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HomeMy Public PortalAbout5616 BALDWIN AVE_Plumbing__ (2) _ 1 7eAee7 17 5-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING ' WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER UAl.LEOULEVARD PLM RECEIVED BY READY FOR DATE ISSUED ADDRESS 8300 EAST VALLEY BLVD. r-c FIRST INSPECTION AOSEMEAD CITY TEL, NO. AM 2-, BUILDING ADDRESS COUNTY • , LOCALITY LICENSE NO. EXPIRES NEAREST J��y/'�,r •d CROSS ST PERMIT FEES NUMBER TYPE OF FIXTURE OR ITEM FEE OWNERdTHIS� MAIL2/19 WATER CLOSET (TOILET) @ 0.50 $ D ADDRESS � �JTBATH TUB @ 0.50 I `I"J 6/ CI Y ,O�I.�-:© 1/ // —3�CiCi� fTEL. NOel `SHOWER. @ 0.50 I HEREBY A¢°ICNbWLEDGE THAT I HAVE READ R LAVATORY (WASH BASIN) @ 0.50 I / /� APPLICATION AN'''"'bbbbbb STATE.THAT THE ABOVE IS CORRECT AND _ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 , °^(, STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS _ LAUNDRY TUBO TRAY @ 0.50 ..�'/`"7 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER OF THE RESIDENTIA P OPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ O.50 4 + � sl .SIGNATURE OF WATER HEATER @ O.SO I 'sj XPi PERMITTEE ///!!! F� r' .- •±i✓:%I, s.f.,a.>: SLOP SINK @ O.So I INSPECTION RECORD �--- FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.501 [[[ DISHWASHER @ 0.501 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.501 •J HOUSE SEWER @ 0.501 I Q Z MISCELLANEOUS I� O I� APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING /,/ •''`L�/? GAS PIPING GAS VENT CESSPOOL r @ 1.00 I CESSPOOL SEPTIC TAN I SEPTIC TANK I DRAIN ) PIT ( ) @ 1.00 I SEWER PERMIT . I 1.00 GAS TEST • UTILITY CO. NOTIFIED r/I �/' ve^'•f_�'� TOTAL FEE I $ I ®a` ; FINAL ��'� WORKERS'COMPENSATION DECLARATION 7 Js 4 I herebyJaffirm khat I have a certificate of consent to self APPLICATION' FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or I a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS AN S BU DfNG A SAFETY Policy No. Company / ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRI INT OR TYPE BUILDING ADDRESS �y ❑ Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE department. WATER CLOSET LOCALITY Date Applicant NEAREST BATH TUB CROSS ST. (� CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved LAVATORY MAI L ADDRESS J_,-,�'Z/4j (/`k by the permit is for one hundred dollars ($100) or less.) SINK � ITy TEL. NO.4 (� � U I certify that in the performance of the work for which this DISHWASHER T 0 permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS (j Date Applicant SWIMMING POOL RECEPTOR a- NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO. y Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS with comply with such provisions or this permit shall be WATER HEATER � deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. 0CESSED B i ,LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirmathat I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000),of Division 3 of the Busi- FINAL ness and Professions Code, and my license is in full force and DATE VALIDATION r L��/ effect. License NumberLic.Class FINAL BY . Contractor Date ❑ I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ �- acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE r� Lic.or Reg.No. Date Plan check applicant c4 v 0 th 5 A HOME OWNER-BUILDER DECLARATION Name � o0eo © 5 1 hereby affirm that I am exempt from the Contractor's IlAddress License Law for the followingreason Section.7031.5, Busi- 2 © 1 Q,0 0 ( City Tel.No. ness and Professions Code): 0 0 0 I Q, 0,0-J I, as owner of the property, am'exclusively contracting with licensed contractors to construct thero•ect P J o �,30-81 (Section 7044, Business and Professions Code). 1 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 ,I 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 ter upon the above-mentioned property for inspection purp ses. Signature of Permit e D to