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Home My Public Portal About9855 VAL ST_Plumbing__ _ F 76A667-CE#817 4-67 APPLICATION FOR PL MBING /PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIN JOHN A. LAMBIE. COUNTY ENGINEER ADDRES COLEMAN W. JENKINS. SuP'T. of BUILDING LOCAL � lwz FOR APPLICANT TO FILL IN NEAREST CROSS NUMBER FIXTURE OR ITEM EACH FEE OW B WATER CLOSET $1.25 MAn BATH TUB 1.25 ADD SHOWER 1.25 CI TEL. NO LAVATORY 1.25 CO CT p SINS 1.25 ADDREZIM Kai DISHWASHER 1.25 CI TEL. N on STALIC LAUNDRY TUB 1.25 LCE ESE NOCLASS �C � CLOTHES WASHER 1.25O D' T ' �, GRO V WATER HEATER 1.50 (^, GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD O� O V O W y Z .I . APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S JC NDER SLAB WORK OUGH PLUMBING TOTAL FEEAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TNI.. APAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREETWITH ALL COUNTY ORDINANCES AND STATE LAWS ROT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGIST ELUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.A RESIDE IN.THE ABOVE DESCRIB ESIDL PRTILITY CO.NOTIFIED SIGNATUREOF PERMITTEEINAL VK. ALIDATION JACK R. ALLEN M.0. CASH SUPERVISING MECHANICAL ENGIR. 76AS67A CE617IREV.6/78) ®s Y_ ;F APPLICATION FOR. PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND.SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE). BUILDING yti j. r, NUMBER FIXTURE OR ITEM ® FEE ADDRESS p v t.% ��. Ile WATER CLOSET LOCALITY1 74 NEAREST BATH TUB CROSS ST. G l dCd GcIT 3;g U L SHOWER OWNER G 7111VA/ )�✓A7 n LAVATORY MAIL ADDRESS #C- I Z SINK CITY I� TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS // 0 9tJ ( 61 .1v QA 1r� SWIMMING POOL RECEPTOR / CITY �a�J!/�� ,11'5 TEL:NO.. /`.2 LAWN SPRINKLER SYSTEM STATE �7 el LIC. ry WATER HEATER LICENSE NO..,J CLASS GAS SYSTEM OUTLETS _ APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES jn GAS.TEST/ Plan check fee UTILITY'CO:NOTIFIED PLUMBING PERMIT ISSUING FEE$ AM e TOTAL FEE' f�J FINAL v Plan check applicant t PLAN CHECK VALIDATION Name M-1-Al 4 AZ —M.4& -liff ' Address 6�/ r,� ,. City r,_R,4v j C& ,1 11C; Tel.No. ?. ,� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ---r 9 1 C 0 P THAT THE ABOVE•IS'CORRECT AND�AGREE To COMPLY WITH ALL COUNTY ORDINANCES " AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION. ' 0 0 0 0 0 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED ASREQUIRED BY LOS r� AT I AM THE LEGAL OWNER OF ANDS INTEND TO RESIDE.NLES COUNTY AND ATE OF-CALIFORNIA o THE ABOVEDES EDHRESID NTIAL L PROPERTY. O'o O SIGNATURE OFPERMITTEE 0225-80 i DISTRICT NO. /PRROCESSED BY. INDUSTRIAL WASTE APPROVAL WORKERS'COMPENSWN DECLARATION 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent'to serf ir;- 76A667A I sure,ora certificate of Workers'Compensation Insurancd.or a '4CE 817(REV.8/86) ILjI certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policypo. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING q /� Certified copy is filed with the county building inspection ADDRESS ( �5S U tel" �.• department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY p(r/ 5 Date Applicant c3 WATER CLOSET(TOILET) NEARESTf'3 I G CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB Q CROSS ST. COMPENSATION INSURANCE ( SHOWER71 OWNER 1� w u (This section need not be completed if the work Involved by U MAIL _ the permit Is for one hundred dollars($100)or less.) LAVATORY 00 ADDRESS � � � �, V Pr(_LIE'4 3 L I certify that in the performance of the work for which this per- SINK p mit is issued, I shall not employ any person in any manner so CITY 5.4.1 lT f�JZ h r3Cr TEL. NO. as to become subject to the Workers'Co 'pensation a S. C DISHWASHER Q ILD�v -n �_� 1 CONTRACTOR � L,A f N (r(1 Date V Applicant CLOTHES WASHER ® ADDRESS O W l C LAO s 7.,„/Z ` NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption,you should become subject to the Workers'Compen- CITY ( f7OJR- TEL. NO. SJ L-&J 3 sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATELIC. ed. WATER HEATER LICENSE NO. 1- CLASS C LICENSED CONTRACTORS DECLARATION i DI RI Nq,/ OCESSE Y I hereby affirm that I am licensed under provisions of Chapter �' GAS SYSTEM /` OUTLETS QUI 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL I VALIDATION � �y (- DATE License Number C Lic. Class v P i� �� "Y( IIA26;0L 6— l> BY AL Contractor. Date O C) I am exempt under'Sec. vvuv- 9L � B.BP.C. for this reason Plan check fee � Date- PLUMBING PERMIT ISSUING FEE$ �d oO Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION PP icant I hereby affirm that I am exempt from the Contractor's License Name _ Law for the following reason (Section 7031.5, Business and uv Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. 3307 140.50 structure is not intended or offered for sale(Section 7044, �� C� Business and Professions Code). � TOTAL 140 o 50 CONSTRUCTION LENDING AGENCY i I hereby affirm that there is a construction lending agency for CHECK 140.510 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). CHANGE .011 Lender's Name G(MO-13001 f 8/913 Lender's Address ,31 1 certify that I have read this application and state that the t$�ft ' 1M 9ems, 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 abov - ntioned prop for inspection purposes. I---�-0(,-) SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date