HomeMy Public PortalAbout5148 BARELA AVE_Plumbing__ 78A887.CEV817 9/89 001e7 � „
APP.LICATION - •FOR PLUMBING PERM .-
COUNTY' OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND 'SAFETY"DNISION 'BUILDING
JOFIN A.LAM IE,.COUNTY ENGINEER
WILLIAM'A.JENSEN,SUPT OF BUILDING
LOCAL1Tir Temple Cit
FOR APPLICXN.T TO FILL IN NEAREST.
ST: ,.Tem 1a Cit Blvd.
. .
'NUMBER FIV OR ITEM EACH FEE'. OWNEA :R. ,Tin91ey
WATER,CLOSE[ ;1.25
MRIL
BATHTUB ' . 1:25 ADDRESS. "Some
'Elle
SHOWER 1.25 CITY TEL NO.
LAVATORY 1,25 CONTRACTOR General Installation Co:.
R1Ns :. I.25 ADDRM 6558 Wes_t Blvd. '
DISHWASIMs 1.25 ciFY 'Los Angeles 'TEL..NO. PL 3-2541
CONTRACTORS: C46 151839 787 co TvATTE
LAUNDRY'TUB.' 1:25 REGIST.RATI.ON No.
CLOTHES WASHER 1'.25 'DISTRICT'NOG - D.6Y
l ,WATER,HEATER 1.50 ], ,5D "; 'Q ,{
GAS SYSTEM. OUTLETS. A'50 INDUSTRIAL . 0
WASTE APPROVAL.
OUTLETS OVER S.PER SYSTEM;, .90r
INSPECTION RECORD
U
WATER SOMNER Ready for Inspection Now p.
U.
APPROVALS - DATE INSPECTOR'S SIGNATURE
PERMIT E 2 06 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE I '3 517
GAS-PIPI;NG
'1 HEREBY ACKNOWLEDGE'THAT 1 HAVE READ THIB APPLICATION '\ -
AND STATE THAT THE ABOVE I8 CORRECT AND AGREE TO COMPLY OAS VENT R
WITH ALL COUNTY,ORDINANCES AND -STATE' LAWS REGULATING
PLUMBING.
HOT WATER HEATER j w
'
1 NEREBY CERTIFY THAT ,1 AM PROPERLY REGISTERED''AND/OR. PLUMBING FIXTURES' _
TEST
LICENSED'.'AS' REQUIRED,BY LOS ANGELES COUNTY AND STATE' OF'
CALIFORNIA OR THAT,[ AM THE LEGAL OWNER OF,AND INTEND TO GAS. I.� 6
RESIDE IN;THE ABOVE DESCRIBED RESIDEN L.P� UTILITY.C.O.NOTIFIED. ff' �•,�✓
r .
SIGNATURE 1 l
OF 4PERMITTEE
FINAL
ALIDATION ROBERT A.WOOD
CASH SUPERVISING MECHANICAL ENG'R
Leo .-:1 4Zoa' NO-V 16 5 0 3.50- V
WORKERS'COMPENSATION DECLARATION '20-00
tii K;reby,•affirm that I have a certificate7666
of consent to self in- 26 DPW 4/87 APPLICATION FOR PLUMBING PERMIT ;
7666676
sure,c�'cfsrtificate of Workers'Compensation Insurance,ora CE 817(REV.8/86)
►.ceotifiad copy thereof (Sec..3800, Lab. C.)
Policy No. : Company -COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Certified copy is.hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR-TYPE) L
Certified copy is filed with the county building inspection ADDRESS
' department: NUMBER FIXTURE OR ITEM . @ FEE LOCALITY -C-
WATER Applicant WATER CLOSET(TOILET) NEAREST C.
CERTIFICATE.OF EXEMPTION-FROM WORKERS' ' ., BATH TUB CROSS ST. .L kd f Z
'COMPENSATION INSURANCE . SHOWER OWNER
(This section need riof be completed 07the work involved by MAIL P q
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS �5�� E ^ 2Ya �" t {f��J^
I'certify thaf in the per'fbrmbnce of the workfor'which,this per- : SINK J
mi.Yis issued, I shall'not employ any-person.in any;•tndnner so �0 CITY 4 gg ��-
as'to become subject to.the Workers'Compensation Laws, ,DISHWASHER
_ - e,�•�• CONTRACTOR
Date L' Applicant. Y CLOTHES WASHER 0
' _ ADDRESS
,
NO.TIC.E TO.APPLICAN: :;If, after making this-Certificat of Ex- ;..SWIMMING POO(:RECEPTOR.
erriptioh;you should become subject to the'Workers'Compen- CITY:' +='. TEL. NO.,
sation provisions of the Labor.Code,you must forthwith comp- LAWN.SP.RINKLER SYSTEM
ly with such'provisions-or this.permit shall be deemed revok- STATE L'IC. '
ed. WATER HEATER UdENSE'NO. CLASS•
LICENSED CONTRACTORS DECLARATION DISTRICT NO ROLES ED B
I hereby affirm that-I am licensed under provisions.of.Chiipter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3'of the Business OUTLETS OVER CJ
and Professions Cbde, and my license is in.full force and ef- 5 PER SYSTEM: FINAL ALIDATION }
fect; DAT d -
License.Number Lic. Class (0j
FINA cc
Confrcicto'r "Date BY O
❑ I-dm exempt under Sec. W
B.&P:C.-for this reason . a
Plan cheek fee ► `—( z
Date: PLUMBING PERMIT ISSUING FEE$
Signature .TOTAL FEE
„` 'SINGL•E FAMILY Plan check applicant
'HOME.OWNER-BUILDER DECLARATION
(,,hereby affirm that I am exempt from the Contractor's License
Name ACCT■T
,Law for the following reason (Section 7031:5, Business and �� r€.°5C1
Professions Code):• Address : qq ITEM
,
I, as owner of the property, will•do�the work and'the' City Tel. No: 1 tT
structure is not intended or offered for sale(Section 704.4,
TOTAL 28.50
Business and Professions Code).
2850
CONSTRUCTION LENDING AGENCY , °
I hereby affirm that there is a coristruction lending agency for CHANGE' ■011 '
the. performance of the work for which this permit is issued
(Sec. 3097:.Civ.. C..).
fOOQ- 0171 11/14/8
L'ender's Name
Lender's Address• Ib0, 9 1
I certify that I have read this application and state that the. x '
above information is correct. I agree to comply with all County ,
r ordinances and State laws regulating Plumbing, and hereby
authorize representatives of-this County to enter upon the ;
a ve-mentioned pr rty for i spection'purposes.
SEE'REVERSE FOR-EXPLANATORY LANGUAGE
Signature of Permittee d7 Date _ ;