HomeMy Public PortalAbout5117 ARDEN DR_Plumbing__ 76A667-CE#817 4-64
APPLICATION FOR PLUM ING PE IT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING `
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS �J /
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEARESSCROSS T.
NUMBER FIXTURE OR ITEM EACH FEE J
OWNER
WATER CLOSET $1.25 .H✓ MAIL / N
BATH TUB 1,25 ADDRESS / C�
SHOWER 1.25 CITY L' TEL. NO. 3 767�T 9
LAVATORY 1.25 ��j CONTRACTOR
SINS 1.25 ADDRESS `� /� n
DISHWASHER 1.25 CITY r � TEL. NO I( Q
LAUNDRY TUB 1.25 REGISTRATION NO. .� . COUNTY
CLOTHES WASHER 1.25 DISTRICT NO. 6R �PE PRO BS BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
-� WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD V
O
U
ua
a
N
z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK 4'I
ROUGH PLUMBING o I .1
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
ANO STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
PLUMBING FIXTURES 'L„� .- �;IV ir,(PAt;Fy?,-4!'�
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DE6CfRIBEO RESIDENTIAL PROP TY. UTILITY CO. NOTIFIED
SIGNATURE ( � /
OF PERM ITTE ! / FINAL
VALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
'R 15 5 D 6.0 0-
WORKER'S COMPENSATION
certificate
of consent to 76A666DPW 9/89 APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self insure, 76A667A
or a certificate of.Worker's Compensation Insurance, or a certified
copy thereof(Se`. 3800 Lab.C.)
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company „
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 3mo,p—g� �✓
❑ Certified copy is filed with the county building inspection ADDRESS' 5117
f l7 IW 6►�(-
department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY f 15"PtE 21
Date Applicant 2 WATER CLOSET
NEAREST /�
CROSS ST. L� P o_?A
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL ,
permit is for one hundred dollars($100)or less.) LAVATORY OWNER /t'/7c6L G
I certify that in the performance of the work for which this permit MAIL
is issued, I shall not employ any person in any manner so as to / SINK ADDRESS ��/
become subject to the Workers'Compensation Laws.
DISWASHER CITY `'M /`/F fl ` 'TEL.NO. r-72047
Date Applicant / CLOTHES WASHER CONTRACTOR r
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.NO.
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER CL
(commencing with Section 7000) of Division 3 of the Business and STATE LIC. O
Professions Code, and my license is in full force and effect.
GAS SYSTEM OUTLETS LICENSE NO. CLASS V
OUTLETS OVER DISTRICT NO. CCC��� PROCESSED BY O
5 PER SYSTEM
License Number Lic.Class ,J l! L F—
FINAL _ U
DATE _`} VALIDATION W
Contractor Date (n
❑ IL
I am exempt under Sec. FINAL \ Z
B.&P.C.for this reason BY
Date: Plan check fee
PLUMBING PERMIT ISSUING FEE$
Signature
❑ TOTAL FEE a J
Plan check applicant H(_:( {,
SINGLE FAMILY _
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law "
for the following reason (Section 7031.5, Business and Professions Address T TE §fit
Code
City Tel. No. 'r.._' � a•.?':="_
I, as owner of the property,will do the work and the structure T_O�` IL ';�2
ASF
is not intended or offered for sale (Section 7044, Business _��d ;% _,„„ •.�
and Professions Code).
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.) ;j i;4j_I—LIFti_
-t-r j 'pi'[ °
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 laws regulating Plumbing, and hereby authorize
representatives of this County to enter upon the above-mentioned
iLpiernttr o 'nspectio p rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Sgr of Per ,ittee ate