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HomeMy Public PortalAbout9123 BROADWAY_Plumbing__ 76 A 6 67 (CE-817)-4/72 APPLICATION FOR PLUMBING PERMIT {� COUNTY OF LOS ANGELES 11 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION a1AKe cHscxs PnrneLr r0! Aoo ESNs HARVEY T. BRANDT. COUNTY ENGINEER I OCALITY177 �` PY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST J a CROSS ST. NUMBER FIXTURE OR ITEM @ FEE / OWNER �jA, WATER closer 1.75 MAIL BATH TUB 1.75 ADDRESS SHOWER 1,75 CITY TEL. NO. LAVATORY 1,75 CONTRACTw /09—/ , SINK 1,75 DISHWASHER 1.75 / PLl ✓ CLOTHES WASHER 1.75STATE ' _ LIC I SWIMMING POOL RECEPTOR 1.75 LICEN NOCLASS 36 DISTRICT NO. GROUP ZONE FROC ESSED BY LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1.75 INDUSTRIAL y WASTE APPROVAL 1 GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD V OUTLETS OVER 5 PER SYSTEM .30 0 W G. N Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 DO TOTAL FEE ,S APPROVALS DATE INSPECTOR 5 SICN AruRE Plan Check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER I 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 PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REOUI RED BT LOS ANGELES COUNTY AND STATE OF y CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO / RESIDE IN THE ABOVE DESCRIBED RESIDENTI1 PER TT. FINAL ( /w U SIGNAT '. URE OF PERM I TT FF�.�• .�_—/ ..• �� PERMIT VALIDATION CK. M,D. CASH PLAN CHECK VALIDATION CK. M.D. CASH 1 ,LT" G n 6 .z N OGT 3 5 0 4.7 5� r ,'BAas;. APPLICATION FOR PLUMBING PERMIT 1 BBs"IT DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING ADORE JOHN A.LAMBIE. COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SUPT OF BUILDING —7— �T . ...-< -.: _. LOCALITY FOR APPLICANT XO FILL INNEAREST }��� CRO OWNER //� VWi'V DISTRICT NO. GEP ZONE READY FOR INSPECTION .. MAIL C ADDRESS INDUSTRIAL CITY EL. NO. WASTEAPPROVAL PLUMBER INSPECTION RECORD ADDRESS �f/~/ T�=d"C7R',6v f] P IA B TCS CITY TEL. NO.O'. l G _LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE u WATER CLOSET (TOILET) @ $1.00 $ 00o BATHTUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 O� ,KITCHEN SINK @ $1.00 ego' DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ $1.00 WATER HEATER @ $1.00 G SSYST, @ $1.00 41 APPROVALS DATEe INSPE CTOR'S SIGNATURE UNDER SLAB WORK ^Lt) ]� �y 1♦r _ PERMIT $ 7 00 ROUGH PLUMBING GAS PIPING TOTAL FEE BD GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY •'WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES f I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST �elrj� n�l Ate,.•_ LICENSED AS REQUIRED BY LOS ANGELS COUNTY AND STATE OF •- CALIFOftNIA OR THAT 1 'AM THE LE OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTI PPERTY. i I SIGNATURE OF PERMITTEE FINAL o5 / /I/f LA.,_-�� JOHN A. LAM , COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF P1-BG. INSPECTOR M.0. CASH 4 1 8 3 MAR 6 3 8.0 O N 6.0.3.17 25M SETS 2-47 1 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY 5] COUNTY OF LOS ANGELESPLUMBING l7 WM. J. FOX. CHIEF ENGINEER _ NATURE OF INSTALLATION DISTRICT O. GROUP ZONE �/CPERMIT ROUGH FIXTURES COMPLETE \J (� , �l •(/ �/ L READY FOR HEATER CESSPOOL I—IBEPTIC TANK RECEIVEDBY DATA Is UED FIRST INSPECTION /�Ja/�D- GAB MIBGELLANEOU6 APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY ' JOB C NAME ADDRESS E W ADDRESSL#7 4 LOCALITY J REST A CITY TEL.NO. ROBS ST. COUNTY% CERT.No. T NAME I PGT' LOCATION OF SEPTIC TANK, OR CESSPOOL' z MAIL 3 ADDRESS NORTH 0 ' CITY TEL.No. I AM THE LEGAL POSSESSOR OF THE ABOVE LOB ANGELES COUNTY CERTIFICATE OF QUALIFICATION. " PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED fit , I ABOVE. D • .3` • N OWNER 5. y 4i CORRECTIONS SOUTH DESCRIPTION OF WORK a Z _ BATH TUB