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HomeMy Public PortalAbout10919 WILDFLOWER RD_Plumbing__ 7BS CE eIAPPLICATION FOR PL:UMB.ING PERMITT 1 Me-SB BUILDING AND SAFETY DMSION _ Deportment of County Engineer County of Los Angeles BUILDING JOHN A.LAMBIE,COUNTY ENGINEER ADDRESS CASSATT D.GRIFFIN,SUPT of BUILDING LOCALITY �'- ` FOR APP LICAN TO FILL IN NEAREST CROSS ST. OWNER DISTRICT NO. , IGROUP� ZONE READY FCR iNsaECTIOI. MAIL -All ADDRESS /7U CITY TEL.NO. INDUSTRIALWASTE APPROVAL PLUMBER valley Plumbing 00. INSPECTION RECORD 442 y y ADDRESS W. Fleetwood P]. en ora Ed 5-129 CITY TEL.NO. P LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ SI.00 $ S BATH TUB @ $1.00 SHOWER @ $1.00 .1 LAVATORY (WASH BASIN) @ 51.00 KITCHEN SINK @ S1.00 DISHWASHER @ 51.00 LAUNDRY TUB OR TRAY @ 51.00 CLOTHES WASHER @ $1.00 WATER HEATER @ SI.00 GAS SYSTEM @ 51.00 r APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK •� '•' " ROUGH PLUMBING /;'•y+�i.•, •ri�l. ..��.+,n �� • PERMIT S I 1 00 '; .. GAS PIPING /v� Art 461 TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AHD AGREE TO COMPLY HOT W&TER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING, g / ) HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TESTLICENSED ANGELES COUNTY AND OF CALIF RNIASOR THATDIBY LOSGALE AL OWNER OF THEATE ABOVE UTILITY CO.NOTIFIED f- • ~fl� DESCRIBED RESIDENTIA OPER . SIGNATURE g a OF PERMITTE FINAL ROBERT A.WOOD. JOHN A.LAMBIE.COUNTY ENGINEER `VALIDATION SUPERVISING MECHANICAL ENG'R CK N.C. CASH `., 3 5 :1 4N ®CT 18 3 1. 0.0 0 R WORKERS'COMPENSATION DECiARATION APPLOCATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 176A667A insure, or a certificate of Workers'Compensation Insurance, f CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800; Lab. C.) I COUNTY OF'LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING } © FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 0 9 / 9 LU I L Q F L O w t 2 Certified copy is filed with the county building inspec- tion department. //.. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Date ��ZS -g3 AppligantJc-��11 L6--K Chi• 0V4_ WATER CLOSET Z 110 _ NEAREST &M LC CERTIFICATE OF EXEMPTION FROM WORKERS' d BATH TUB CROSS ST. L. A�1f r COMPENSATION INSURANCE ( SHOWER ,� OWNER A E Lo b C_^(This section need not be completed if the work involved by the permit Is for one hundred dollars(;100)or less.) MAIL ADDRESS f 2 Avc I certify that in the performance'of the work for which this permit is issued, I shall not employ any person in any manner Z., SINK CITY A �J � 0 t TEL. NO. (i.7„s S so as to become subject,to the Workers'Compensation Laws. �_. DISHWASHER ,` - CONTRACTOR u C D$ 0 Q Date Applicant CLOTHES WASHER ADDRESS ^ NOTICE TO APPLICANT: If, after•making this Certificate of Z L S. FOU o �� Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY ;� 6 A TEL.N LAWN SPRINKLER SYSTEM 04g7'535-0 •�.--, with comply with such provisions or this permit shall be STATE LIC. h deemed revoked. WATER.HEATER LICENSE NO. CLASS /'t LICENSED CONTRACTORS.DECLARATION DIST NO. ROCESSED 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. 5 PER SYSTEM FINAL VALIDATION 3 '12 -7P DATE W License Number Lic. Class 16 99 FINAL J O Cnu Z —�Contractor L BY y ❑ rm. I am exempt under Sec. Im. H B.&P.C. for this reason Plan check fee • Date: PLUMBING PERMIT ISSUING FEE$ Signature G Plan check applicant TOTAL FEE 74.3A SINGLE FAMILY 0 0 0 0 0 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License (Address 1 o 0 Z 6 5 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ° 0 0 3 6 5 0 v ❑ 1, as owner of the property, will do the work and the _ 2 5—G 3 structure is not intended or offered for sale (Section 7044, Business and Professions Code). i 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 a (Sec. 3097, Civ. C.). Lender's Name Lender's Address I certify that I have read this application and state that the Ohl 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 4gnva entionedpr rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE P-e of ermittee Date `