HomeMy Public PortalAbout5142 BARELA AVE_Plumbing__ 76 A 657 — CE 617 7-69 l
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APPLICATION FOR PLUM ZING P MIT
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(PR NT-OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE ,
OWNER
WATER CLOSET 1.50 MAIL
BATH TUB 1.50 ADDRESS
SHOWER 1.50 TY EL. NO. _ Q
LAVATORY 1.50 CONTRACTO
SINK , 1.50 ADDRESS
.DISHWASHER 1.50 CI - l L. NO.•
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. /. CLASS
SWIMMING POOL RECEPTOR 1..50 - DIS ®._l GROUP ZONE P O BY
LAWN SPRINKLER SYSTEM 2.00 Q u /i�
r
WATER HEATER 1.50 INDUSTRIAL O
WASTE APPROVAL V
GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD z
OUTLETS OVER
5 PER SY TEM •30 ` 0
uj
z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address - GAS PIPING
GAS VENT
City. Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I 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.
1 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 RES NTIAL PR RTY. FINAL -
SIGNATURE ' JACK R. ALLEN, SUPERVISIN " HANICAL ENG'R.
OF PERMITTEE- -
PERMIT VALIDATION CK. M,O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
E P..fs 4 2 f i6c":2' vid,30 fl 3.50
i
., • d WORKVR3'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
r-hepoyrdffitm t a-14 hgve a certificate of consent to self 7BA887A ✓I I
• insure, or q certito'te'of Work'b.rs'Compensation Insurance, CE 817(REV.8/88) ILII
or a certified copy thereof(Sec.;3800,•Lab. C.)
Y- - COUNTY OF LOS"AN:GELES DEPT. OF PUBLIC WORKS'+.'
Policy No. Company
.Certified copy'is liereby;furn!shed. -
BUILDING,
FOR APPLICANT TO FILL IN(PRINT OR TYPE) q "•� '
❑ Certified copy is filed with the county building inspec- ADDRESS'
NUMBER FIXTURE OR ITEM.'; ® 'FEE
tion department. LOCALITY
WATER CLOSET d r
{+'•',
.Date 'APPli�gnt i� .CROSS ST:'' ``': �?''
CERTIFICATE OF EXEMPTION.FROM WORKERS' . BATH TUB _. �"
COMPENSATION INSURANCE , OWNER
(.This saefiodnead naf•be completed iF.the workSHOW
.involved by,'. .ER t OS u
fhe.Perr iif is for one hundred dollars($100)or less.) LAVATORY r' / ADDRMAILESS
Vicertjfy that in*the performance of the'.wbrk.for which this r,
permit is issued;I shall not employ any person in any manner SINK CITY . ,TEL.NO
so as to become,subject.id the Workers'Compensdtion Laws. DISHWASHER ��'
i CONTRACTOR ,
p CLOTHES WASHER r'
Date�, �' �' ppltcanf .' .. ADDRESS
NOTICE TO APPLICANT: If,'affer-making this. Certificate of SWIMMING POOL RECEPTOR ' !
Exemption, you shbuld become subject to the Workers' CITY TEL.NO: -
Conipensation.provisions`of the Labor Code, ,you must forth- LAWN.SPRINKLERSYSTENI It
with comply with such provisions or this permif shall be r STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION ' i DISTRICT NO. r_ CP �E BY
I hereby affirm that i am•licensed uhder provisions of CKapter 9 GAS SYSTEM- OUTLETS Ver /jii"
(commencing with-Section 7000)'of'Division 3 of;the Business OUTLETS-OVER
and Professions Code,-and m license is in full-force and effect. - 5;PER SYSTEM
Y FINALVALID ION V
DATE.
License Number Lit. Class
FI O
BY,
F^
Date
Contractor _ _ . .. _ .. -• .. .�
❑-�'I am exempt under'Sec. 0.
Z
B.BP.C, for'this reason
Plan check-fee:,
Date:
PLUMBING PERMIT ISSUING FEE$
Signature
'TOTAL FEE SO
Plan check applicant '
SINGLE FAMILY '
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt•from.the Contractor's License Address -
Law for.the following reason (Section 7031.5,,.Business and
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 -
70", Business and Professions Code):
�729,9A
' 'CONSTRUCTION LENDING AGENCY + `
I hereby offirm'Ihat there is a.cohstruction lending agency for #,•,• • ;ip 5
the performance of the work.for'whic.k this permit Is issued
(Sec. 3097;civ. C.)� : w• 58.5 0.
Lender's Name '. 5 8 5 0'
Lender's Address 0 6 22 87
I•certify that'I,have'read this.application and state Ihot 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 e-hter upon the
above-mentioned property for inspection purposes.. SEE.REVERSE FOR EXPLANATORY LANGUAGE
SigriaturE� ermit a Date /