HomeMy Public PortalAbout9448 BROADWAY_Plumbing__ F. D.B.S.-17 25M SETS iz-as APPLICATION FOR PERMIT ®
DEPARTMENT OF BUILDING AND SAFETY ®�®
COUNTY OF LOS ANGELES PLUMBId`p®0� '
Wm. J. FOX. CHIEF ENGINEER
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TURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO.
FIXTURES COMPLETE
CESSPOOL -I SEPTIC TANK RECFIV ED BY_ READY FOR DATE ISSUED
'y`�, FIRST IN6PEGTION 4
MISCELLANEOUS / � ��
,APELICANT FILL IN HEAVILY.OUTLINED
��PORTION ONLYJOB .
/yy��_/�i �fJ/' ADDRESS JS -(/ 1, LOCALITY2oN 'NEAREST
T ;N O CROSSBT/ �{ P/ 7a-O./ , EXPIRES T ¢ NAME
N OF SEPT C TANK, OR CESSPOOL 'z MAIL
ADDRESS
NORTH O / �L
CITY IJ TEL. NO
I AM THE LEGAL POSSESSOR OF) THE�ABOVQ LOB
ANGELES COUNTY CERT IPICATE�OR�pU ALIFICATIO
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBQO
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ABOVE. 1.
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CORRECTIONS
-SOUTH
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DESCRIPTION OF WORK r� l .-
ATH TUB' FURNACE/>JA CJ
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ROWER DISHWASHER O
LAVATORY REFRIGERATOR'
KITCHEN BINK WATER SOFTEN ER
FLOOR BINK SAND TRAP
LOP BINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS.
-WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME
WATER HEATER DENTALLAVATORY ROUGH PLUMBING
METERGAB
OUTL SODA FOUNTAIN GAS PIPING {{{
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GAB VENT I`
/ CESSPOOL
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TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOL SEPTICTANK SEWER I I
- I s I I
TOTAL FEE l UTILITY CO.NOTIFIED q I
FINAL �� L2J.� 1 ///,.M✓'�-�
WORKERS( e SATION DECLARATION APPLICATION .FOR PLUMBING PERMIT
I hereby-affi.,m thatt I have a certificate of consentto self 76A667,4! L�
,insure or'a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a cern ' d copy thereof ec. 38001 Lab. C.) COUNTY OF LOS,ANGELES BUILDING AND.SAFETY -
P❑olic12
y N 'Pony -
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county buil ing in,pac- FIXTURE OR ADDRESS
lion department. NUMBER �' FEE .
LOCALITN-
Date �--Z -Applicant 's WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST, -
COMPENSATION INSURANCE OWNER
SHOWER
,(This section need not 6e completed if the work involved by '
the permit is for one hundred ($100)or less.) , LAVATORY MAIL r-' 60c`
I certify that in the,performance of the work for which this - ADDRESS YG
permit is issued', I shall not employ any person in any manner 'SINK CIEL.
so as to become subject to the Workers Compensation Laws. DISHWASHER -
CONTRACT R
Date Applicant - - - - CLOTHES WASHER ADDRESS
/(
NOTICE'TO APPLICANT: If, offer making this Certificate of / � V
Exemption, you should become subject to the Workers'. SWIMMING POOL RECEPTOR Nle
Compensation provisions of the Labor Code, you must �
forth- CITY . 6l. 0. TEL N Y
with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM
STATELIC.
deemed revoked. WATER HEATER 0 LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. -PROCE BY ,
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 5-- o� _
(commencing with Section 7000) of Division,3 of the Business OUTLETS OVER C.�
and Professions Code;and licence is in.full force and effect: SPER SYSTEM DATE VALIDATION d
License Number Code;
V
FINAL
Contract to 7`Z BY - O
❑ I am exempt under Sec. - w
d
H
B.BP.C. for this reason Plan check fee ► Z
--Date:- PLUMBING PERMIT ISSUING FEE$' Q
Signature c
TOTAL FEE- . G So J///� {,LE��, < 2 4.27 A
Plan check applicant /�/•" �/ "' # e e'o e 05
SINGLE FAMILY
HO that I a ER-eUILDERmpt from
m the CATION Name GL.i - 2 e e j(a -0
I hereby affirm that am exemprfrom the Contractor's License P, // -
Law for the following reason (Section 7031.5 Business and Address .✓� ?j .n o o e.3.6.5 0 6
Professions Code): - - City Tel. No. r
El 0 7 0 2,=.8 4
I, as owner of the property, will do the work and the
structure is not intended ar offered for sale (Section pop.
CONSTRUCTION
Business and Professions Code). , .i. -
CONSTRUCTION LENDING AGENCY .. - . .
I hereby affirm that there is a construction lending agency for -he performance of the work for which this permit is issued
,(Sec. 3097, Civ. C.)�� (� - -
Lender's.Name r L/.� r��c
Lender's Address
I certify that I have read this application and state that the
above information is correct: I dgree is comply"with all County
ordinances and State lows regulating Plumbing, and hereby _
authorize representatives of thisCounty to enter upon the
abov encned ro eR�.>f4r inspection purposes. -
�rLLJJ � SEE REVERSE F.OR-.EXPLANATO RY.LANGUAGE _
Signature of Permittee Date