The URL can be used to link to this page

Home My Public Portal About6204 AVON AVE_Plumbing__ 75A 557C (C9 8178) 97 5 APPLICATION FOR PLUMBING PERMIT BUILDIN D SAFETY DIVISION j`ll J FOR APPLICANT TO FILL IN (PRINT OR TY PEI ADDRESS 2 (/L NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET LOCALITY 6AV/ ��f' NEAREST BATH TUB CROSS S SHOWER 3 OWNER LAVATORY MAIL 3 ADDRESS SINK CITY S11 TEL NO 2 �dLI DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS / SWIMMING POOL RECEPTOR CITY TEL NO LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LICENSE NO CLASS DISTRICT NO GROUP NEaSSED YGAS SYSTEM OUTLETS OUTLETS OVER vI 5 PER SYSTEM INDUSTRIAL CDCD WASTE APPROVAL V W INSPECTION RECORD v7 Plan check fee PLUMBING PERMIT ISSUING FEE S TOTAL FEE Plan check applicant Name �(�C/ S�� + y APPROVALS DATE INSPECTOR S SIGNATURE l�� / �C UNDER SLAB WORK Z-/-27 Address6LOf/ ��N C ROUGH PLUMBING � a�C C I t y L Tel NO 2.9,7 GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER 1 PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM T LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DES R/ ENTIAL PROPERTY UTILITY CO NOTIFIED LSGNATURE / G� �� OF PERMITTEE -G GG FINAL PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M 0 <CASH 869r'-CCC ,�2 5 0 1 650 - � 11 WORKERS COMPENSATION DECLARATION Y > �—} APPLiCAPON FOR PLUMBING PERMIT 'n°I�er affirm thgt I have a certi- ate of consent to self 76A667A ; y t r insure or a certificate of Workers Compensation Insurance CE 817(REV 8/86) t4 ; �f or a certified copy thereof (Sec 3800 Lab C ) a COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No Company ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGO ' J�,1� r/ ❑ Certified copy is filed with the county building inspec ADDRESS /) .e /V 6i tion deportment NUMBER FIXTURE OR ITEM Q FEE LOCALITY 1 /,(/,,5._� _��j� Date WATER CLOSET Appligant NEAREST / CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST -rca r L Gam? COMPENSATION IN> SHOWER SURANCE OWNER (This section need not be completed if the work Involved by MAIL I /I '/ ,/ the permit Is for one hundred dollars($100)or less ) LAVATORY ADDREss4p524 �( UIl1I/ (�P I certify that in the performance of the work for which this ,,/ permit is issued I shall not employ any person in any manner SINK CIT l* '.�� TEL so as to become subject to the Worker om sation Laws •��"' f0 DISHWASHER CONTRACTOR e Dot��fApplicant /GcUrG CLOTHES WASHER r NOTICE TO APPLICANT If after making this Certific f ADDRESS Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR r Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM CITY TEL NO with comply with such provisions or this permit shall be STATE , LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NC3� P SSED I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ND (commencing with Section 7000) of Division 3 of the Business _ OUTLETS OVER and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VALI TION DATE C,10 (� License Number Lic Class FINAL Contractor Date BY Im ;2874,t1 A W ❑ I am exempt under Sec ,I _-nj J� U) # c o c o 0 5 fA B 8P C for this reason Date Plan check fee ® 1 - 2250, Z Signature PLUMBING PERMIT ISSUING FEE$ ` o�0 - 22500 � TOTAL FEE D Plan check applicant 01 1 1 -88 SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor s License Address Law for the following reason (Section 7031 5 Business and 11 Pr9fessions 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 t ® f 7044 Business and Professions Code) CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for l ,0 +' the performance of the work for which this permit is issued hl",- L+�/ ,(Sec 3097 Civ C ) ' o fell t �6 a , �` Lender s Name �l ? Lender s Address 1w � . I certify that I have read this application and state that the �)�� above information is correct I agree to comply with all County 1 ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the ab ment ed property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKF,RS"COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT y,affirm that I have a certificate of consent to self 78A887A ir,, e, or a certificate of Workers' Compensation Insurance, CE 817-(REV. 8/88) or a certified copy thereof(Sec. 3800, Lab. C.) - COUNTY OF LOS ANGELES DEPT`=OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. ❑ le/�FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING. - y Certified copy is filed with the county building inspec- ADDRESS le /V NUMBER FIXTURE OR ITEM ® FEE LOCA tion department, - ITY / ! 7 L , WATER CLOSET - 7 Date AppMPTI CROSS ST./�� JlijdSG a. f'[� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' _ _. BATH TUB _ _ COMPENSATION INSURANCE _ OWNER c- (This section need not be completed if the work involved by _ SHOWER MAIL Q �J� y/� the pormit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this 4 permit is issued, I shall not employ any person_in'any manner SINK �j CITY �,�� TEL. NO. ,�0 so as to become subject to the Worke om I sation Laws. _._ _ _ DISHWASHER ' /) � '' CONTRACTOR J Date Apelicant CLOTHES WASHER ADDRESS j� NOTICE TO APPLICANT: If, after making Xis Certificatyrs' SWIMMING POOL RECEPTOR Exemption, you should become subject to the Work CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. R SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �c and Professions Code, and m license is in full force and effect. 5 PER SYSTEM y FINA EL VALI TION V License Number Lic. Class FINAL 6 Contractor Date BY l' V ElI am exempt under Sec. Q B.BP.C. for this reason Plan check fee m Date: PLUMBING PERMIT ISSUING FEE$ Signature ' TOTAL FEE 27 b IL 3 A Plan check applicant #- 00005 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name -( .o o 1 650 1 hereby affirm that I am exempt from the Contractor's License law for.the following reason (Section 7031.5, Business and Address 0 - 16, 505 {Prroofe/ssions Code): City Tel. No. 0$l1l 1 -87 CJ 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 ork for w ich thi permit is issued (Sec. 3097, Civ. 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 abo 7 do d=property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE j (`i5 anoture of Permittee Z Date