HomeMy Public PortalAbout9073 WOOLLEY ST_Plumbing__ OBS-175.99 APPLICATION FOR 'PLUMBING PERMIT
OBS-173-53 7
D kISION OF BUILDING AND SAFETY
'° Depozimeat of County Engineer
County of Los Angeles
WM.J. FOX.COUNTY ENGINEERBUILDING
_
CASSATT D.GRIFFIN,SUPADDRESS OF BUILDING -
mm LOCAL
FOR APPLICANT TO FILL IN NEAREST /
�,,,, CROSS ST.
OWNER� 7Si.l�rL�
'�` DISTRICTMAIL NO. GROUP I ZONE READY FOR INSPECTION
ADDRESS b .�✓
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INDUSTRIAL
CITY C::;�- TEL.NO/ WASTE APPROVAL
PLUMBER INSPECTION RECORD
-ADDRESS
CITY (�� TEL 'NO �O �l0 9�1� I A ►I�QA
'LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET)
BATHTUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK �y n
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO. 0.130 .APPROVALS
DATE INSPECTOR'S SIGNATURE
GAS SYSTEM OUTLETS @ 1.00'
WATER HEATER ® 1.00 UNDER SLAB WORK (�
ROUGH PLUMBING. $ $S �. Q P la. e...._
PERMIT S 1 00
GAS PIPING.
TOTAL'FEE GAS VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING. + l+ Z4 ,+
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST _ t"
LICENSED AS REQUIRED. BY LOS ANGELES COUNTY AND -STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL ROPERTY.
SIGNATURE
OF PERMITTEE ��'�� � FINAL. 10014","tA-,
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD.,CHIEF PLBG.INSPECTOR
.&0, s 71s MV25 3 3.60 Q
WORKERS'COMPENSATION"DECLARATION • , ,' 76ps67A t
I hereby affirm that I have a' certificgUe of.donspt tQ. self - Ca: e»,(z-ao);1 P L 1(A T I®N FOR PLUMBING PERMIT
insure,or a certificate of Workers'ComHensation4nsuran.9 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. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDIN
Certified copy is filed with the county building inspection NUMBER FIXTURI3 OR ITEM • FEE ADDRE
department. WATER CLOSET C40LOCALIT
Date Applicant NEAREST
0-1129. v
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB U CROSS STl
COMPENSATION INSURANCE SHOWER OWNER
i
(This section need not be completed if the work involved LAVATORY � MAIL ADDRESS Q /.� d }
by the permit is for one hundred dollars ($100) or less.)
SINK CITY Q G� TEL.N . _ 7 SA 0
I certify that in the performance of the work for which this DISHWASHERV
permit is issued, I shall not employ any person in any manner CONTRACT R
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER0
ADDRESS O
Date Applicant SWIMMING POOL RECEPTOR 0
NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. W
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM- OUTLETS V DISTRICT N P SSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect.
FIN
License Number Lie.Class B
i
Contractor Date
Ell am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ c3
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lie.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name &eseq eo e. , e r
I hereby affirm that I am exempt from the Contractor's Address 09• Mno I/e 6 11 79 R
License Law for the following reason (Section 7031.5, Busi- City (f -/ el.No. —
ness and Professions Code):
I, as owner of the property, am exclusively contracting
of ith licensed contractors to construct the project 2 0 - 241-50
(Section 7044,Business and Professions Code).
00024,503)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency 0 910-82
for the performance of the work for which this permit is
issued(Sec.3097,
Lender's Name
Lender's Address "r o
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
authorize representatives of this County to enter upon the
above-mentions property for in action purpose 411
Signature kff Perms ttee Date