FURNACE C7 ROWER —DISHWASHER �� D LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER '• FLOOR BINK SANDTRAP GLOP BINK FLOOR DRAIN LTOTALTIFEE ABH TRAY • —URINAL APPROVALS ATER CLOSET DRINKING FOUNTAINDATE INBPECTOR•0 NANEATER NEATER DENTAL LAVATORY ROUGN PLUMBINGETER:GA8 SODA FOUNTAINOAB PIPINO •�NLOOUTLGAS VENTCESSPOOLOTAL NUMBER OF FIXTURES � SEPTIC TANKESSPOOI REPTICTANK Qd SEWERUTIL{TY CO.NOTIFIED O vS 06.1 FINAL 96A667 DRB IV II-50 APPLICATION FOR PERMIT "DEPaARTMENT OF BUILDING AND SAFETY L -"0 N"' a ` COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER O. O . FOR APPLICANT TO FILL IN D ('ZONE PERMIT_ ( Off`7 PLUMBER _ RECEIVED BY READY FOR DATE ISSUED L FIRST INSPECTION APDRE99 Ii�A� � �h1,N BUILDING CITY A � („�� TEL. ND.�f}/ ADDRESS /A � A COU TY e C LOCALITY LICENSE NO. EXPIRES �JP�N Z NEAREST PERMIT FEES CROSS ST. / NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER O MAIL / WATER CLOSET(TOILET) @ 0.50 111I ADDRESS I BATHTUB @ 0.50 CITY ' TEL No. SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASHBASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT --ff AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER GAS SYSTEM OUTLETS @ D.50 Q OF THE RESIDENTIAL PROPERTY DEBC [BED OVE. SIGNATURE OF i - I WATER HEATER @ 0.50 PERMITTEF�� C _ SLOP BINK @ 0.50 INSPECTION RECORD r FLOOR SINK @ 0.50 FLOOR DRAIN (@ O.50 DISHWASHER @ 0.50 -r-" PGBI OCG DRINKING FOUNTAIN @ 0.50 dT GYN A--' A'-o URINAL @ 0.50 HOUSE SEWER @ 0.50 �� �. i.4Ti ea Z _Z MISCELLANEOUS O INA'//✓G n ii r N I � D � .'iGaJ� c/OitiT'J O .,40,0+APPROVALS DATE INBPEOTOR'B NAME ROUGH PLUMBING GAB PIPING OAS VENT CESSPOOL @ /.00 LOAS POOL SEPTIC TANK: IC TANK DRAIN ( ) PIT ( ) @ 1.00 R PERMIT 1.0 TEST Q V UTILITY CO. NOTIFIED TOTAL FEE FINAL �CN"_-��� `J y' /✓ L I / _S tr.ea7.t-CE 817 8/88 >r h APPLICATION FOR PLUMBING PER IT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMSIE. COUNTY ENGINEER ADDRESS �J.�„z ,� p COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY .— i FOR APPLICANT TO FILL IN (PR NT OR TYPE? NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER •'�.•% %� w, G WATER CLOSET I�JR �j MAIL BATH TUB 1.50 ADDRESS / SHOWER 1.50 CITY TEL. NO. 17 LAVATORY 115, 75- � CONTRACTOR 4 SINK 1,m 'ADDRESS DISHWASHER 1.� CITY LO. TEL. NO. C �Frt I.9g STATE / CLIC LASS - LICENSE NO.' _3 ,Mz S TOR IJ DISTRICT NO. ROUP 2 E P C S BY LAWN SPRINKLER SYSTEM 2.00 V WATER HEATER I.ryr�_L 7 WASTE AIAL WASTE APPROVAL_ �� Z GAS SYSTEM /Q OVTLETS 1. /INSPE ON RECORD OUTLETS OVER U 5 PER SYSTEM '301. h iivE;n LG � Z 3 _ �- Dr 7 Pl.vi check fec 2S o uI above. See reverse. I'L.UINI NG PERMIT ISSIIING VEE 5 00 TO :AL EEE —APPROVALS GATE I PECTO 5 GNATU RE f'Iml cberk n11lllir.nni UNDER SLAB WORK �7 -��. Name ROUGH PLUMBING Address GAS PIPING GAS VENT Cit} IeI. N, HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIE APPLICATION 'ANO STATE'TNAT'THE ABOVE IE CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL- COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED 71L• LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF.ANO INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY, FINAL SIGNATUREJACK R. ALLEN ' ANICAL ENG-R. OF PERMITTEE , SuERVI51MEC PERMIT VALID 1T O cK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH r r Li;LID 5 0 5 5 MR 2 M .5 62.25- Q' i ,B.aRTDEAPPLICATION FOR PERMIT PARTMENT OF BUILDING AND SAFETY 41, p COUNTY OF LOS ANGELES p V WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER LS/.