HomeMy Public PortalAbout9206 WEDGEWOOD ST_Plumbing__ 76A667 DeB 17 11-50 � APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY i 1
COUNTY OF LOS ANGELES �t Pte., P L U B 1 N G 1
WILLIAM J. FOX, CHIEF ENGINEER YY
FOR APPLICANT TO FILL IN DIBTR _CT GRO P /b� sPERMIT 2•
PLUMBER ESpg�1� MIRACLE RECEIVED BY READY FOR 7DATE ISSUED
WAUER +%J, ` = C�r:�����t®Iltl FIRST INSPECTION
ADDRE89 N S
•l BUILDING L
E ` ADDRESS
CITY ��11 TEL N0. m. a A-COUNTY I
LICENSE NO. r/C/ EXPIRES U^'� j LOCALITY ,. 0.
NEAREST
PERMIT FEES CROSS ST. J
NUMBER TYPE OF FIXTURE OR ITEM FEE DWNER x+11!���+�•a.0 -QJC/�'M'l1
MAIL
WATER CLOSET(TOILET) @ 0.50 $
ADDRESS .✓.j(012V
BATH TUB Q 0.50 CITY.0 TEL No.
SHOWER @ 0.50 I HEREBY ACKNOWLEDA 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
KITCHEN SINK @ 0.50 AND STATE 9 REGULATING PLUMBING. �.za
I CERTI THAT 1 POSSESS THE ABOVE VAWN OS
LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL •NER
OF THEsBE81DENTIAL PROPERTY DEPRIBED A130V
GAS SYSTEM OUTLETS 0.50 SIGNATU E O Ate'
WATER HEATER 0.50 PE lEl_
d
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK 0 0.50
FLOOR DRAIN @ 0.50
DISHWASHER 0.50
DRINKING FOUNTAIN Q 0.50
URINAL @ 0.50 J
Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS
O
7
APPROVALS
DATE INSPECTOR-8 NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK* SEPTIC TANK
DRAIN ( ) PIT ( ) @ 7.00 SEWER
PERMIT .
I 1.00 GAS TEST
y UTILITY CO.NOTIFIED
TOTAL FEEFINAL G�
WORKER'SCOMPENBATIONDECLARATIQN;•' sU r 30002eDPw9/89 APPLICATION FOR PLUMBING PERMIT
I hereby afffrrtPthat I h$ye a certificate of consent to self IrBufe,' 78A887A
or a certificate of Worker's.,Compenealion Insurhnce,or a certified
copy fhereo'f(Sec.3800 Lab.C.)
Policy No. Company ; COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
i
❑ Certified.copy is hereby furnished.❑ BUILDING� FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS S
Certified copy Is filed with the county building inspection
1.
department. I NUMBS FIXTURE OR ITEM ® FEE LOCALITY
Date ApplicantWATER CLOSET
.i NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS,ST.
COMPENSATION INSURANCE BATH TUB
ASSESSOR
(This section need not be completed If the work Involved by the SHOWER MAP BOOK PAGE PARCEL
.permit is for one hundred dollars($100)or less.) LAVATORY OWNER `
I certify that in the performance.of the work for which this permit
is issued, I shall not employ,any person In an manner so as to MAIL
Y SINK ADDRESS pZD �(
become subject to the Workers'Compensation Laws.
C� 'l DISWASHER CITY TEL.
OTl E TO APPLICANT: if, after making.this Certificate.•of
emption,you should become subject to.the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS
pro sions of the Labor Code,you must forthwith comply With such
provisions or this permit shall be.deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY L.NO.
I hereby affirm that I am licensed under provisions of Chapter 9' WATER HEATERS
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO.
LIC. S Q
V
Professions Code,and my license Is In full force and effect.
5OUTLETS OVER PER SYSTEM DISTRICT N P O SED B Q
License Number Lic.Class
FINAL 6/ALIDITII;�N W
DATE "�T.�/, IL
Contractor Date G �r !A
E] I am exempt under Sec. BY AL JS Z
B.&P.C.for this reason ,
Plan check fee
Data. ,
PLUMBING PERMIT ISSUING FEE$
Signature �s-(ed
❑ TOTAL FEE
SINGLE FAMILY Plan check applicant
ACCT.s
HOME OWNER-BUILDER DECLARATION Name ' 7 . �
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Address
Code): i ITEMS
❑ City Tel.No. _
I,as owner of the property,will do the work and the structure TOTAL 143.00
is not Intended or offered for sale(Section 7044, Business
and Professions Code). , CHECK 143.00
CONSTRUCTION LENDING AGENCY �' CHANGE .00
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.) GGGG'GGG 1 7/ 5/911
Lender's Name 1666 1 AM 7151
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