HomeMy Public PortalAbout10922 WILDFLOWER RD_Plumbing__ 71IM07-CE817 10-60
APPLICATION FOR PLUMBING' -PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FAD
JOHN A. LAMBIE, COUNTY ENGINEER I� �.�'
WILLIAM A. JENSEN, SUPT OF BUILDING
r 'M
FOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM
WATER CLOSET L,BATE TUB TEL.NO.SHOWER
OR ,
LAVATORY
ADDRESS
SINS (�� j• .' �/
DISHWASHER .�� CITY
`TIg TYRE� ONLAUNDRY TUB REGISTRATION COUNTY
CLOTHES WASHES DISTRICT NoGRO ZO E P O ED BY
WATER HEATER /•. 5 �`��, �
GAS SYSTEM J G INDUSTRIAL
WASTE MBOVAL �.
INSPECTION RECORD a
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n:
O
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z
$1.00 PER ITEM
OR FIXTURE $ APPROVALS DATE INSPECTORS SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE p ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
LS
COUNTY ORDINANCES AND STATE. LAWS REGULATING
. HOT WATER HEATER
Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES '
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
A OR T T. AM THE LEGAL OWNER OF THE ABOVE REBID L PEUTILITY CO.NOTIFIED
REMI ✓ / FINAL "
AUDATION ROBERT A. WOOD -
cK. M.o: CASH SUPERVISING MECHANICAL ENG'R.
AD 7 0 �8 GGT 25 5 a 8.00^ R
` 87 APPLICATION FO R PLUMBING P E R IVI I T
817
CE 817 _SB
BUILDING AND SAFETY DIVISION
Department of County Engineer
County of Los Angeles BUILDING
JOHN A.LAMBIE,COUNTY ENGINEER ADDRES Q
CASSATT P.GRIFFIN.SuP'T of BUILOINca
LOCALITY041
FOR APPLI TO FILI. IN NEAREST
CROSS ST.
OWNER DISTRICT.NO. GROUP I ZONEI READY FOR INSPECTION
E MAIL for
'r• ADDRESS
INDUSTRIAL ..
CITY TEL.NO. WASTE APPROVAL
'MlPLUMBER
.® ttmbS.ng Co. INSPECTION RECORD
442 W. 71-eetwood P1.
i ADDRESS
®n ora Ed 5--12
CITY TEL,NO.
LICENSE NO:
NUMBER TYPE OF FIXTURE.OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $.
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ .$1.00
KITCHEN SINK @ $1.00
DISHWASHER @ .$1.00
t- LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS'
s
DATE INSPECTORS SIGNATURE
i, UNDER WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING Z-17 I
TOTAL FEE
GAS V.ENT
IS `J{
I 'HEREBY ACKNOWLEDGE THAT I HAVE READ THIS HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR' GAS TEST --Zoo Yf,
LICENSED :AS REQUIRED BY LOS ANGELES COUNTY .AND STATE OF .
CALIFORNIA OR THAT I M THE LEGAL OWNER OF THE ABOVE `.UTILITY CO..NOTIFIED
DESCRIBED RESIDENT IA ROPER
.
SIGNATURE
OF PERMITTE F NAL vtM vv�sy
ROBERT A.WOOD,
JOHN A.LAMBIE.COUNTY ENGINEER 'VALIDATION' SUPERVISING MECHANICAL ENG-R.
CK M.O. CASH
�,+ 3 5 .1 36-, OCT 18 3
10 0 0 0
WORKERS'COMPENSATION DECLARATION APPLICATION
ICATION FOR PL 1AABMG PERMIT
I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW
�� 6'!PT r 6 deme 1r r u,Y,LoldAr PERMIT
sure,or a certificate of Workers'Compensation Insurance,ora
certified copy thereof(Sec. 3800, Lab. C.) - ..� '
COUNTY OF LOS ANGELES i �.> DEPf. OF PUBLIC WORKS
Policy No.-Company
i
El
Certified copy is hereby furnished. ,
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
F1 Certified copy is filed with the county building inspection ADDRESS
department. rUMBER FIXTURE OR ITEM @ FEE LOCALITY /� ✓
Ddte Applicant WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' !
BATH TUB 'CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER go
� S ` O
(This section need not be completed if the work involved by MAIL 7p
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS /Af /.rte''. Rd
I certify that in the performance of the work for which this per- SINK CITY TEL. NO. /
mit is issued, I shall not employ any person in any manner so _ t�s 7
as to become subject to the Workers'Compensation Laws. DISHWASHER G n
CONTRACTOR J
® J tp
Date Applicant CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY L.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DLGIRI SIO. PR Y
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS C(J{
9(commencing with Section 7000)of Division 3 of the Business I OUTLETS OVER.
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fect. HOSE BIB- DATE
IL
License Number Lic. Class. ,•'
Wl� IL
2. /S- .S FINAL 0
Contractor Date BY, �J V
OC
I am exempt under Sec. V
B.BP.C. for this reason C
Plan check fee // j _`'"`'' a
Date: ) Z(0 ® ala =%,i:s Z
PLUMBING PERMIT ISSUING FEE$
T I
Signature TOTAL FEE l(O
SINGLE FAMILY TOTAL,i.A�ALLM „ Z:--,"5
HOME OWNER-BUILDER DECLARATION Plan check applicant
F��;r
I hereby affirm that I am exempt from the Contractor's License Name `HE'C*
Law for the following reason (Section 7031.5, Business and 'C*HAWGE olJlj
Professions Code): Address
I, as owner of the property, will do the work and the by Tel. No.
structure is not intended or offered for sale(Section 7044, i)I jajj—fit#; �!/4`i_
Business and Professions Code). .-
5227 A !
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
(Sec. 3097, Civ. C.).
Lender's Name
Lender's•Address
I certify that I have read this application and state that'the
above information is correct. I agmarto comply with all County
ordinances and State lawWfiplu ng, and hereby
authorize re resentativesenter upon the
above-ment ned p�rposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permit e Date