT[ LAWS REGULATING PLUMBING
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY @ O SO ANGELS COUNTY LICENSE OR 1 AM THE LEGAL OWNER
OF THE REBIDENTIAL� RTY EBORIBED ABOVE.
GAS SYSTEM OUTLETS @ DSO SIGNATURE are-
Or
FC YYY/1/ r�-•IL,,,�,��o- y�
WATER HEATER @ O SD PERMI
SLOP BINK @ coo INSPECTION RECORD
BOOR BINK @ CSO
►LOOR DRAIN @ C.BO
DISHWASHER @ 050
1 DRINKING FOUNTAIN @ O So
URINAL @ O SO J
NOURE SEWER @ C.SO ZQ_
MIBCEL NUBEO _O
1 �
O
APPROVALS
DATE IN KN MANE
ROUGH PLUMBING
GAB PIPING '
GAB VENT )�
CESSPOOL @ 1 DO CESSPOOL
BEPTIO TANK- SEPTIC TANK
DRAI ( ) PIT ( ) 0-100 SEWER
PERMIT 100 OAS ' OT
UTILITY CO NOTIFIED
TOTAL FEE B Amo
w S�'
v�RIC�RS'COMPENSATIO[J DECLARATION APPLICATION FOR PLUMBING PERMIT
_ ( frbY o nm that I have a certBicats of convent to veli 7848874 ✓1 I
msur♦<)o o cer1111cate of Workeri Comperxatlon Insurance CE 817(REV 8/Be) ILJI
sS(a certified copy thereof(Sec 3B�O0,,�(Lob�LC ) I
Pollcy No JQDX ,r ComponyZ-iil,C F0I16 COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
®, Certified copy is hereby furnished
FOR APPLICANT TO Fltl IN(PRINT OR TYPE) BUILDING [l .7
Certified copy a filed with un bu I Ing ADDRESS �1 A
hon deportment NUMBER FIXTURE OR ITEM ® FEE
LocnLm G
WATER CLOSET
Dote – Q Applitont NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS
COMPENSATION INSURANCE OWNER(This section need not be complMd H WInvolved
ethe stork by SHOWER
the permit Is for one hundred dollen ($100)or less ) LAVATORY AIIL
I certify that in the performance of the work for which this f�
permit Is issued, I shall not employ any pawn In any manner SINK CITY TEL NOo2 p^�
w as to become subject to the Workers'Compensation Laws !_ ,
DISHWASHER CONTRACTOR SSV- C.$VS
Dote Applicant CLOTHES WASHER �7 y/
NOTICE TO APPLICANT If after making this Certificate of ADDRESS i INs DJ
L_
you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL HD
IAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATELIC
deemed revoked �.� WATER HEATER LICENSE NO D CLASS JS
LICENSED CONTRACTORS DECLARATION DiSTM NO BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS / 01$O O r
(commencing with Season 7000) of Division 3 of the Business OUTLETS OVER (/ ���fff
and Professions Cade,and my license is In full force an effect S PER SYSTEM FINAL VALIDATION O
�j/y��'�QQ DATE U
License Number-00CLCIC7L Lic Class C
FI
Contractor •s�l j���,/vl/ Dote
BY
❑ I am exempt under Sec
B 8P C for this reason plan check fee his, z
Signature Date
PLUMBING PERMIT ISSUING FEE f
TOTAL FEE
SINGLE FAMILY
Plan check applicant
i
HOME OWNER-BUILDER DECLARATION Nome I is —t S
I hereby offum that I am exempt from the Contractor's License
Law for the following reason (Section 7031 3, Business and Address j l -2
Professions Code) City VlArl Tel No 77707 •
4.Td3
❑ 1, as owner of the property, will do the work and the 1 ITEMS
structure is not intended or offered for sale (Season 11110 TOTAL 4 10
7044 Business and Profusions Code)
CONSTRUCTION LENDING AGENCY CHECK 34.50
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permit is issued MANGE •�
(Sec 3097 Ctv C )
Lender's Name
Lender's Address 2421 1 AM 7:&','
1 certify that I have read this application and state that the ►
a ormatwn n correct I agree t amply with all County
or nanc and State lawn regulot lumbing, and hereby
a horize repraw � Thi unry to enter upon the
ab v -m retia rtyyr' ction purposes
SEE REVERS! FOR EXPLANATORY LANGUAGE
Signature of ermittae Dote