�/ J � �q/ aaaccc REE// EI V)ED�BY READY FOR DATE ISSUED ADDRESS of 16 eQ4 a � it,# � Ji/��.J FI R/S�T' INSPECTION pg q 9— BUILDING CITY EL V mrg' TEL. NO! FU - %J1`�-w ADDRESS �.Q/♦,� L , (//�q�'1 01110 A/ COUNTY t ' EXPIRES . � �S LOCALITY Fi/'!P� `J rk/ LICENSE NO. yyr NEAREST �\ o P " PERMIT FEES CROSS ST. J/ a7 ) I'C}1���J/f //•�) ({�q J NUMBER /�/ TYPE OF FIXTURE OR ITEM FEE OWNER Ai S Fp/r vp/,tR./V Ort I�,lLF/1f•l A4" MAIL /WATER CLOSET (TOILET) ® 0.50 S 5�v ADDRESS .J M J BATH TUB Q O.SO CITY TEL. NO. SHOWER @ 0.50 1' HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 2. cm APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN). @ 0.50 AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND ' STATE LAWS REGULATING PLUMBING. /KITCHEN SINK ® 0.50 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, "Qft 1 A THE LEGAL OWNER OF THE RESIDENTIAL PROPER D/ESG IBEO ABOVE GAS SYSTEM-OUTLETS @ O.So SIGNATURE OF !� WATER HEATER @ 0.50 PERMITTEE SLOPSINK @ o.So INSPECTION RECORD FLOORSINK @ O.SO FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50I .DRINKING FOUNTAIN @ 0.50 t/URINAL (t 0.50 �i HOUSESEWER @ 0.50 G _Z MISCELLANEOUS V' 0 Q APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING G GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . I 1.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE S - '��j %: �.J O FINAL a'a /.?/ 76AG67-CE817 660 Il% / APPLICATION FOR PLUMBING PERMIT' I COUNTY OF OLOS ANGELES BUILDING AND SAFETY DIVISION BUDING, F 3 x-- O (mow JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN, SUVT OF BVIL..No LOCALCIY C( FOR APPLICANT TO FILL. IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER/fr. EIS u WATER CLOSET MAIL BATH TUB ADDRESS = 0 L CITY U' TEL. NO. SHOWER LAVATORY CONTRACTOR S Q, etu,� SINK ADDRESS / F Q DISHWASHER C!"sO. TEL NO.,y 7�I-11 CONTRACTUB 'S OG 5o COTTATE LAUNDRY TUB REGISTRATION NO. CLOTHES WASHER DISTRIaaCT,N/fj// GROUP Z NE ES BY WATER HEATER C C v v GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD I D U w r o a � I6 1. Yiee.: d .liduv-t I rn:s I / O $1.00 PER ITEM GAJ/7'i/Co� -,`L� 1�Ca-0 G,+I.�G. d�:CGS' / OR FIK7URE APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ $ 00 UNDER SLAB WORK / TOTAL FEEiM ROUGH PLUMBING V L, GAS PIPING M M 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES C / fir LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFGAS TEST IdWIL41 CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED I I� SIGNATURE OF PERMITTE FINAL �r &VALIDATION ROBERTI G WO D,� /� L� M.O. WB SUPERVISMECHANICAL ENG'R I .c6533 —� ;a,Y g 5 D 1400 �. 78AC" 17 S-AS ® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING I WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICTNO. GROUP ZONE PERMIT NO. PLUMBER N ��� ,s RECEIVED By READY FOR DATE ISSUED FIRST INSPECTION ADDRESS Q 2 /P GI(� r ��(('`CC BUILDING CITY /I� � //� TEL. NO. O� _ ADDRESS COUNTY /Ji LICENSE NO. / ^^ EXPIRES ��Q^�Q LOCALITY NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNERJ6$tf, { MAIL WATER CLOSET (TOILET) �y 0.50 5 ADDRESS SLI =O ,AT. TUB @ O.SOI CITY TEL. NO. SHOWER n O.SOI I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) 9-v 0.501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY.ORDINANCES AND KITCHENSINK (r;l 0.501 STATE LAWS REGULATING PLUMBING. - 1 CERTIFY THAT I POSSESS T AS E VALID LOS LAUNDRY TUB OR TRAY O 0.501 ANGELES COUNTY LICENSE. OR 1 M T LEGAL OWNER OF THE RESIDENTIAL BPPERTY CR AB VE. GAS SYSTEM OUTLETS C O.SOI SIGNATURE 0 /1// WATER HEATER rt 0.50 PERMITTEF SLOPSINK a 0.501INSPECTION RECORD FLOOR SINK (a 0.501 1 j� FLOOR DRAIN @ 0.501 ^Y I DISHWASHER © 0.50 T,4�i!`���'����'4✓�S^ � DRINKING FOUNTAIN 0) 0.501 URINAL 0 0.501 1 HOUSESEWER R 0.5011__ Z MISCELLANEOUS 1 o I�I I I APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING _ GAS VENT J CESSPOOL 011 1.001 CESGPOOL SEPTIC TANK: I SEPTIC TANK DRAIN ( ) PIT ( © 1.00 1 SEWER PERMIT. I.00 GAS TEST •r' Pi 1- //,, UTILITY CO. NOTIFIED TOTAL FEE 15 / I�(.l ` FINAL APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY. o T ' COUNTY OF LOS ANGELES Wm.