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Home My Public Portal About6152 AVON AVE_Plumbing__ 76A667 CE817 8 57 APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS AulAl JOHN A LAMBIE COUNTY ENGINEER Q�� CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY G FOR APPLICANT TO FILL IN NEAREST CROSS ST / NUMBER FIXTURE OR ITEM WATER CLOSET MAIL OWNER / 0 BATH TUB ADDRESS SHOWER CITY fA A/ CIALIkiielTEL. NO LAVATORY CONTRACTO OP1 0 N SINK ADDRESS DISHWASHER CITYLJEL NO LAUNDRY TUB CONTRACTORT STATE REGISTRATION NO 0 d COUNTY CLOTHES WASHER DISTRICT NO GROU ZONE READY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPErTION RECORD APPROVALS ,./ @p $100 PER ITEMQ DATE INSPECTOR S SIGNATURE OR FIXTURE $ UNDER W RK f� r PERMIT s 1100 ROUGH PLUMBING ) � GAS PIPING TOTAL FEE Do GAS VENT � Gi - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER 7, AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES L PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST �7 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED z5"� DESCRIB-D RESIDENTIAL PROPERTY SIGNATURE FPERM[TTEE FINAL © V IDATION ROBERT A WOOD SUPERVISING MECHANICAL ENG R CK M 0 CASH LAColl 4 6 00R JUN 4 3 A 800 ` ♦WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I �Preby affirm that I have a certificate of consent to self 76A667A nsure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No '��Zcompan�yM zc—,r Z, ❑ entified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building mspec ADDRESS tion department NUMBER FIXTURE OR ITEM Q FEE LOCALITY _ c Date�Zd\—�� Applicant ` E, 1 WATER CLOSET NEAREST , CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB d CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less ) , LAVATORY �� ADDRESS ,\ %3d� I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK CITY _ �; TEL NO ts so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers CITY ` TEL NO _ tq Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM �l with comply with such provisions or this permit shall be STATE IC deemed revoked WATER HEATER LICENSE NO ' \ CLASS -- LICENSED CONTRACTORS DECLARATION p DISTVT GAS SYSTEM OUTLETS NO�y } PROCESSED BY O /� / I hereby affirm that I am licensed under provisions of Chapter 9 (1 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER d and Professions Code and my license is in full force and effect 5 PER SYSTEM DATE VALIDATION V License Number��V�� Lic Class , 2 +U-r 09 FINAL f O Contractor��Atii�Cl Date \ -'�—�� BY V ❑ w I am exempt under Sec in B 8P C for this reason Plan check fee ► —' Date i��\�� PLUMBING PERMIT ISSUING FEE$ Signotur 11 1 TOTAL FEE Q S� SINGLE FAMILY Plan check applicant i A HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s License Address r Low for the following reason (Section 7031 5 Business and Professions Code) City Tel No ❑ I as owner of the property will do the work and the structureis not intended or offered for sale (Section , 7044 Business and Professions Code) CONSTRUCTION LENDINGAGENCY I hereby affirm that there is a construction lending agency for c 7 3 2 6 A the performance of the work for which this permit is issued (Sec 3097 Civ C ) i 1 9 0 0 0 o o 5 Lender s Name 2 - - 4050 Lender s Address ° 0 0 4 0 5 0 XQ I certify that I have read this application and state that the above information is correct I agree to comply with all County 205-83 ordinances and State jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above me ed-prop rty for inspection purposes „ SEE REVERSE FOR EXPLANATORY LANGUAGE SignaPermittee 1�_ Date ture of