HomeMy Public PortalAbout9102 BROADWAY_Plumbing__ 7g A,667i CE 817 8/68 `
APPLICATION FOR PLUMBING PER IT
COUNTY OF LOS'ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUR.DING AND SAFETY DIVISION BUILDING • O
•1 JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS /j A ,4DWAY
COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY "" Z - c
O
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE �' ��
/ OWNER
WATER CLOSET l0
5 �1 �jj',�i _
BATH TUB 1.50 ODRESS y /la
SHOWER I.50 C17Y Lr 1ryTEL. NO. -1p` p
LAVATORY I." 0 CONTRACTOR /I
SINK 1.50 ADDRESS _
DISHWASHER 1.50 CITY TEL. NO.
CLOTHESWASHER 150 STATE LIC
LICENSE NO. - CLASS
SWIMMING POOL RECEPTOR 1.50
D`I TRICT NO. GROUP ZONE P C 9Y
LAWN SPRINKLER SYSTEM 2.00' J/ •F 6 U
WATER HEATER 1.50- INDUSTRIAL Z
WASTE APPROVAL o
GAS SYSTEM OUTLETS L50 INSPECTION RECORD w
OUTLETS OVER d
.5 PER SYSTEM .30. - vl
Z
Plancheckfee 2.5" of above. See reverse.
PLUNIBING PERMIT ISSUING FEF. S 2 00
APPROVALS YAT§ sP EToWs Ic ATURE .
Plan cheek applicant UNDER SLAB WORK /0
Name ROUGH PLUMBING
ArfdreSs GAS PIPING _
GAS VENT
City Tel. No.. HOT WATER HEATER
I HEREBYACKNOWLEDGE 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
PLV MBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY'REGISTERED ANO/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
SIGNATURE �
OF PERMITTEE - JACK R. ALLEN, SUPERVISING MECHANICAL ENG'R.
PERMIT VALIDATHJ CK. M.O_ CASH
•PLAN CHECK VALIDA ON CK. M.0. CASH
3 O o .120V 7 5 D 6.50
�7Gif�:G[�vot/
a'77MtS'COMPENSATION hve DECLARATION - 20 0026 APPLICATION
FOR PLUMBING PERMIT
Y here of utri that have'b certificate oPmnsent to self in- 76AM7 DPW 4/87 - P'i PY t� �y PERMIT -�
sale,.ora certificate of Workers-Com ensation Insurance;ora-' CE 81 7( '-
certified copy thereof (Sec 3800, Lab. C.). - � - -• - •
COUNTY OF lOS-ANGELES DEPT. OF. PUBLIC WORKS
Policy No. Com pa ny -
Certified copy is hereby furnished. i r
❑•-- FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
"Certified copy is filed with the county�bu (ding inspection ADDRESS
department: NUMBER FIXTURE OR ITEM Ca •FEE - -
-
Date Applicant WATER CLOSET(TOILET); NEAREST !/
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
' "COMPENSATION INSURANCE- I OWNER
SHOWER _
(This section need not be completed if the work involved by - MAIL 'o - v C V }
the permit is 4or.ona hundred dollars(5100),orlesz:) LAVATORY- ADDRESS •� •t,
I certify that in the performance of the work for which this.per- I - -
mit is issued, I shall;not employ any person in any manner so SINK CITY C TEL. NO..AS gk Z8'!
as to became'subject to the Workers'Com11pensat is Law . '. DISHWASHER - C/
�j�
CONTRACTOR >y r
Date.]_' q— gY_Applimc{v CLOTHES WASHER-
NOTICE TO APPLICANT: If, after making' is Ce'rtific'ate of Ex- t. ADDRESS,
SWIMMING POOL RECEPTOR
.emption,�you should become subject to the Workeri Compen- CITY TEL NO n ��'�'
sation provisions of.the Labor'Code, you must forthwith.comp- .LAWN SPRINKLER SYSTEM
.
ly'with.such provisions-or this permit shall be deemed'revok' STATE - - LIC
ed. WATER HEATER LICENSE NO. CLASS
.•
LICENSED CONTRACTORS DECLARATION ' DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS. /���r-s,
9(commencing,with Section 7000)of Division 3 of'the Business OUTLETS OVER - v< /
and Professions Code, and my license is in full force and ef- 5 PE SYET M FINALIV VALIDATION
feet. . . i- DATE
License Number -Lic.Class - - '
+s _ _ • FIN '- V
ContractorDate - BY ¢O
f
Iameaempt under Sec.
e.aPSG. for,this reason a
Plan check fee '
p Z
Date:' PLUMBING PERMIT� ISSUING FEES Q
Signature - 9 9.5 5'1-A
_ •' TOTAL FEE
SINGLE FAMILY ,a•e • • • 5
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License Name 650
,1
Low for the following reason (Section 7031.5, Business.and - - - •z..a'e &505
Professions Code): - _ . ' Address - - O�Si O 9"8 8
as owner of the property, will do the-work and the Ci)y .. Tel. No.
structure is not intended or offered for sole,(Section 7044, ,
Business and Professions Code). - D
CONSTRUCTION LENDING AGENCY - - - - - -
'+ I herebyaffirm that there is o construction lending agency for. S
the performance of the,work for which this permit is issued -
(Sec..3097, Civ: C.).
Lender's Name
Lender's Address ? -
1 certify that I have read this application and state that the - - -
above information is correct.I agree to comply with all County D -
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the •�+
ob ve-mentioned propertyL��r��rTP yctyi�ry put r use�sg. p. - - t Q,. ,T'./lLCO•" SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of PgAittee'' 'Date ..