HomeMy Public PortalAbout5315, 5317 ARDEN DR_Plumbing__ DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
. ,DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES _
BUILDING
• WILLIAM J. FOX, COUNTY ENGINEER .ADDRESS
FOR APPLICANT TO F LL IN LOCALITY ,,
NEAREST
BUILDING CROSS ST.
ADDRESS aA,
' DISTRICT NO- GROUP /ZONE PERMIT NO.
LOCALITY T I
NEAREST
CROSS ST. RECEIVED BYV Ready for Inspection DATE ISSUED
OWNER /f /ti'F �„IJr�_A
MAIL INDUSTRIAL
ADDRESS /J -�...�.QWASTE APPROVAL
CITY TEL.N0.
INSPECTION RECORD
PLUMBER I� ,A
ADDRESS �y 9
CITY TEL.NO.
J V STATE
LICENSE NO. 9 ZCOUNTY J
PER IT FEES a
z
DUMBER TYPE OF FIXTURE OR ITEM FEE Ui
WATER CLOSET(TOILET) @ 0.80 3 O
BATH TUB @ 0.80
SHOWER 8gnq@ 0.80 d
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80 �4 y
SLOP SINK @ 0.80 !� -
FLOORSINK @ 0.80 f�
FLOOR DRAIN @ 0.80
f .
DISHWASHER @
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM..............OUTLETS @ 1.00
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE ® GAS PIPING 410
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ T IS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABO DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE ( /
F PERMITTEE - ..-._...-.-_.
FINAL �'. •s
O
76A667 DBS 17 Ob 12-53
D.S.S.17 25M SETS 12•44 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND -SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WM. J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP I ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE
HEATER CESSPOOL I—I SEPTIC TANK RE E(VED BY READY FOR DATE ISSUED
FIRST INSPECTION J,
GAS MISCELLANEOUS 'r�''-
APP ICAN FILL IN HEAVILY OUTLINED PORTION ONLY
JOB r
E NAME .,� /E ADDRESS
W
XM ADDRESS �� /�za ,)LOCALITY
_ T
D - o y V/` NEAREST
J CITYy'iM TEL.No. CROSS.ST.
IL
cou � F
CERT.No. EXPIRES W NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL
3 ADDRESS
NORTH O
CITY TEL.No.
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFIC TE OF QUALIFFI,TIIN*
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
A
i OWNER
1010111111111 ____
CORRECTIONS
i
i
SOUTH ra
�i
DESCRIPTION OF WORK
BATH TUB FURNACE �+
O
SHOWER DISHWASHER
LAVATORY REFRIGERATOR
—KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER.CLOSET DRINKING FOUNTAIN DATE IN9P[CTOR'•NAM[
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I
METER GAS SODA FOUNTAIN
OUTL GAS PIPING
GAS VENT
IBIBIBBICESSPOOL
TOTAL NUMBER
rynOFFIXTURES � SEPTIC TANK
CESSPOOL�Y�sEPTIC TANK SEWER
TOTAL FEE
�G (/ " e ffi �0 � ? UTILITY CO.NOTIFIED
I I
FINAL
WORKER'S COMPENSATION DEconsen to 76A666DPW9/89 APPLICATION FOR PLUMBING^PERMIT
of f i r 76A667A
that I hive a certificate of consent to self insure,
4 r -rti. aq+' °ji f)corker's Compensation Insurance, ora certified
copy thereof(Sec.3800 Lab. C.)
a"
Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
❑ Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS 53
department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY
Date Applicant WATER CLOSET '
NEAREST �
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
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($100)or less.) OWNER
I certify that in the performance of the work for which this permit LAVATORY 'S
is
is issued, I shall not employ any person in any manner so as to SINK MAIL
become subject to the Workers' Compensation Laws. ADDRESS 3( A AO
DISWASHER CITY C� TEL.NO. l,s
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.NO.
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(commencing with Section 7000) of Division 3 of the Business and STATE LIC.
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS V
OUTLETS OVER DISTRICT NO. PROCESSED BY
5 PER SYSTEM
License Number Lic.Class Of
FINAL Z� p
DATE '� .-' VALIDATION �
Contractor Date n
❑ I am exempt under Sec. FINAL I /i
B.&P.C.for this reason
Plan check fee ,
Date:
Signature PLUMBING PERMIT ISSUING;FEE$
❑ TOTAL FEE
SINGLE FAMILY Plan check applicant
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
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). ,
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, f :_
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 laws regulating Plumbing, and hereby authorize
representatives of this County to enter upon the above-mentioned
proper for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
t/ 1111C /•O/Q�a�'/.�
S gnature of Permittee to