The URL can be used to link to this page

Home My Public Portal About9560 BROADWAY_Plumbing__ .T.6R15 , L] CG REV.6/781 • APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE] BUILDINGT NUMBER FIXTURE OR ITEM ® FEE ADDRESS ',1 Zj LOCALITY 4• WATER CLOSET .172 �F/t NEAREST BATH TUB CROSS ST. 7"- SHOWER - OWNER LAVATORY MAIL ADDRESS SINK �l CITY ei' TEL.NO.ZIY3 DISHWASHER CONTRACTOR ( ' v CLOTHES WASHER ADDRESS'- \ vq SWIMMING POOL RECEPTOR CITY TEL NO. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. CLASS GAS.SYSTEM OUTLETS APPROVALS DATE INSPECTOR'A SIGNATURE OUTLETS OVER UNDER SLAB WORK S PER SYSTEM ROUGH PLUMBING ' GAS PIPING - d GAS VENT V 0 HOT WATER HEATER 1� PLUMBING FIXTURES U GAS TEST N Plan check fee UTILITY CO.NOTIFIED z PLUMBING PERMIT ISSUING FEE$ '2 TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDATION Name Address , City Tel.No. - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECTAND AGREE TOCOMPLVWITH ALLCOUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 23 89.3 A I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED PNP/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE # 0 O O O 0 5 LEGAL OWNEROF.AND INTEND TO RESIDE IN THE ABOVE DESCRIQ D RESIDENTIAL .p ,(�, PROPERTY. L O O 1 Q O O SIGNATURE (� OF PEftM ITTE .O 0 O 1 QOOU DISTRICT hOL PR sseD.Bv o4, 1 91-79 INDUSTRIAL - - - WASTE APPROVAL - 76 A 667—CE Si] 8/68•_ APPLICATION' FOR ' PLUMBING. P MIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING,AND SAFETY DIVISION BUILDING /O JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS (d COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY 7 �. FOR APPLICANT TO FILL IN(PR NT OR TYPE) cno"sSsst. �G NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1.50 MAIL BATH TUB 1.50 ADDRESS A5 4 SHOWER 1.50 CITY TEL. I LAVATORY L50 CONTRAC A SINK 1.50 ADDRESS �(�` DISHWASHER 1.50 CITY ✓ - TEL. NO: CLOTHES WASHER 1.50 STATELI ' LICENSE NO. A CLASS SWIMMING POO[, RECEPTOR L50 DISTRICT NO GR IO E PROC ES D BY a LAWN SPRINKLER SYSTEM 2.00 7s l • U / WATER HEATER INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.50w INSPECTION RECORD 5 PER SY STRM �• ,� Z Plan check fee 2546 of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 00 TOTAL FEE APPROVALS DATE rNSPECTOR's sIGNATV RE Plan chCCk applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City' Tei Nc. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWSREGULATING GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I A THE LEWL OWNER OF,AND INTEND TO //TT RESIDE IN. THE ABOVE DE BIDED RESIDENTIAL PROPERTY. FINAL p� r SlGNA TUMI !✓Y L,�% ^ JACK R. ALLEN, SUPERVISING MECHANICAL EN G'R. OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH PLAN_ CHECK VALIDATION CK. M.O. CASH l.iva u 8 7 N t ? 1 4 5 D 4.7 5— v WORKER'S that14veacNSATIONDECLARATION 76A611DPW9/69 APPLICATION FOR PLUMBING PERMIT 6A667A I hereby aiflrm that I fiave a certificate of consent to self insure. , or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) - COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. - 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 inspection ADDRESS department. NUMBER FIXTURE OR ITEM � F4 FEE LOCALITY l Dat plicant qWATER CLOSET NEAREST CERTIFICATE OF EXE ION FR6 WORKER CROSS ST. f BATH TUB COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as to SINK MAIL become subject to the Workers'Compensation Laws. ADDRESS DISWASHER CITY TEL.NO. Date 1 �ppplicant W CLOTHES WASHER I N CE TO APPLICANT: It, aper mak' g this Cer]ji a of CONTRACTOR Exemption,you should become 2>11ject to We Workers'Coirpthsation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS ..