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HomeMy Public PortalAbout6243 AVON AVE_Plumbing__ 76A667A CE 81 7 fREV.�6/78) ©s o a APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS �y( s 1 NUMBER FIXTURE OR ITEM @ FEE LOCALITY ,S �(�� �' 7`•v WATER CLOSET NEAREST p +��'�� (1 BATH TUB CROSS ST. \ SHOWER OWNERMAIL Q> �11' �`/�C� ^� LAVATORY ADDRESS Qqp V A`l " 1 SINK CITYsIn �T,NO. Iib-3�5� DISHWASHER CONTRACTOR (� C fQI& CLOTHES WASHER ADDRESS ��.��� SWIMMING POOL RECEPTOR CITY' TEL.NO. LAWN SPRINKLER SYSTEM LSTATE LIC. WATER HEATER ENSELNOta CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT I� HOT WATER HEATER PLUMBING FIXTURES GAS TEST 3 Plan check fee UTILITY CO.NOTIFIED L� PLUMBING PERMIT ISSUING FEE$ o TOTAL FEE FINAL PLAN CHECK VALIDATION n Plan check applicant Name Address City Tel.No. ll,d � I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 1, 0 AND STATE LAWS REGULATING PLUMBING. �RMIT V I `TIrl,,a " 3.J I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS I 1a , c> O o O 5 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA THAT I THE E, 1 LEGAL OWNER OF.AND INTEND E ABOVE DESCRIBED RESIDENTIAL 0C', O V (TIO O PROP SIGNF4TURE , 0n 0.0 0✓J OF PERM DISTRICT NO. PRO SED BY 0.031' %9 INDUSTRIAL WASTE APPROVAL 76A667 ('1!iF'8P7)-`3/72 C-s( C✓�_ ill lY� APPLICATION R PLI /IBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7BD MAKE CHECKS PAYABLE TO: 2 AvonHARVEY T. BRANDT, COUNTY ENGINEER FOR APPLICANT TO FILL IN (PRINT OR TYPE) NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1.75 3 G OWNER Ray Mosure C/ MAIL ur.6 o_-z BATH TUB 1,75 ` � ADDRESS11 W. SHOWER 1,75 J "^ CITYSTEL. NO. y�s'-of�91 LAVATORY 1,75 j CONTRACTOR Owen Bross Plumbing / SINK 1,75 ADDRESS 1,2265 N. Baldwin Ave. DISHWASHER 1,75 CITYEl Monte TEL. NO."3-007$ CLOTHES WASHER 1'75 STATE LIC LICENSE NO.231 741 C36-20 CLASS SWIMMING POOL RECEPTOR 1,75 DISTRICT Oc GROUP NEROCESSED BY LAWN SPRINKLER SYSTEM 1,756-1,08 T _+ p L WATER HEATER 1.75 INDUSTRIAL `5 WASTE APPROVAL a GAS SYSTEM OUTLETS 1.75 NSPECTION RECORD CD OUTLETS OVER 30 5 PER SYSTEM CD F- U W a. h Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE ECTOR'S IGNATURE Plan check applicant UNDER SLAB WORK yr 2 Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT `��i) rf� I HEREBY ACKNOWLEDGE .THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE.IS,CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST ) L a'/ �Ii /'� .tis-- >{ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVEUSCED RESIDENTIAL_PROPERTY. FINAL SI GNA TU RE PERMIT VALIDATION OM... CASH PLAN CHECK VALIDATION CK. M.O. CASH � I , 18 5 0 22.25'A WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 sure,or a certificate of Workers'Compensation Insurance,ora 76A667A certified copy thereof (Sec. 3800, Lab, C.) COUNTY OF LOS ANGELES DE T. OF PUBL WORKS Policy No. Company fl Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspection ADDRESS (Q department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET.(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 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($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK ,/- mit is issued, I shall not employ any person in any manner so CITY / TEL. NOS as to become subject to the Workers mpensation Laws. DISHWASHER CONTRACTOR Date r �Applica CLOTHES WASHER ADDRESS Sgp4la NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption,you should become subject to the Workers'Compen- CITY TEL. NO ��b� sation provisions of the Lab-)rCode, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE �® LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. // HOSE BIB DATE r License Number WZA I _Lic. Clas FINAL ?d;`_ ,a V Contractor Date BY +- - 9X ❑ I am exempt under Sec. .•__._ ± O B.&P.C. for this reason Q - LU Plan check.fee ► 3-��4�' l=-,ij x w = _ CL Date: PLUMBING PERMIT ISSUING FEE$ q = g Signature r• TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION PP I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and -' Professions Code): Address `s=3=t Vii.:; '1Ay==„ ❑ I, as owner of the property, will do the work and the City Tel. No. 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 Ceunty ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date