HomeMy Public PortalAbout9552 WEDGEWOOD ST_Plumbing__ 78A887-CE#817 10-82
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APPLICATION FOR PLUMBING PERMIT
t COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FNEAREST
NG
BUILDING AND SAFETY DIVISION S
4 JOHN A. LAMBIE. COUNTY ENGINEER
11 WILLIAM A.JENSEN,SUPT OF BUILDING TY
FOR APPLICANT TO FILL IN S . f
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 0 CONTRACTOR
SINK 1.25 ADDRESS 1417
DISHWASHER 1.25 -- CITY TEL. NO
LAUNDRY TUB 1,25 CONTRACTOR'S STATE ;9
REGISTRATION NO. d COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PR CESSED BY
WATER HEATER 1.50 Q / +
GAS SYSTEM_,,,-- OUTLETS� 1.50 Q INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD
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APPROVALS RATE INSPECTOR'1LSIGNA•jURE
UNDER SLAB WORK /'AA�L 4 .';if "e✓jr
PERMIT $ 2 00
2. ROUGH PLUMBING f
TOTAL FEE GAS PIPING II 'I 'rr`✓v-�`
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANWOR PLUMBING FIXTURES - % ✓- �- �
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO GAS TEST f"?��(� a.,.�,a•,��7 ,1,� ,
RESIDE IN.THE ASO SCRIBED RESIDENT L PR E UTILITY CO.NOTIFIED 1',4f v" f
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SIGNATUREAO
OF PERMITTE c 5
FINAL
ALIDATION ROBERT Ar WOOD
cK.
m.0. CASH SUPERVISING MECHANICAL ENG'R
L&9-.9-2 4" JUN 10 5-0 1625-
c
r. W RKERS',COMPENSATION DACLARATION JAPPLICATION FOR PLUMB-ING PERMIT
I hereby a.'r th(*1 have P,certificate of consent to self 20-0026 DPW 6/87
insure, or a h rtificcte of Workers'Compensation Insurance, 76A667A
or a certified,.opy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS
Policy No. Company
Certified copy is hereby furnished. BUILDING
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS
Certified copy is filed with the county building inspec-
AJ
tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date AppliSant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed If the work involved by MAIL
tho permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner , SINK CITY TEL.NO.
so as to become subject to the Worker 'Compensation Laws. DISHWASHER
`�^ CONTRACTOR
Date —J pplicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after ma this Certificate of SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers' CITY TEL.NO.
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER 0 LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DI TRICT NC
6i PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS !(y/�C/(
(commencing with Section 7000)of Division 3 of the BusinessOUTLETS OVER
-and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL l CVALIDATION
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License Number Lic. Class DATE C(;
FINALContractor Date BY C
❑ I am exempt under Sec.
B.&P.C. for this reason
Plan check fee cr
Date: PLUMBING PERMIT ISSUING FEE$ 10150>
Sigpature
TOTAL FEE I 1h .50
SINGLE FAMILY Plan check applicant 5
HOME OWNER-BUILDER DECLARATION Name D04 ACCTAirI hereby affirm that I am exempt from the Contractor's License p5S2 `'�� Gu DD 3307
Law for the followingreason Section 7031.5, Business andAddress
. % 16.50
,pr9kessions Code): City—ref"1941(121ty Tel. 1 ITEM
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section TOTAL 16 o 50
7044, Business and Professions Code).
CHECK 16.50
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for CHANS ,01I
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
Lender's Name
QQQQ-QIID1 9/ 5/19
Lender's Address 5 481 1 AN 80031
1 certify that I have read this application and state that the D
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize repre°sentatives of this County to enter upon the
above-mentioned property for inspection purposes.
r/ SEE REVERSE FOR EXPLANATORY LANGUAGE
-"/),o I -?_r b
nature o P rmittee Date