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION 1 oISTRI NO. GROUP O PERMIT O. ROUGH FIXTURES COMPLETE IlV /J✓ s_ HEATER CESSPOOL —I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION 2 -4,, ASMISCELLANEOUS APPLICANT FILL I VILY OUTLINED //''PORTION ONLY JOB E NAME M. C. NO • ADDRESS I7T7 D ADDRESS 23 No. Clover y Ave. LOCALITY ' elrr TiMPLE CITT u N �~ o BBT. Pa R�1v P/i/L f�/;a! COUNTY CERT.NO. EXPIRES It - NAME / 114n L /LGTt T/ulX LOCATION OF SEPTIC TANK, OR CESSPOOL 2 MAIL 3 ADDRESS NORTH O ' CITY TEL.NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS . ANGELES COUNTY CERTIFICAi OP•QUALIFICATION. PPUMBER �/IA.I.L III AM THE LEGAL OWNER OF THE.PROPERTY DESCRIBED ABOVE. A 3 OW NEX CORRECTIONS SOUTH J DESCRIPTION OF WORK i BATH TUB FURNACE SHOWER DISHWASHER � LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR BINK SANDTRAP SLOP BINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I METER—GAS SODA FOUNTAIN OAS PIPING I I OUTL OAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I I ' CESSPOOL REPTICTANK l� SEWER I I S UTILITY CO.NOTIFIED I I TOTAL FEE FINAL 7.A96; 17 6-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER ' FOR APPLICANT TO FILL IN DISTRIC .NO. GROUP I ZONE PERMITN PLUMBER en, RECEIVED BY READYFOR DATEISSUED /q�//qq�-' - /- qq � �� J FIRST INSPECTION ADDRESS /a � /�' L�. G(�� !! ee BUILDING Y CITY TEL.TEL. .&" ��_.?//.. ADDRESS / A. „ad COUNTY LICENSE NO. EXPIRES LOCALITYtot NEAREST PERMIT FEES CROSS ST. /A,. A .Y.�AA/IIAMi w� iIY.{� NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL n WATER CLOSET (TOILET) Q 0.50 $ ADDRESS -�cl .. - BATH TUB rQ 0.50 CITY TEL. NO. SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) Cao 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. KITCHEN SINK CN 0.50 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE GAS SYSTEM OUTLETS Q 0.50 SIGNATURE OF WATER HEATER Q 0.50 PERMITTEE2!2 SLOP SINK n 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 _ FLOOR DRAIN © O.SO DISHWASHER @ 0.50 DRINKING FOUNTAIN (oJ 0.50 URINAL r@ 0.50 ..1 HOUSESEWER (n] 0.50 Q z MISCELLANEOUS U' a o I I APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( 1.00 SEWER PERMIT . 1.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE 5 / Sys �, S O FINAL /� d WORKERS'COMPENSATION DECLARATION APPLICATION FOR I�LY.irppl�ING PERMIT I hereby, affirm that I have a certificate of consent to self in- 40-0026 DPW 4/90 P'i P'i OCI PLUMBING �C� sure,ora certificate of Workers'Compensation Insurance,ora 76A667A certified copy thereof (Sec. 3800, Lob. C.) LIILJII' Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ti ❑ Certified copy is hereby furnished. BUILDING -/ F-1CertifiedAPPLICANT TO Flll IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS J V department. NUMBER FIXTURE OR ITEM @ FEE �- LOCALITY Date Applicant WATER CLOSET(TOILET) .NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 1 BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER tj�dol j(, (This section need not be completed If the work involved by AWL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 4(/ I certify that in the performance of the work for which this per- /L _ mit is issued,/I shall not employ any per�gn in any manner so SINK CITY y TEL. NO. as to becom sub ect to the Workers'Q mp soti n s. DISHWASHER CONTRACTOR Date Applicant / 'CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption,you should become subject to the Workers'Compen- / /' sotion provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS CITI� !j� �..J TEL.NO. ly with such provisions or this permit shall be deemed revok- STATE '�r LIC. ed. WATER HEATER LICENSE