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Home My Public Portal About9842 VAL ST_Plumbing__ 76A557 17 25M SETS 7-48 - APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY' COUNTY OF LOS ANGELES PLUMBING 1 WILLIAM J.:FOX, CHIEF ENGINEER FOR ?A6L IN DISTRICT GROUP I ZONE P 7 . PLUMBER RECEIVED Y READY FOR SDA IS E SUED CO. FIRST INSPECTION /'`- f ADDRESS 1/ U 1313 CITY ADDRESS ' rOUNo ggy� rJ�' 'y,0 LICENSE ICEN E NO. EXPIRES i% LOCALITY { Rxg 7/ I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS NEAREST CRASS 8T. I Fr � � ANGELES COUNTY LICENSE. g� 1e^� 1 OWNER 1a Y � V6s, '4..a��•r— MAIL Ar 11 I PL'wHElr- ADDRESS PERMIT FEE IS $1.00 FOR THE FIRST FIXTURE OR CITY. TEL. No. ITEM LISTED BELOW, PLUS 50o FOR EACH ADDITIONAL I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- ITEM. FOR EACH SEPTIC TANK AND PIT OR GRAINFIELD ERTY DESCRIBED ABOVE. $1.00. MINIMUM FEE FOR ANY.PERMIT $1.00. EACH GAS SYSTEM 15 A SEPARATE ITEM. OWNER NUMBER TYPE OF FIXTURE .OR ITEM WATER CLOSET (TOILET) CORRECTIONS BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK LAUNDRY TUB OR TRAY GAS SYSTEM X OUTLETS v� WATER HEATER SLOP SINKJ _ Q FLOOR SINK _Z FLOOR DRAIN O DISHWASHER 13 �y= DRINKING FOUNTAIN URINAL MISCELLANEOUS APPROVALS DATE INSPEOTOR'9 NAME ROUGH PLUMBING ' GAS PIPING GAB VENT CESSPOOL SEPTIC TANK - DRAIN ( ) PIT. ( ) $ SEPTIC TANK. CESSPOOL $ SEWER HOUSE SEWER $ �, GAS TEST TOTAL FEE R 1�ia1 s�y UTILITY CO.NOTIFIED 1 V 1FINAL O ;WORKERS'COMPENSATION DECLARATION , ` APFLNCA k1 �ON FOR PLUMBING ING PERMIT •1 hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 �j insure, or a certificate of Workers'Compensation Insurance, 76AS67A IL-11 ora certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. pony, ren Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building Inspec- ADDRESS ST tion department. NUMBER FIXTURE OR ITEM FEE LOCALITY ,Applicant Date Applicant - - NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNERf (This section need not be completed it the work involved by SHOWER Fka�� nL the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS I certify that in the performance of the work for which this � permit is issued,'I shall not employ any person in any manner SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR �� Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS , Exemption, you should become subject to the 'Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL.NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER 'LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT PROCESSED BY I hereby affirm-that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license.is in full force and effect. 5PER SYSTEM FINAL VALIDATION DATE. License Number Lic. Class (oj FINAL Contractor Date BY 0 ❑ I am exempt under Sec. LIJ. B.BP.C. for this reason d " t 0i Plan check fee v Date PLUMBING PERMIT ISSUING FEE$ 76 Signature TOTAL FEE PIK Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address Professst ' ns Code): City Tel. No. I, as owner of the property, will do the work and the ructuree is not intended or offered for sale (Section E„.rr•;; 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 (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 representatives of this County to enter upon the above-mentioned property for inspection purposes. ' ' SEE REVERSE FOR EXPLANATORY LANGUAGE _ V SignatureerDo e i 78A687 17 8-4s® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING �� 1 COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I Z NE PERMIT NO. �- -/ 4/ 77; 7 FLADDRESS ®- KEliN BAILER MAG2 ®(SP9 n (R4 RECEIVED BY READY FOR DATE ISSUED t•f'JlAv FIRST INSPECTION /6_y`t EL MOfdTE, CALIF. �C. F010it TEL. NO. BUILDING "] ADDRESS o� LOCALITY �• EXPIRES ; PERMIT FEES NEAREST. 'I 11 / NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER _ L•�i' , '3 V U MAIL WATER CLOSET (TOILET) 0.50 S ADDRESS BATH TUB O.50 CITY TEL. NO. SHOWER ( O.SO 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED• BOVB. GAS SYSTEM OUTLETS C¢1 0.50 SIGNATURE OF �- �� WATER HEATER O.50 PERMITTE SLOP SINK 0.50 INSPECTION RECORD FLOOR SINK 0.50 FLOOR DRAIN (a 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN 0.50 URINAL 0.50 HOUSE SEWER Q 0.50 Z MISCELLANEOUS (� 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL 7.00 "�� CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) Q 1.001 1 SEWER PERMIT1.00 GAS TEST TOTAL FEE S 21 ef o UTILITY CO. NOTIFIED 4 aa FINAL