--G provisions or this permit shall be deemed revoked: L 7 AWN SPRINKLER SYSTEM , LICENSED CONTRACTORS DECLARATION CITY / TEL.NO. l p I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER j/� s a�/ a (commencing with Section 7000) of Division 3 of the Business and STATE LIC. Q Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. �� CLASS V OUTLETS OVER DISTRICT NO. PROCESSED BY Cc ��/ 6 PER SYSTEM �["Od� O License Number 6 / �i Lia Class FINAL VALIDATION a DATE Contractor h' / ate �y �/ FINAL _I Z I am exempt under By B.&P.C.for this reason a Plan check fee �7 Date: Signature 'ry PLUMBING PERMIT ISSUING FEE$ t� 7.!_ .j�11]i" CI ' ❑ TOTAL FEE C 7+� _ Plan check applicant jl1`hi- 39 - :30 SINGLE FAMILY `.F'��s; et�e 11 HOME OWNER-BUILDER DECLARATION Name - 1 hereby affirm that I am exempt from the Contractor's License Law /� e, -- r for the following reason (Section 7031.5, Business and Professions Address l.hi�l'K-_ , h Code): ❑ City Tel.No. I,as owner of the property,will do the work and the structure j o C?2 is not intended or offered forsale (Section 7044, Business (,IL!-Il`I�I t �-/��}y and Professions Code). D 111--50 $ All J:O CONSTRUCTION LENDING AGENCY I - 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.) Leader's Name Lender's Address 1 certify that I have read this application and state that the above - D 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 p poses. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign re of ermine Date . •WOthatI.SCOMPENSATION ateofconsentto 20-0026 DPW 9169 APPLICATION FOR PLUMBING PERMIT ll 0-0026 I hereby affirm that I have a certificate of consent to sect insure, or a certificate of:Worker's Compensation Insurance, or a'certifietl copy thereof(Sec.3800 Lab. C.) .. - COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OFPUBLIC.WORKS DIV. Policy No. Company - _ - v , •4 , ❑ Certified copy is hereby furnished.. r,❑ BUILDING _ FOR APPLICANT TO FILL IN OR TYPE), - gDDRE55 Q� Certified copy is filed with the county building.inspection� ' department: ,. NUMBER FIXTURE OR ITEM ® FEE - . - - LOCALITY Date u Applicant • WATER CLOSET / NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. - COMPENSATION INSURANCE ASSESSOR (This section neednot be completed If the work,involved by the SHOWER - MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) LAVATORY - j OWNER I certify that in the performance of the work for which this permit MAIL is issued, I shall not employ any person in any manner so as to SINK _ ADDRESS - - become subject to the Workers' Compensation Laws. DISWASHER CITY TEL NO, Cat CLOTHES CLOTHES WASHER - . NO ICE TO APPLICANT: R, 3�r ma i g this Cer l c e of CONTRACTOR/,AM zfe- ZD 1 5 Exemption,you should become subject to the Workers'Camp sation SWIMMING POOL RECEPTOR a1 Zee, �� provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CfTY n TEL.N0. 1- WATER HEATER �n `�' > a hereby affirm thatSe am licensed under provisions u Chapter 9 STATE LIC. O (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. �� CLASS U Professions Code,and my license is in full force and effect. /� OUTLETS OVER DISTRICT NO. y� PROCESSED BY O License Number h/�Zzl k le/-l Lia Class S.r _ 5 PER SYSTEM O C»_ =i— U FINAL VALIDATION ll! 1 ;L - DATE - d Contractor G V Date b��i•� (q ❑ am exempt under Sec. FINAL r ? BAP.C.for this reason V - Plan check fee D r•(i' ' s Date: - - r_•_•. .r PLUMBING PERMIT ISSUING FEE$ 75 ryl j _ Signature - --•r - TOTAL FEE_ �a, �s i 1(ME. Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name - r•. rn � C". 1 hereby affirm that I am exempt from the Contractor's License Law �u�t for the following reason,(Section 7031.5. Business and Professions Address \ Code): ❑ City Tel.No. - I,as owner o5 the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business D ;(F "i-(%!"j�_(1• './'i'� lo, J{`I', 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 1 have read this application and state that the above D 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 1 property for inspection rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE' Sign t e of Perralded7 Date