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HomeMy Public PortalAbout9669 BROADWAY_Plumbing__ 76A667-CE617 3S9 APPLICATION FOR PLUMBING PERMIT, COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER / - BUILDING AND SAFETY DIVISION ADDRESS (,9 ,�, /-eRDWA IOHN A. LAMBIE. CountT Eagweer CASSAFT D. GRIFFIN. Supt of Ruilding LOCALITY FOR APPLICANT TO FILL IN xEARI;RTMP�� /T t 41.0NUMBER FIXTURE ORITEM CROSS ST. OWNER d WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY TEL. NO. LAVATORY CONTRACTOR � 5-41,001-i9 ,r�I,� �+ SINK ADDRESS Q Sr S( F'ISlvrr^ ' DISHWASHER CITY ,=,oV,0,0,o',# TEL. NO. 067.9 CONTRACTOR'S / STATE LAUNDRY TUB REGISTRATION NO. /�_7��90 COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP ZONE 9 I P CESSED BY WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD 0 4I.UO PER ITEM gE 7 �-7i /T 6 ©V APPROVALS IfLh'QK �yDATE INSPECTOR'S SIGNATURE PERMIT S 2100 UNDER SL WORK�/ !J - 4/ G ,/�/-.y/plJL-I tgflOn// TOTAL FEE L( �O ROUGH PLUMBING /. /7 'Z3'!ud (-t?T tea/A GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENTWITH ALL PLUMBING, COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER - CEN CERTIFY THAT I PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES > LICENSED AS REQUIRED BY ANGELES COUNTY AND TATE OF GAS TEST ��PRL �/ -61.1 /A , CALIFORNIA OR THAT HE LEGAL OWNER OF E ABOVE DESCRIBED RESIDENT[ ERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTE FINAL -�SFjO ✓ ®T r gUDATION ROBERT A. WOOD. M.0. CASH SUPERVISING MECHANICAL ENG'R Lf.Co 4 7 6 5 ALIG, 5 0 1 1 .010 �; ' 76A667 -CE#817 4-64 �fEti/.cLr C7- APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER q 66q m�aa BUILDING AND SAFETY DIVISION FDIJI ING JOHN A. LAMBIE. COUNTY ENGINEER ESSWILLIAM A. JENSEN. SUPT OF BUILDING LITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER P �, �A\ WATER CLOSET $1.25 MAIL BATH SUB 1.25 ADDRESS 6 SHOWER 1.25 Cin SEL. NO. LAVATORY 135 CONTRACTOR �eWnnu✓ SINK 1.25 ADDRESS DISHWASHER 1.25 CITY TEL. NO. CONTRACTOR'SZ, STATE ❑ LAUNDRY TUB 1.25 REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT . GR-O�U`P ZONE PROC SED BY WATER HEATER 1.50 _ S,, NOl �I GAS SYSTEM OUTLETS L50 SO INDUSTRIAL 6 WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD U O F- U W a N Z APPROVALS DATE INSPECTORS SIGNATURE '.PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL�FEE ` GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I 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 HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES [� LICENSED AS REQUIRED 81 LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO _ RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL VALIDATIOROBERT A. WOOD CK. - M,O. cASH 'SUPERVISING MECHANICAL ENG'R LN6o'b G 3 O m !-lAy 18 5 D 3.50- G ��9�i� TBI,66>-C E9817 5/63 APPLICATIO FOR PLIBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS iZ o i JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDINGLOCALITY / FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1,25 ADDRESS SHOWER 1,25 CITY TEL. NO. LAVATORY 1,25 CONTRACTOR �¢1 � SINK 1,25 ADDRESS .7 0DISHWASHER 1.25 1.25 CITY .. � •. p TEL. NO. �.. �J'� I-r LAUNDRY TUB 625 CONTRACTOR'S REGISTRATION NNO. I,S cl O I U COUNTY STATE El CLOTHES WASHER 1.25 DISTRICT NO. OUP ZONE P O ED Y WATER HEATER 1.50 ( 0 ©Q } CAS SYSTEM I OUTLETS 1'� `, D TRIAL WAASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 V INSPECTION RECORD a -- a z APPROVALS DAT/ INSPECTOR�'S 517-UinE 4 ' PERMIT $ 2 00 UNDER SLAB WORK ,J� - 3 c+; ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS PPLIC TION GAS VENT ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING, I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES I A LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST Q CALIFORNIA OR THAT 1 AM T LEGAL O NER OF,ANO INTEND TO I Ilk RESIDE IN,THE ABOVE DESC D RESIO IAL ROPERTY UTILITY CO. NOTIFIED r SIGNATURE OF PERMI FINAL G/Z VALIDATION ROBERT A. WOOD cn. M.D. CASH SUPERVISING MECHANICAL ENG'R ACO1 9 6 2G OCT 29 5 D 4.755- a xy WORKER'S COMPENSATION DECLARATION 20-0026 DPW PW 9,89 - APPLICATION FOR PLUMBING PERMIT I,hereby affirm that I have 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. BUILDING ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS &q MQAD department. NUMBER FIXTURE OR ITEM @ FEE. LOCALITYrj TV ' Date Applicant / WATER CLOSET +!"� NEAREST „- ,f r/ NEAREST. �� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB / L V COMPENSATION INSURANCE /`� ASSESSOR (This section need not be completed if the work Involved by the SHOWER J-v MAP BOOK 'Z PAGE PARCEL permit,is for one hundred dollars($100)or less.) LAVATORY OWNER Lk I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toSINK MAIL �� rj become subject to the Workers' Compensation Laws. ADDRESS 1 CJ DISWASHER CITY MA Dale Applicant CLOTHES WASHER C CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO. }C I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and STATE NO. CLASS O Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS V OUTLETS OVER DISTRICT PROCESSED BY 0 5 PER SYSTEM D Q License Number Liu Class � FINAL 2 X.ALIDATION UJI DATE Contractor Date d- L�. AIC .i rn ❑ I am exempt under Sec. FINAL B.&P.C.for this reason - Plan check fee D1 ITEE tIS 1 Date: PLUMBING PERMIT ISSUING FEE$ TOTAL '85 ' 65 Signature �� . . \ `.1 rHEC' ' _c `F. TOTAL FEE _HECK Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name -- -- I hereby affirm that I am exempt from the Contractor's License Law r 2/9-17 for the following,reason (Section 7031.5, Business and Professions Address 2 S'+ '� �. G Iil)I]Q�I]IJIl1 41 ''/Y` C�). City e 'Tel. No. ¢� '3 - ...._. . 4�)�l`'u 14 I, as owner of the property,will do the work and the structure q is not intended or offered for sale (Section 7044, Business 4t I OO�j `N 3 362.4 t^v and Professions Code). 1 / 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 �' r Lender's Address I certify that I have read this applicationd state that the above - D information is correct. agree to comply wit 11 County ordinances and State laws regulating Plum -1 an hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. J SEE REVERSE FOR EXPLANATORY LANGUAGE . 73 Signat a Of Permit ee Date ,