Loading...
HomeMy Public PortalAbout5122 BARELA AVE_Plumbing__ 76A667A(CE 817B)-11/76 - APPLICATION FOR PLUMBING PERMIT �s BUILDING AND SAFETY DIVISION j] FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING q /T V`�t'— NUMBER FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET LOCALITY a� N EAREST BATH TUB CROSS ST. SHOWER OWNERMAIL LAVATORY ADDRESS SI Z 2 SINK CITY -(G /e ej 41A, TEL.NO. ?X^'7'-�Cl7 DISHWASHER CONTRACTOR doh CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR 7 �J CITY C LAWN SPRINKLER SYSTEM TEL.NO. , z� STATE LIC. WATER HEATER LICENSE NO. CLASS GAS SYSTEM OUTLETS G/ ( DISTRICT NO. GROUP ZONE PROCESSED BY OUTLETS OVER ' t� U . S PER SYSTEM INDUSTRIAL WASTE APPROVAL 0 INSPECTION RECORD Iola u LOU Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE r Plan check applicant S APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address fV ROUGH PLUMBING c -1 Citycivl�l Tel.NO. -'3—Z2fp j GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOSANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL GAS TEST �- �Cf rr d ij' "-�•�;� PROPERTY. UTILITY CO.NOTIFIED SIGNATURE 40 - 79-29-, '7, OF PERMITTEE FINAL ti9-29 9�/�" /%? ' PLAN CHECK NVIDATION CK. M.0., CASH PERMIT VALIDATION CK. M.O. CASH 646'c"-SEP 7 5 1 0.500 Os • • w'WORKERS'COMPENSATION DECLARATION . APPLICATION FOR PLUMBING PERMIT I hereby affirm ,Shat I,have a certificate of consent to self 20-002Q DPW 6/87 insure, or a certificate of Workers, Compensation Insurance, 76A667A ' ora certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /I�� f r— r r— Certified copy is filed with the county building inspec- ADDRESS d � 7��1.� tion department. NUMBER FIXTURE OR ITEM @.n FEE LOCALITY Date Applicant WATER CLOSET 7 v NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSSST Tc G COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by MAIL SHOWER P ( ) Q© ADDRESS the permit is for one hundred dollars §100 or less. LAVATORY L 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.W-7 Q so as to become subject to the Workers'Compensation Laws. DISHWASHER n d CONTRACTOR f Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR 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 C/ 0 0 LICENSE NO, CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM 0 (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 .00 © FINAL �` VALIDATION DATE J ( / License Number Lic. Class CJ. FINAL Date BY 0 Contractor ❑ I am exempt under Sec. 5 LU B.&P.C. for this reason Plan check fee 10. Qa Date: AINT■T PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE C 52-433j IT EMS Plan check applicant +� SINGLE FAMILY TOTAL I(AL 1-5 2 13 HOME OWNER-BUILDER DECLARATION Name CHECK 152.13 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address CHANGE ■(.Ill Professions Code): City Tel. No. I, as owner of the property, will do the work and ther � structure is not intended or offered for sale (Section , 13010113-11311301 ..t/rn�t/ ( 7044, Business and Professions Code). OQ09 ! AM 7 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature-61 Permitlee Date