HomeMy Public PortalAbout5336 ARDEN DR_Plumbing__ 1
D.B.S.-l; 23M SETS 12-17 APPLICATION FOR PERMIT
REPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES �`�M�'��
WM. J. FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO GROUP 'LONE I PERMIT NO.
ROUGH FIXTURES COMPLETE
HEATER CESSPOOL I 8EPTIC TANK RECEIVED BY f READY FOR DATE ISSUED
__ FIRST INSPECTION _
GAS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
E I NAME -- ADDRESS
W
® ADDRESS LOCALITY
0 NEAREST
4 CITY _ TEL. No. CROSS ST.
COUNTY
-----
CERT. No. EXPIRES - X I NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL
3 ADDRESS
NORTH0 - —.._..-------------------
i ---- ------ CITY TEL. NO.
I AM THE LEGAL POSSESSOR OF THEABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRINKD
ABOVE.
RI
as OWNER
CORRECTIONS
I - -
SOUTH
DESCRIPTION OF WORK - --- -
z
BATH TUB FURNACE V'
SHOWER DISHWASHER a'
LAVATORY REFRIGERATOR
-KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
--SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
.—WATER CLOSET DRINKING FOUNTAIN _ DATE INSPECTOR'S NAME
WATER HEATER DENTAL LAVATORY
ROUGH PLUMBING
METER GAS _ SODA FOUNTAIN
OUTL GAS PIPING
GAS VENT
CESSPOOL I _
LCESSpooOTAL NUMBER OF FIXTURES _-- SEPTIC TANK i
I SEPTIC TANK
—TOTAL
I
UTILITY CO.NOTIFIED
TOTAL FEE
FINAL
D.B.Sr1,F7 25M BETS ,,.ae APPLICATION FOR.OF BUILDING AND SAFETY ,PLUMBING
COUNTY OF LOS ANGELES
WM.J. FOX.CHIEF ENGINEER
NATURE OF INSTALLATION DISTRI NO. GROUP ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE 'rJ
HEATER CESSPOOL 141 SEPTIC TANK ECEIV BY READY FOR DATIC ISSUED
6�E " C FIRST INSPECTION _/-
AS -I--MISCELLANEOUS �"'^
aim
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
/�/y�J _ JOB
tC NAME (01 - �^ ADDRESS A.L14Na
_ADDRESS /JAp C /�_L � LOCALITY
DA
NEAREST
'1 CITY TEL.No. CROSS ST. 1
0.
COUNTY
CERT.No. EXPIRES m NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS
NORTH O
CITY TEL.No.
IAM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
r� PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
a
3 i OWNER
CORRECTIONS
SOUTH J
DESCRIPTION OF WORK z
BATH TUB FURNACE
SHOWER DISHWASHER O
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE 1 NflP6CTOR'3jNAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING V6I,"I
METER GAS SODA FOUNTAIN
OUTL GAS PIPING I /
GAS VENT I I
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK I I
-CESSPOOI SEPTIC TANK SEWER I
S UTILITY CO.NOTIFIED I. I
TOTAL FEE
FINAL
r
WORKERS'COMPENSATION DECLARATION 76A667A
I hi rjby(firm that I have a certificate of consent to self ce 617 (2-60) APPLICATION FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or �J 1
a certified c�py.jhergof,(Sec .3 0,La .C.) �G J
// v7o� ^, _�/-G-/� COUNTY OF LOS ANGELES BU)JDiNG AND SAFETY
Policy 16d. Company _
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS
I==/VC/V
Certified copy-is filed with eco t lding inspection NUMBER FIXTURE OR ITEM • FEE
rieparlp,en .� WATER CLOSET LOCALIR `
Date Applicant NEAREST
BATH TUB CROSS ST. LLQ/
CERTIFICATE OF EXEMPTION FROM WORKER
COMPENSATION INSURANCE SHOWER OWNER
LAVATORY MAIL
(This section need not be completed if the work involved _ DDRES }
by the permit is for one hundred dollars ($100) or less.) SINKTEL. NO. a
CITY 0
(I certify that in the performance the wor for which this DISHWASHER V
1 permit is issued, I shall not empl y an erso in any manner CONTRACTQ± vV cc
J so as to become,subject to the 0 pensation Laws. CLOTHES WASHER ADDRES$ � I� 0
I Date I'� � Applicant t SWIMMING POOL RECEPTOR � f W
NOTICE TO APPLICANT: If, after making this Cer ' ate of CITY TEL. Nn. tL
W
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATEr� LIC. to
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 DIST'R'ICT NO. P CES EQ BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER �✓ ®�
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYST M FINAL ?9�I Ll i
9 (commencing with Section 7000) of Division 3 of the Busi- VALIDATIO
ness and Professions Code, and my license is in full force and DATE ��
C/ # ° o o ° j
effect.
J FINAL
License Numbo�t \LLic.Class _ BY ✓ 2 0 0
Contracto tJ 5 to / ° 1 3,0 0 5:
ElI am exempt from the licensing requirements as I am a Plan check fee ' '0.S . 80 8 0
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ i-- 3 7t4
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE i
Lie.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER•DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No. ;?2 9 3 A
ness and Professions Code):
F1 I, as owner of the property, am exclusively contracting
0 0 0 0 0 5
with licensed contractors to construct the project #
(Section 7044, Business and Professions Code). 2 0,0 1 3 0 0
CONSTRUCTION LENDING AGENCY ° ° ° 1 3.0 0 5
I hereby affirm that there is a construction lending agency
for the performance of the work for,which thi permit is1,05780
issued(Sec. 30`� .��_kIJ�LC
Lender's Namerl
Lender's Address oz,'v`yZA •
I certify that I have read this application and state that the
above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorizer presentatives of this County to enter upon the
ab`Z
e-me - oned property for inspection purposes.
gnature of Permittee Date