HomeMy Public PortalAbout9565 WEDGEWOOD ST_Plumbing__ APPLICATION FOR PERMIT
76A667 088 17 7-51 '
'-DEPARTMENT OF BUILDING AND SAFETY PLUMBING -:�=�, .•
COUNTY OF LOS ANGELES
WILLIAM d. FOX, CHIEF ENGINEER
FO PLICAdQT TO FI LsL I � DISTRICT� GROUP I ZONE *g -7-2�.
PLUMBER READY FOR D
o
RED IVSD BY DATE ISSUED
FIRST INSPECTION
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OITY �� e _ JIILDING �/�„
�„•• TSL:No. - �S„ �� DDRESS l�A ,
COUNTY LOCALITY
NSE NO. EXPIRES
PERMIT FEES OBB a.
/rJ -Ci,S �
NUMBER TYPE OF FIMURE OR ITEM FEE OWNER �r�Y_�1.•.-s
MAIL
WATER CLOSET(TOILET) @ 0.50 111 ADDRESS
BATH TUB Q 13.913 CITY TEL No.
SHOWER ! 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ.THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
AND AGREETO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE' ABOVE VALID LOS
LAUNDRY TUB 05 TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNS
OF THE RESIDENTIAL PROPERTYPDESBRISED�AB VE.
GAS SYBTEM UTLETS ! 0.50
SIGNATURE OF� ��s
WATER HEATER 0.50 PERMITTE
SLOP BINK ® 0.50 INSPECTION RECORD
FLOOR SINK 0.50
FLOOR DRAIN 0.50
DISHWASHER @ O.tiso
DRINKING FOUNTAIN 0.50
URINAL 0.50 J
Q
HOUSE SEWER 0.80 Z
MISCELLANEOUS Q
!Y
O
APPROVALS
DATE INSPE12TCRO9. NAME
r�
ROUGH PLUMBING
a
GAS PIPING /
GAB VENT
CESSPOOL Q 1.00 CESSPOOL
SEPTIC TANKS SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 SEWER
PERMIT 1.00 GAS TEST S
• UTILITY CO.NOTIFIED
TOTAL FEE �®
FINAL 10 _aI, �'�►.
k
WORKERS'COMPENSATION DECLARATION A
I hereby affirm thatI have acertificate of consent to self C9817(2-801
981r(z-so) �P P L 0 C A T@®N FOR PLUMBING PERMIT
.,insure,or a certificate of Workers'Compensation Insurance,or
aiierta.P&d copy thereof(Sec.3800,Lab.C.) 'fl
dglbio p 94 03 57com any Aetna Insurance COUNTY OF LOS ANGELES BUILDING AND SAFETY
Poli o
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS 9565 Wed (✓wood
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ® FEE
department. - WATER CLOSET LOCALITY Tem 'le Clt
Date 7.11-04 �pplicant (lrsTon Bros P1 rtmh�ng NEAREST /Qf
BATH TUB CROSS ST. .Q/,- L
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
LAVATORY MAIL -
(This section need not be completed if the work involved ADDRESS
V
I certify that in the performance of the work for which this DISHWASHER M
CONTRALTO
permit is issued, I shall not employ any person in any manner Q
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER H
Date Applicant ADDRESS 4265 N. Baldwin Ave. w
SWIMMING POOL RECEPTOR CL
NOTICE TO APPLICANT: If, after making this Certificate of CITY E1 Monte TEL.N 3-007$ to
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code, you must forth- LICENSE Nd 31 741 CLASS C36-20
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS ,B� 0 t:) DISTRICT NO. ROC SSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER _ Q
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL ff1�
ness and Professions Code,and my license is in full VALIDATION force and DATE ����/ Gr
effect. C36-20 FINAL
-
License Number231 741 Lic.Clas �XM BY
Contractakagn Bros-Pl bg pate 7 f 1 Q/gn
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 0
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
ness and Professions Code): i
I, as owner of the property, am exclusively contracting 1 2 k P
with licensed contractors to construct the project
(Section 7044,Business and Professions Code).
0 0 0 0 0
CONSTRUCTION LENDING AGENCY o 0 1 ^()
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is -
O O O 1
issued(Sec.3097,Civ.C.).
Lender's Name 07. 1 G -80
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
aut e r esentatives of this County to enter upon the
f abo e- en 'on property f inspection purposes.
SignDtQe of Permittee Date