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Home My Public Portal About5540 BALDWIN AVE_Plumbing__ •76 A 6.67—CE 817 8/68 �f APPLICATION FOR PLUMBING �PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS. . . - COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY - FOR APPLICANT TO FILL IN(PRINT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1.50 f MAIL BATH TUB 1.50 ADDRESS SHOWER' 1.50 CIzi TEL. NO. r� �� LAVATORY 1.50 CONTRA OR SINK 1.50 ADDRESS DISHWASHER 1.50 CITY TEL. NO. CLOTHES WASHER 1.50 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE PROCESSED BY LAWN SPRINKLER SYSTEM 2.00 O WATER HEATER .1.50 �� INDUSTRIAL U WASTE APPROVAL o GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD �. OUTLETS OVER U 5'PER SYSTEM .30 - a v) I i Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE $ 2 00 TOTAL FEE r � APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING. City Tel.. No. GAS VENT HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 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 ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL . SIGNATOR JACK R. ALLEN, SUPERVISING MECHANICAL ENG-R. OF PE IT PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH WORKERS'COMPENSATION DECLARATION C. /_13 A5PnPLICATION FOR PLUMBING PERMIT affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified��c00opp�y��thher�reQQof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Po cy NR � . Y_ — Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county buildin inspec- ADDRESS NUMBER FIXTURE OR ITEM @ FEE tion department. LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY ' TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR �� Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR c � <� � CITY TEL. NO� Exemption, you should become subject to the Workers' / Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM �(9 7a with comply with such provisions or this permit shall be, STATELIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 00 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL 7VA ATION 2 DATE License Number 7 Lic. Class_ Q ` ��.� ® FINAL Contractor Date (f BY ❑ I am exempt under Sec. U B.&P.C, for this reason LLI Plan Check fee ► 0_' Date: PLUMBING PERMIT ISSUING FEE$ L S� ;26663A z Signature TOTAL FEEell) ISO # • • • • • 5 SINGLE FAMILY Plan check applicant • -,2250 HOME OWNER-BUILDER DECLARATION Name -• •2250 I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and 03. 12-87 Professions 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 , 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 above-menti net property r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date