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Home My Public Portal About6302 AGNES AVE_Plumbing__ l 76A667A v CE 617tREV 8/761 1 I ®Sp f APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE( ADDRE V4 6302 N ASS AVE NUMBER FIXTURE OR ITEM @ FEE LOCALITY I-E CITLY WATER CLOSET NEAREST BATH TUB CROSS ST ?r✓' r SHOWER OWNER '1'AL'vWKA 'TS'UYOSHI LAVATORY MAIL �j� AD SINK CITY TEL NO DISHWASHER CONTRACTOR 'IRANE HCC CLOTHES WASHER ADDRESS 2034 N PECK SWIMMING POOL RECEPTOR CITY TEL NO ' LAWN SPRINKLER SYSTEM WATER HEATER LICENSE NO 265094 CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING a GAS PIPING GAS VENT V 1119 HOT WATER HEATER PLUMBING FIXTURES GAS TEST #:It- Plan check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ y v r TOTAL FEE /Ds lJ FINAL m l r 1� rrc Plan check applicant PLAN CHECK VALIDATION Name Address !/ City Tel No o_7�Zi I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE la.6 Q 1 A THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS # O O O O O 5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCR ED RESIDENTIAL 2 O O 100 0 TY PROPER ` (� SIGNATURE /�/ /� 0 0 0 1 Q 00,6 OF PERMITTEE ••�✓✓� Z 79 DISTRICT NO PROCESSED BY a `� 1 _ d J INDUSTRIAL \ WASTE APPROVAL 76A667 CEr817 6 65 'T-2 v APPLICATION FOR PLUMBI PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING O JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUP T OF BUILDING LOCALITY a FOR APPLICANT TO FILL IN NEAREST CROSS ST 71� NUMBER FIXTURE OR ITEM EACH FEE OWNER A\, �; ` �S WATER CLOSET $1 25 MAIL BATH TUB 1 25 ` !�j ADDRESS (�^h SHOWER 125 CITY TEL NO LAVATORY 125 CONTRACTOR Y` v `� SING 125 ADDRESS o C) DISHWASHER 1 25 CITY QS \1G TEL NO r� LAUNDRY TUB 12S \ STATE LIC LICENSE NO CLASS CLOTHES WASHER 125 DISTRICTT NO GR ZO E PR CESSE BY WATER HEATER 150 : ! GAS SYSTEM— �_OUTLETS 150 INDUSTRIAL O WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V GT=� T Oma, V W a N Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING Gje—1 TOTAL FEE GAS PIPING r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT / r J_�v7 � AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY` WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES le 10, LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANDSTATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOXE DE6CRIBED 81 T PR RTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTE FINAL VALIDATION r CK M O CASH LhL,O7 7 5 11 MAR 24 5 D 12.5 O~ + a WORKERS' COMPENSQTIOM DECLARATION APPLICATION FOR PLUMBING PERMIT !1 I hereby, affiim that I have a certificate of consent to self in- 76A666 DPW 4/87 76A667A -lsuie,or a ceM'ficate of Workers'Compensationlns,urancP_,or a CE 817(REV. 8%86) certified copy thereof (Sec. 3800, Lab.^CC f)) ` Policy o/`Ci(7�l L- Compony Pau COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. �30Z FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE -7,LOCALITY Date IL A lican ^� WATER CLOSET,(TOILET) PP NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. ��- '�✓�l�� COMPENSATION INSURANCE OWNER TjGhov��` SHOWER (This section need not be completed if the work involved by MAIL / �jy,� the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS (QJV I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY � �� C f7 TEL. NO. as to become subject to the Workers' Compensation Laws. DISHWASHER CONTRACTOR /ii/l (le Date Applicant CLOTHES WASHER t ADDRESS // --c NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY �� /'��j/y�- TEL. NO. �/� 3 sation provisions of the Labor Code, you must,forthwith comp- AWN SPRINKLER SYSTEM ly with such provisions or'this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION gISTRICT,pLO., ROJqff BY I hereby affirm that I am licensed underprovisions of Chapter GAS SYSTEM. OUTLETS hJ U 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full forces and ef- .5 PER SYSTEM FINAL VALIDATION fect. `C C(JO`C ( b ( -PLC}OCL. Gll'� DATE License Numbei Lic. Class o in ri 0 �U FINAL 1 V Contractorllkgd Lue_ Date—,/L—+ � BY O i- U am exempt under Sec. LAJ B.&P.C. for this reason Plan check fee ► g Date: PLUMBING PERMIT ISSUING FEE $ Signature TOTAL FEE SINGLE FAMILY . HOME OWNER-BUILDER DECLARATION Plan check applicant - I hereby affirm that I am exempt from the Contractor's License Name •� Law for the fallowing reason (Section 7031.5, Business and r•pp^ a ... .. ._.......__. ACC 6 .,r Q Professions Code): Address yy''�� • ... � :frl'J j i4 0�� I, as owner'of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, 1 ITEMS Business and Professions Code). ► TOTAL 34 =50 CONSTRUCTION LENDING AGENCY �}Crc I hereby offi"rm that there is a construction lending agency for the performance of the work for which this permit is'issued SCtHANGE .00 (Sec. 3097, Civ. C.). Lender's Name i-100-0001 00 Lender's 7/N Lender's Address }IC1 AMID00 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 laws regulating Plumbing, and hereby authori representatives of this ty to enter upon the dbo - entioned propert for in tion purposes.. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date