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Home My Public Portal About9523 BROADWAY_Plumbing__ D.B.S:17 PSM SETS 11-46 APPLICATION FOA PERHIIT COU DEPARTMENT OF BUILDING AND SAFETY [PLUMBING� 91 COUNTY OF LOS ANGELES Cl WM.J. FOR. CHIEF ENGINEER rR TURE OF INSTALLATION LDSTRI NO. GROUP o e P RMIT NO. FIMUREB COMPLETEBBPTICTANK REApY FOREC IV D✓BY FIRST INSPECTION DATT3 ISSUED MISCELLANEOU 1 A) APPL�IC/A�NT FIL�LL�IN HEAVILY OUTLINED PORTION ONLY JOB ADDRESS 60 {S" LOCALITYCv,� /' Q R1 !'1'/ [t I cNo9i T.N .,YoEXPIRESryAMEN OF SEPTIC TANK, OR CESSPOOL z MAIL 3 ADDRESS NORTH O CITY TEL.No. I AM THE LEGAL PO EBSOR OF THE ABOVE LOS ANGELfiB COUNTY CHRTIF! TE OP OUA FICAT�ION. / PLUMBER1 AM THE LEGAL OWNER OF T�fEPROPERTY DESCRIBED ABOVE. owrvew CORRECTIONS c_ V? r< o� Pel- SOUTH eNSOUTH J DESCRIPTION OF WORK z z BATHTUB it FURNACE L7 SHOWER DISHWASHER D IAVATORY REFRIGERATOR KITCHEN SINK —WATER SOFTENER FLOOR SINK BAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY ✓ URINAL APPROVALS' WATER CLOSET ✓ DRINKING FOUNTAIN DpATe�fi �Irv+apECTOw'6 NAME WATER HEATER 6-� DENTAL LAVATORY ROUGH PLUM BINE I✓�'f/ �n I C' a"CvS METER—GAS &ODA FOUNTAIN [ /- OUTL GAS PIPING �S` '2� �� ✓4h3 GAB VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK ' CESSPOO, &EPTICTANK � U_ O SEWER B UTILITY CO.NOTIFIED TOTAL FEE / 00 FINAL D.B.S.-17 asM sETa c-as 'APPLICATION FOR.PERMIT (DEPARTMENT OF BUILDING AND SAFETY - COUNTY_OF LOS ANGELES �`� � � ' Wm.J. FOX,CHIEF ENGINEER fHrAR TURE-O INSTALLATION DISTRICTNO. GR ouP zo E ��'PP REMIT O. 'FIXTURES COMPLETE - / 1 •`mT�J • CESSPOOL, SEPTI0.TANIC - RE IVED BY READY FOR �,DAT6168UED FIRSTINSPECTION SUMISCE .A/PPPLICANT F�IL/L IN H�E�AVILY OUTLINED`PORTION ONLYJOB /,// I/{(/M> � A1/f.IZ�2��/A V+le<l ADDRESSS (p p LOCALITYNEAREST (jl //�(r(9..Li(,p TE�NO: .C��D.Z • CROSSST.S-N L� EXPIRES �W�/ -�d- NAME. J'OF SEPTIC TANK, OR CESSPOOL '3 MpoAEBe 9/V/I— NORTH O' ,/,/ ,( . .CITY !.! U TEL. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFIfy� F gUyLIFICATION. /I 1// g•V/17''' PLUMBB�ER 1 AM THE LEGAL OWNER OF THE.PROPERTY DESCRIBED ABOVE.- , •�� ' a _ i y - OWNER CORRECTIONS SOUTH _ J DESCRIPTION OF WORK a z BATH TUB. . FURNACE ❑_ - WER 'DISHWASHER. _ _ ❑ ---/—LAVATORY REFRIGERATOR KITCHEN SINK :WATER SOFTENER FLOOR BINK. SANDTRAP - GLOP SINK FLOOR DRAIN WASH TRAY URINAL. APPROVALS ---LWATER CLOSET. DRINKING FOUNTAIN - DATE INSPECTOR'S NAME WATER HEATER DENTALLAVATORY ROUGH PLUMBING METER 26AS SODA FOUNTAIN OUTL GAB PIPING GAB VENT I I ' [/ p} CESSPOOL I I TOT AL NUMBER OF FIXTURES -/ [, � SEPTIC TANK I I CESBPOOI ' REPTIC,TANK SEWER - 8 TOTAL FEE UTILITY CO.NOTIFIED' I -I - - '•FINAL WORKERS'COMPENSATION DECLARATION 7GA667A I hereby affirm that I have a certificate of consent to self icEen (z-ea) APPLICATION FOR PLUMBING PERMIT insure, or'a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800, ab.C. COUNTY OF LOS ANGELES. BUILDING AND SAFETY Policy No. Company TEMPLE- Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Certified opy is filed with Oa county building inspection NUMBER FIXTURE OR ITEM OFEE. de t e � LOCALITY ;.. _ / WATER CLOSET Date 'c-Applicant NEAREST BATHTUB CROSSST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER )MAIL /��j (This section need not be completed if the work involved LAV ATORV ADDRESSIY 0y. by the perm 'i5 for One hdrldred dollars (SI00) or less.) SINK CITYT LZV TEL. NOa 3V•-T3 O wh 1 certify that in the performance of the work for ieh•,this•- DISHWASHER 1CC permit is issued. I shall not employ any person in any manner - CONTRACTOR O so as to eco a subject to the Workers' Cu_mpensation'Laws. CLOTHES WASHER U .{�1J ADDRESS Date_Y SWIMMING POOL RECEPTOR W NOTICE TO APPLICANT: If, a ter making this Certi -nate of CIT e.,AC TEL NO. Q-'070 Z 'Exemption, you should' become subject to the Workers' LAWN SPRINKLER SYSTEM Compensation provisions of the Labor Code, you must forth- STATE LIC. r _ CLASS with comply with such provisions or this permit shall be WATER HEATER LICENSE NO. � p' deemed revoked. GAS SYSTEM OUTLETS DISTRICT T NOy../ PRO ESSEDBY LICENSED CONTRACTORS DECLARATION _ OUTLETS OVER Seo rr I hereby affirm that I.am licensed under provisions of Chapter 5 PER SYSTEM - 9 (commencing with Section 7000) of Division 3 of,the Busi- FINAL yr-,� VALIDATION ness and Professions Code, and my license is in full force and DATE effect. FINAL r License Number'sl S C Lic.Class' BY 'VI Contractor S'.d— Date � � ' F1I am exempt from the licensing requirements as f am a - Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and-Professions Code). TOTAL FEE 1,2. SID Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address \ .License Law for the following reason (Section 7031.5, Busi- City Tel.No. ness and Professions Code): 1, as owner of the property, am exclusively contracting - - 3 9 1 A with licensed contractors to construct the project ,q!�q (Section 7044, Business and Professions Code). 11-121.1.4gr p"#1 e e 5 t CONSTRUCTION LENDING AGENCY T1' Z 5 O hereby affirm that [here is a construction lending agency ��{aq fop, @Ee W' tltl e for the performance of the,work for which this permit is e s e 2506 issued(Sec. 3097,Civ.C.). ,C,,ib GGG""" Lender's Name 05, 12-82 Lender's Address - 1 certify that I have read this application and-statethatthe . aboveinformation is correct.I agree to comply with all County. .SEE REVERSE FOR EXPLANATORYANGU AGE - ordinances'and State laws regulating Plumbing, and hereby - authorize representatives of this County to enter upon the - bove-mentioned property for inspection prpos s. S�gratmc of Permittee Dae .