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HomeMy Public PortalAbout9157 WOOLLEY ST_Plumbing__ 76A867 (CE-817)- 5/73 ' APPLICATION F. PLUMB G PERMIT COUNTY OF LOS ANGELES �- DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ',� ,� i MAKE CHECKS PAYABLE TO: BUILDING 'A/V u/%' S77 HARVEY T. BRANDT, COUNTY ENGINEER A D CA L1TY ,nFOR APPLICANT TO FILL I.N (PRINT OR TYPE) OSS NEAREST.• • �`.:'•JF/�J/V/T/'� , ST/j NUMBER FIXTURE OR ITEM Ca FEE � WATERCLOSET 1,75 OWNER. . '/CG/ j,. je / S ,• MAIL /+ BATH TUB 1.75 ADDRESS / d . /-- .,ova lT//e• SHOWER 1.75 CITY-77/�©�r L��Ta TEL..NO.,>_� 3Z � LAVATORY 1,75 CONTRACTOR s £ ,/ '���/ '• SINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. NO. . CLOTHES WASHER 1.75 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. 'GROUP NE " CESSED B LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1.757 INDUSTRIAL \J WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 f INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM •30 a 5 CD H • v W N Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ a 00 TOTAL FEE 6 Plan check applicant APPROVALS DATE ' INSPECTOR'S SIGNATURE UNDER SLAB WORK Name P6.9 j //AaAfS ROUGH.PLUMBING Address 19 /.S` 1�- Alf, V xccs GAS PIPING City e r_7 ,P C C, Tel. No.Zc`Y,7-f34' GAS VENT . HOT WATER HEATER .1 HEREBY ACKNOWLEDGE. THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST L E,�S f7' .A I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICEN SEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN OF, AND INTEND TO RESIDE IN THE ABOVE D 1B ESIDENTI PROPERTY. FINAL SIGNATURE OF PERMITTEE RMIT VALIDATION CK�M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 20 .2J�-�P; 25 5• D 6.50A98 WORKERS'COMPENSATI011 cat.- .:AoAse ;. APPLICATI®N F®R PLUMBING PERMIT11 I hereby affirm that I have a certificota.r�f corrseM-to self ;6 7A • r insure, or a certificate of 1i:urkers';omperi anbn'Irya;irance, ^E g17(REN. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRES i• �� tion department. NUMBER FIXTURE OR ITEM Ca FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB r CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section nood not bo eomplotod if tho work involvod by MAIL tho pormit is for ono hundrod dollars($100)or loss.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK -s CITY TEL. NO. so as to become subject to the rkers Compensation Laws. � DISHWASHER CONTRACTOR pZ-fly- - Date pplicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making t 's Certificated SWIMMING POOL RECEPTOR Exemption, you should become subject o the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PR ED BY I hereby affirm that I am licensed under provisions of Chapter 9 1 GAS SYSTEM OUTLETS r (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATI 3. r DATE 0 License Number Lic. Class FI f Contractor Date 4U I am exempt under Sec. c» B.BP.C. for this reason :112 Z 6 A � Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ ® S +! o 0 0 0 0 Signature TOTAL FEE I o 0 6&5 0 bql /, O O O 64,51. Plan check applicant SINGLE FAMILY 1 2. 1 -.— (� HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). lop 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 agree to comply with all County ordinances and State lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the bove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature f rmittee Date I