HomeMy Public PortalAbout6272 AVON AVE_Plumbing__ mm
o. It. Is s-•Eo Eer - 'APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
.11
PLUMB
N . CHIiF [N(1NEER
ING_
NATURE OF INSTALLATION DISTRICT NO. GR UPI Z E PERMIT NO.
ROUGH1.41
PLUMBING FIXTURES COMPLETE RECEIVED BY READY FOR OAT[ 1{{ 1 1
O; TER 4CESSPOOL SEPTIC TANK ) /� FI
R{T INSPECTION 01044v
MISCELLANEOUS
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AlYT FIL IN HEAVILY OUTLINED PORTION ONLY
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NAME JOQ ADDR[ff 14
ADDRESS L % _LOCALITY
D N[AR EST
CITY NO. 099 ST.
COUNT
CERT. NOS- EXPIRES NAM[
LOCATION OF SEPTIC TANK; OR CESSPOOLMAILADDRFS8
NORTH
CITY TEL No.
7 1 A7w' Ti7a La'.inL PvooaTiI'a As-vii L&S
f ANGELES COUNTY CERTIFICAT ALIPI ION,
I - u
IAM THE LEGAL OWNER OF THE PRL *DESCRIBED
DE{CRIIlED
ABOVE.
OWNER
I
I CORRECTiGNS
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�--.. DESCRIPTION OF WORK �µ -I_. �;.<, _,... . . ....•. ..:; ...�,_,:
BATH Tun FURNACE
SHOWER DISHWASHER
—LAVATORY REFRIGERATOR
—KITC`--" mINK
WATER SOFTENER
FLOOR SINK BAND TRAP
LOP SINK n
OOR DRAIN
APPROALS :
WASH TRAY V URINAL
WATER CLOSET
DRINKING FOU ;
NTAIN DATE - INSPECTORy
o.f,. G„WATRR HEATER .,_,. P4?l TAL L.kV�TQRy I ��L�CN wL�uCwC / I
Ar
METER GAS SODA FOUNTAIN GAS PIPING
VTL
Y
GAS VENT
_.
CESSPOOL
_ ,.
TOTAL NUMBER OR FIXTURES SEPTIC TANK
014
' .
_-L—CESSPOOL lSIiPliC TANK r
UT1LfTYCO NOTINIEO
TOTAL FEE
IiNAL ' r 75}r
WORKERS' COMPENSATION DECLARATION 20.0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT
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I hereby, affirm thot ' have a rertificate of consent to self in- 76A667A
sure, or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified copy thereof (Sec. 3800, Lab. C. ---
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company
,Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE)
Certified copy is filed with the county building inspection ADDRESS Z
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
WATER CLOSET(TOILET)
Date Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' ?j BATH TUB CROSS ST.
oA
COMPENSATION INSURANCESHOWER ! OWNER
(This section need not be completed if the work involved by G MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY d ADDRESS C
I certify that in the performance of the work for which this per- SINK CITY TEL' cg
mit is issued, I shall not employ any person in any manner so _
as to become ubject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making t s Certificate of ADDRESS
SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Com CITY TEL. NO.
sation provisions of the Labor Code, you must forthwith c p LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO, ESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 6
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER O
.and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fect. DATE i a0
License Number Lic. Class V
FINAL p�
Contractor Date BY I O
1 am exempt under Sec. W
t a
B.BP.C. for this reason Plan check fee ► f Z
Da e: PLUMBING PERMIT ISSUING FEE$ U
ii
Signature c, I �
TOTAL FEE Q
SINGLE FAMILY
HOME OWNER-BUILDER DECLAR ION Plan check applicant
I hereby affirm that I am exempt from the ontractor's License Name
Law for the following reason (Section 7031.5, Business and
Professions Code): Address
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 County ,
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
r-mentioned property for inspection purposes.
� SEE REVERSE FOR EXPLANATORY LANGUAGE