NO. L CLASS LICENSED CONTRACTORS DECLARATION DISTRICT 10. PR I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM. OUTLETS 9(commencing.with Section 7000)of Division 3 of the Business OUTLETS OVER _ and Professions Code, and my license is in full and ef- 5 PER SYSTEM FINAL �J �1 Ly/ALl TION fect. HOSE BIB DATE ''L-V � y License er 5 Lic. Class r_ CT i a O QCiJ/yy�)_��9 BY A` ', 3303 43.400 Contractor { am exempt under Sec. ITEM""+y 3 A KKKhhh T 0.8P.C. for this reason W t Plan check fee D - a CMNE 10 }e' PLUMBING PERMIT ISSUING FEE$ r27 30 .00 Signature TOTAL FEE Q LIuBB"OOOS1 m9.e9S SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check pli ant I - I hereby affirm that I am exempt from the Contractor's License Name . - Law for the following reason (Section 7031.5, Business and Professions Code): Address Q J _ ❑ 1, as owner of the property, will do the work and the CityTel. No. 0 structure is not intended or offered for sale(Section 7!4 , Business and Professions Code). Jr 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 D above information is correct. I agree to comply with all County ordinances and State laws 'regulating Plumbing, and hereby out ize repr entad sof this County to enter .upon the a. e- 6 d rty for inspection p ores Q �gr..J1.i c� a s ( 5 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of eermii eee-_ Date 'WLfirm $'COMPENSATION DECLARATION APPLICATION II ICA 4O®fall (�®IO P A A�AfClING PERMIT (firm ficateidove r ca' Comp of consent to self CE 817(R LW Ir I("IL 'bi`'i II . 0tl u NL Ir IL LLY8CU1lY 0�I PERMIT U'locLs II ^, in ure, o �a certificate oP Workeri Compensation Insurance, CE 817(REV. 8/88) �ul or a 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 Certified copy is filed with the county building iropec- - ADDRESS � _.3 E. n Ro'go(s/ lion deportment. NUMBER FIXTURE OR ITEM ®, FEE' LOCALITY Dale Appligant WATER CLOSETNEARESTS - ' CERTIFICATE OF EXEMPTION FROM WORKERS' - BATH TUB CROSS i. NO G COMPENSATION INSURANCE (This section need not be completed if the work Involved by SHOWER OWNER T' G bT LC' AA/ C (lt the permit Is for one hundred dollars $100 or loss. T MAIL' P ( J I LAVATORY L/ ADDRESS / L O W ' I certify that in the performance of the work for which this - permit is issued, I shall not employ any person in any manner SINK CITY-r r,?pl. ,y TEL. NO.. so as to become subject to the Workers'Compensation Laws. DISHWASHER �/�0QD�• /� CONTRACTORy Date 3-3o-87npplicont4.S.TsTf� ht[rN/ytlfv CLOTHES WASHER in A1.5 NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS 0 • ax 69-3 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY L/ L O TEL. NOC� ��S' with comply with such provisions or this permit shall be STATE LIC. �s deemed revoked. WATER HEATER 11 LICENSE NO. a CLASS G� LICENSED CONTRACTORS DECLARATION f/ DISTRICT NO. n PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS. �^ O (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER d and Professions Code,and my license is in full force and effect. 5 PER SYSTEMFINAL , _ V LIDATION O License Number 380 ��� Lic. Class ---3 or DATE LL V L/AA/5 CON "x_30_87 FIN JL O Contractor - Oore BY xup LL) ❑ I am exempt under Sec. - N B.BP.C. for this reason Plan check fee D �6 7 6 8 A Z Data: PLUMBING PERMIT ISSUING FEE.$ Signature # e e e e e 5TOTAL FEE Plan check applicant 1 . 13650 SINGLE FAMILY - e -136505 HOME OWNER-BUILDER DECLARATION Nome I hereby affirm that I am exempt from the Contractor's License Address 0 3.3.0-87 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 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 hove read this application and state that the D 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 3 -50477 ; Signature of Permittee Date - -