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Home My Public Portal About9834 BROADWAY_Plumbing__ °.B.S.- ° Z5M SETS APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFETY COUNTY OFF LOS LOS ANGELES Wm. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION D18TRi ANO. GROUP ZO E PERMIT NO. 8� a'S' �� 8 ROUGH FIXTURES COMPLSEPTICTANK READY ` y MISCELLANEOUS Y FOR NEATER CESSPOOL , RE IVDA BY DAT6188VED G � FIRST INSPECTION ��/Ty Y� GAB APPLICANT FILLS IN HEAVILY OUTLINED PORTION ONLLY- E NAMr�d�0-t4 T (/I�i 41 pljG�&171/�14 --'II' ''A?%(/�'Ll, 6AIDRWS-2 C� w f E ADDREBB,,,( ? �tI CiQ./'CA •'L.� ,(N •v�I LOCALITY O /1._ _ - / A C✓� 6/7 NEAREST A. CITY WT/y��L4,�1// TEL.No� y 3�p`� / CROSS ST. COUNTY CERT.No. ACJ 7—M-47 L-IA/7 EXPIRES C NAME EI LOCATION OF SEPTIC TANK, OR CESSPOOL = MAIL 3 ADDRESS NORTH O CITY TEL. IAM THE LEGAL POBBESSO O HE SOVE LOS ANGELES COUNTY CERTIFIC 1 ICION. PLUM OK AM THE LEGAL OWNER OF THE PROPEROK DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK z / BATH TUB V _FURNACE ED S! SHOWER DISHWASHER �AVATORY // REFRIGERATOR KITCHEN BINK V WATER SOFTENER FLOOR BINK SANDTRAP GLOP SINK FLOOR DRAIN WASH TRAY V URINAL APPROVALS WATER CLOSET P DRINKING FOUNTAIN DATE y y INSPECTOR'S NAME WATER HEATER V DENTALLAVATORY ROUGH � �UGH PLUMBING �f�7'`/ /'� METER_� CX GA8 SODA FOUNTAIN 9PIV1G I6- QL/_L�VI If OUTL GAS VENT I I CESSPOOL I I TOTAL NUMBER OF FIXTURES SEPTIC TANK I I C ESSPOOI SEPTICTANK SEWER 8 UTILITY CO.NOTIFIED TOTAL FEE o c FINAL 1' 25M SETS 2-47. APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES �� WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZO E PE4NO.s�HEATER MESSBPOOANE IUBIBEPTICROUGH FIXTURES OMPL�NKRECEIVED BY READY FOR DAFIRST INSPECTION GA9APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLYJOB NAME lid. �. NOT/T�INGHAM CO. ADDRESS 2 N 2 � . P /t,4-�t1a ADDRESS 12`� No. CIQverly Ave LOCALITY II..P/1/Y� y CITY TEMPLF, f'TTEY.�+Q.',�1.�.lF. NEAREST ST. COUNTY J7 ` CERT.No. EXPIRES m NAME - LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL ADDRESS NORTH O CITY TEL.No. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES CERTIFICATE OF-QYALiFICATION. PLUMBER 11 THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. P y OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK i BATH TUB FURNACE L7 rc SHOWER DISHWASHER O IAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER Ft ' FLOOR SINK SANDTRAP SLOP BINK FLOOR DRAIN WASH TRAY URINAL APPROVALS ALS WATER CLOSET DRINKING FOUNTAIN DATE INIPCCTOR'B NAME WATER HEATER DENTALLAVATORY ROUGH PLUMBING I I METER GAB SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I I _CESSPOO, SEPTICTANK O _SEWER 9 TOTAL FEE UTILITY CO.NOTIFIED �" FINAL I WORKERS'COMPENSATION DECLARATION 76A667A �I I hereby affirm that I have a certificate of consent to self CCSt7 w APPLICATION FOR PLUMBING PERMIT SUI insure,.or a certificate of Workers'Compensation Insurance,or - a ce'n/ff/ d o y thereof(Sec. 3800, df .C.) . fd}r' COUNTY OF LOS ANGELES BUILDING AND SAFETY Put Company � Q' Ce ifled co /i l -v' py is hereby furnished. BUILDING FOR APPLICANT TO FILL IN (PRINT OR Certified co 66 NUMBER FIXTURE OR ITEM O. FEE ADDRESS `J copy filed with the c my uil ifig ins Ction WATER CLOSET LOCALITY -- Date�..,C�� APPlicant y NEAREST f sir_+ j, V BATHTUB CROSS ST. J� F— CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL (This section need not be completed if the work involved ADDRESS by the permit is for one hundred dollars (5100) or less.) SINKtl CITY TEL. NO. 1 certify that in the performance of the work for which this DISHWASHER U permit is issued, I shall not employ any person in any manner CONTRACTOR--- so as to become subject to the Workers' Compensation.Laws. CLOTHES WASHER / e ADDRESS Date Applicant SWIMMING POOL RECEPTOR V NOTICE TO APPLICANT: If, after making this Certificate of CITY y pr - TEL.NO 7-7 d Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE - LIC. Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO. f /�Gsf9 - CLASS �"%V Z with comply with such provisions or this permit shall be DISTRICT NO. P OCESSED BV deemed revoked. GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION OUTLETS OVER (] hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 19 (commencing with Section 7000) of Division 3 of the Busi- FINAL f7^ �� VALIDATION ' ness and Professions Code, and my license is in full force and DATE C JX effect. �/ T �� FINAL ' License Numbe -�/� Lie. Class BY Contractor 1�'A! Date 6 �- /) ElI am exempt from the licensing requirements as 1 am a Plan check fee �a �CI 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 Lic.or Reg.No. Date Plan check applicant i HOME OWNER-BUILDER DECLARATION Name -I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section,1031.5, Busi- City Tel. No. I ness and Professions Code): - 1, as owner of the property, am exclusively contracting ;2 O g 0.8 A with licensed contractors to construct the project (Section 7044, Business and Professions Code). # a opo a etrj CONSTRUCTION LENDING AGENCY 2'a e 1 QO O 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 1 O,O 0 chi issued (Sec. 3097,Civ.C.). , Lender's Name oaz5—si Lender's Address 1 certify that I have read this application and state that the - above information is correct. I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances Band State Iws regulating Plumbing, and hereby authorize epresentati s of this County to enter upon the aUmteuilon d p rl!tyfor inspection purpos ' �r rinrof Permit Datal �.; WORKER,' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I;'�zieby a�ttirm that I have a certificate of consent to self 76A667A rt insure, or h certificate of Workers Compeascinav Insurance, CE817(REV. 10/8)) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT 70 FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- A � tion department. NUMBER FIXTURE OR ITEM C& FEE LOCALITY--r L Date Applicant WATER CLOSET D NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE I. SHOWER / U() OWNER- �n (This section need not be completed.if the work involved by O MgIL �V the permit is for one hundred dollars ($100) or less.) LAVATORY '� ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NOaY,5C723 so as to become subject to the War DISHWASHER CONTRACTOR � Dat licant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making t is art, c of Exemption, you should become subject to the Workers" SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIG. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. '`x/ Pao D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS xrV0r add(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FDIN E AL VALID ION d �t License Number Lic. Class- 0 FIN CJ. Contractor Date BY OC Ellam exempt under-Sec. h- U 8.8P.C. for this reason W Plan check fee D41 9.0 a' Date: # o e e e o � PLUMBING PERMIT ISSUING FEE$ I'e e 4 6 5 Z Signature - " TOTAL FEE . 0 0 46505 Plan check applicant Gal 0-86 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the CoMractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City t Tel. No. JWI, as owner of the property, will do the work and the structure is not intended or offered for sole (Section D 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, (Cv. 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 authorize representatives of this County to enter upon the above-me r ins e bn purposes. ' ///J/ n/ SEE REVERSE FOR EXPLANATORY LANGUAGE Sign--re e mlt(ee__ Date