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HomeMy Public PortalAbout5444 BALDWIN AVE_Plumbing__ 76*A 6G7�CE 817 8/68 • APPLICATION FOR PLUMBING PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION 7 JOHN A LAMBIE COUNTY ENGINEER � ADDRESS 154- 4 COLEMAN W JENKINS SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE Y 5 W WATER CLOSET 1 SO OWNERHAM BATH TUB 1 50 DRESS SHOWER 1 50 CITY T� Ae TEL NO LAVATORY 1 5o CONTRACTOR �i v� dei- 6G SINK t SO ADDRESS 20 2 2 ce v v b�(�., „ /e;i DISHWASHER 150 CITY �4.lntc► '�' L NO 9Z,5,Il1(6V CLOTHES WASHER 1 50 STATE �J/�%/elV CLASS LICENSE NO "] T 7� SWiM1,1ING POOL RECEPTOR 1 50 DISTRICT NO GRO ZONE P O SS BY I AWN SPRINKLER SYSTEM 2 00 © a O WA1ER HFATER 1 505� INDUSTRIAL V WASTE APPROVAL z j GAS SYSTEM OUTLETS 50 5o o INSPECTION RECORD 2 r OUTLFTS OVER' 3G 5 PER SYSTEM �A 50 Plan check fee 2)% of aboNe See reverse PLUNIBIN( PERN1IT ISSIIINC FI E 8 2 00 1 OTAL FF E (o SO APPROVALS DATE INSPECTOR 5 SIGNATURE Plan check applicant UNDER SLAB WORK Namc ROUGH PLUMBING Address GAS PIPING GAS VENT CIL) 1e1 No HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMB NSal*Uj5Afijg E WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST l� PLUMBING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 A THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE 4 RISE _TIAL PROPERTY FINAL SIGNATURE JACK R ALLEN SUPERVISIN MEC ANICAL ENG R OF PERMITTEE PERMIT VALIDATION rK M o CASH PLAN CHECK VALIDATIO CK M o CASH �� 3 0 2 ,6 ,- DEC 5 a 650- 76A667-CE817 3-59 APPLICATION FO PLLJMB�NG PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY D l SION BUILDING CASSAATT I) GHN A �RIFFINC Sup!of Buildmg LocALrn, FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS CITY TEL NO SHOWER LAVATORY CONTRACTOR SINS ADDRE S DISHWASHER CITY TEL No 1 Y/ CONTRACTOR Sv STATE LAUNDRY TUB REGISTRATION NO J COUNTY WATER HEATER " 61CTCLOTHES WASHER �10 GP ZO P CES ED BY GAS SYSTEM INDUSTRIAL ((�IjjJJ WASTE APPROVAL INSPECTION RECORD 0 $1 DOPER ITEM , / 6 a OR FIXTURE $ ! APPOVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2100 UNDER B WOR`k C Q It ,-HTOTAL FEE ROUGH PLUMBING /, v GAS PIPING 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES i LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST , IIIA CALIFORNIA OR THAT I M THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIA OPERTY UTILITY CO NOTIFIED I A 1111 SOF PTURETTE I I ' ' /1�1NI/ II1 11 FINAL /AI OF, LWATION ROBERT A WOOD \ r c:10/ ® 0 C"H SUPERVISING MECHANICAL ENG R LCo 2 5 5 3 SO JU,12 1 5 D 600, n 76A667A CE 6//(REV.6/76) ©i APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY tj FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS NUMBER FIXTURE OR ITEM @ FEE ^' 44 LOCALITY WATER CLOSET NEAREST BATH TUB CROSS ST -,ovzs SHOWER OWNER MAIL LAVATORY ADDRESS �.v G SINK CITY G TEL NO I? DISHWASHER CONTRACTS4,C6 w.I�Ii CLOTHES WASHER ADDRESS 4+w•tr SWIMMING POOL RECEPTOR CITY^ TEL,NO. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO z CLASS C� GAS SYSTEM ! OUTLETS .}_�� APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER Em PLUMBING FIXTURES („,b GAS TEST M. Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ C— ' TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDATION { Name Address City Tel.No, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION I HEREBY CER Y THAT(AM PROPERLY REGISTERED AND/OR LICENSED AS r REQUIRED BY LOS ANG ES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE " LEGAL OWNER OF,AND TEND TO RESIDE IN TH OVE DESCRI RESIDENTIAL PROPERTY. SIGNATURE OF PERMITTEE DISTRICT . /.' PR C SSED BY INDUSTRIAL WASTE APPROVAL WORKERS COMPENSATION DECLARATION CF 817 z APPLICATION FOR P L U M B I'N G PERMIT I hereby ;ff�-rr that I have a certificate of consent to self cE en (z eol insure or a certificate of Workers Compensation Insurance or d a certified copy thereof(Sec 3800 Lab C,) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company 1 u 0 Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDI UU c ADDRESS 7 ( WI n G % Certified copy is filed with the �bld�nspection NUMBER FIXTURE OR ITEM • FEE i m t WATER CLOSET LOCALITY Date Applicant NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS COMPENSATION INSURANCE SHOWER OWNER LAVATORYMAIL (This section need not be completed if the work involved ADDRESS l by the permit is for one hundred dollars ($100) or less) O SINK CITY TEL NO �' U I certify that in the performance of the work for which this DISHWASHER CONTRACTOR permit is issued I shall not employ any person in any manner O so asIto b o e subject to the km en ers sation Laws CLOTHES WASHER ADDRESS 3ko (� U &A64 aAle–Date` �C Applican SWIMMING POOL RECEPTOR a of )� d ek NOTICE TO APPLICANT If aft akin; this Certificate of CITY TEL NO QUe (n Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM STATE Q LIC // n(]/� Z Compensation provisions of the Labor Code you must forth LICENSE NO '01 IS' /� CLASS (C!O( /p1 with comply with such provisions or this permit shall be WATER HEATER deemed revoked GAS SYSTEM OUTLETS /DISTRICT NO P CESS BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER /G(/' I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi FINAL VAL DtATI N ness and Professions Code and my license is in full force and DATE effect g (� License Number 0 �V /4 Lic Class 36 By L Contractor Date I am exem from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051 Bus d iness and Professions Code) TOTAL FEE Q up Lic or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractors Address License Law for the following reason (Section 7031 5 Busi City Tel No ness and Professions Code) 2 0 Q 8 A I as owner of the property am exclusively contracting g��°°� with licensed contractors to construct the projectILI p �USP 3*a $I® 0 0 0 0 0 5 (Section 7044 Business and Professions Code) vi�� 6�•v 2 ° 01000 , CONSTRUCTION LENDING AGENCY v I hereby affirm that there is a construction lending agency o 0 0 Q O O v I for the performance of the work for which this permit is issued(Sec 3097 Civ C) 1 1 8—8 1 J� Lender s Name t i I Lender s Address I certify that I have read this application and state that the 1 1 above information is correct I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing and hereby 4 authorize representatives of this County to enter upon the above me ned pr p tyf r inspection purposes Signature otWiermittee Date