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Home My Public Portal About4874 ARDSLEY DR_Plumbing__ 76A667 I0.55 APPLICATION FOR PL MBING PERMIT 1 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL -IN NEAREST CROSS ST. OWNER + DISTRICT N:j ChROUP ZON I READY FOR INSPECTION MAIL ADDRESS Same Now INDUSTRIAL ' CITY TEL. NO. WASTE APPROVAL PLUMBER GENERAL INSTALLATION CO. INSPECTION RECORD ADDRESS 6558 West Blvd. CITY L.A. 43 TEL. NO. PLeasant 3-2541 LICENSE NO. 787 C-36 151839 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ $1.00 —11 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 WATER SOFTENER 1 00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE 2 00 GAS VENT 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY. REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM HE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL PTy�js�%� SIGNATURE OF PERMITTEE FINAL JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. M.0. CASH O.S.17 25M SETS 1-48 DEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERMIT COUNTY OF LOS ANGELES PLUMBING WM.J. FOX.CHIEF ENGINEER NATURE,OF INSTALLATION- DISTRICT NO. OUP ZONE PERMIT, O. .•'� ROUGH FIXTURES COMPLETE ZX" •//; Y /_3 y HEATER CESSPOOL_ I-I SEPTIC TANK RECEIVED BY READY FOR- DATE ISSUED { r� :�� FIRST INSPECTION t$ �g d j/G AS- M C ELLAN EOUB . O APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY NAME /A JOB ADDRESS I�� m ADDRESS LOCALITY , f m / - n(� NEAREST IL CLL/ yC.. TEL.N .@ �j p CROSS ST. J COUNTY CERT.No.?,&?)� EXPIRE� f�U � E NAME w LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL ADDRESS NORTH O CITY TEL.No. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICA E OF qU LIFICATION. R PLUMiiCR I AM THE LEGAL OWNER OF E PROPERTY DESCRIBED ABOVE. N a i OW NCR CORRECTIONS SOUTH -J DESCRIPTION OF WORK i -BATHTUB FURNACE tL' rr ROWER DISHWASHER 0 LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY I/� URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE { INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I e' METERJ_GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT I I CESSPOOL I TOTAL NUMBER OF FIXTURES SEPTIC TANK I I CESSPOOL SEPTIC TANK SEWER I TOTAL FEE $ C.- UTILITY CO.NOTIFIED FINAL 1 COUNTY OF LOS ANGELES APPLICATION FOR PERMIT " Department of County Engineer DIVISION OF BUILDING & SAFETY � ' ' ♦ WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN DISTRI. O. ZONE RMIT NEI. 6z PLUMBERREADY FOR _� E IVE HY FIRST INSPECTION DATE ISSUED ADDRESS BUILDING CITY TEL No. ADDRESS COUNTY LOCALITY I/�/t LICENSE NO. EXPIRES � PERMIT FEES cRCBS ST. te/'r NUMBER TYPE OF FIXTURE OR ITEM FEE OWNERMAIL �,��/(y�Y /(///y 1/S fes/ (yy/•/0 /�� I�,Q WATER CLOSET(TOILET) @ 0.50 $ ADDRESS Qmf•'jS C¢" f(�• `Y"��E L' �d"0 BATH TUB @ O.SO CITY �,, /� TEL NO./•� 7 `¢"�/ SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ O.SO AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O.SO ANGELES COUNTY LICENSE, OR i AM THE LEGAL OWNER GAS SYSTEM OUTLETS @ 0.50 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. SIGNATURE OF:-- WATER HEATER @ 0.50 _ PERMITTEE ��/^ SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 �• Z'I.. �� EICPA��'4''� �'p�� DISHWASHER @ 0.50 a--lge ae-V C- // -y DRINKING FOUNTAIN @ O.S❑ /��"� Cn lam• F`f'r URINAL @ 0.50 -' _j Q HOUSE SEWER @ 0.50 Z MISCELLANEOUS 0 APPROVALS ATE INSPECTO VSA NAME ROUGH PLUMBINGG«"-�-a....... �fC�I/S 3 GAS PIPING GAS VENT CESSPOOL @ 1,00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ') PIT ( ) @ 1.00 SEWER PERMIT . . . 1.00 GAS TEST TOTAL FEE $ UTILITY CO.NOTIFIED � n XQ� ryry, s V NAL "1 'J ` 2.41AA ''CSI 7GAS67 DBS#17 10/52 ION DECLARATI WORKER'S I have a certificate of consent to 76A626DPW9/69 APPLICATION FOR PLUMBING PERMIT ♦ 76A667A I hereby affirm that I have a certificate of consent to self insure, 'or,a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy'No. Company ❑ Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST n - CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSSST 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($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as toSINK MAIL ADDRESS_ become subject to the Workers'Compensation Laws. DISWASHER CITY TEL.N Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Aczd4lel� Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM - LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER fl (commencing with Section 7000 of Division 3 of the Business and STATE LIC. 0 ( 9 ) — LICENSE NO. cl�sss Professions Code, and my license is in full force and effect. GAS SYSTEM OUTLETS �� V OUTLETS OVER DISTRICT NO. PROCESSED13 a: 5 PER SYSTEM License Number Lic.Class FINAL VALIDATIO% , w ' DATE a._,._ (L Contractor Date _ 0) ❑ FINAL i.F s(-iilL . m. Z-_-- D Z I am exempt under Sec. BY B.&P.C.for this reason ( "(6 % Plan check feer s' E Date: , PLUMBING PERMIT ISSUING FEE$ 5540 Signature ❑ TOTAL FEE O 7 45+47—_JUI Plan check applicant 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 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, 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 property for' spectio purposes. \ SEE REVERSE FOR EXPLANATORY LANGUAGE S. ature f P mittee ate