Loading...
HomeMy Public PortalAbout9844 BROADWAY_Plumbing__ - 17EMPLE CE y1_, , APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER Hu1LD¢aG BUILDING {�uT��P yC rII�FETY IVISION ADDRESS ////���Q� V JOHN A. LkMN IE C.OU NTY NGINEER ; ` 5,/ ` �/ WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN WIT. NUMBER FIXTURE OR ITEM OWNS WATER CLOSET �l L vL ADDRESS E T O19Ri.al' HATH TOB SHOWER CITY frJ/�� CIT NO. T - D LAVATORY CONTRACTOR SINE C ADDRESS DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE ❑ LAUNDRY TUB s REGISTRATION NO. COUNTY ❑ CLOTHES WARNER DISTRICTT NO. GROUP ZONE P OCESSED BY WATER EIRATER �Cr{� GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD n O U C O H U W 4 y Z • 11.00 PER ITEM OR FIXTURE S 7 APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 1 00 UNDER SLAB WORK TOTAL FEE ��� ROUGH PLUMBING z GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 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 PLUMBING. HOT WATER NEATER IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL ',�1 ®• )VALIDATION ROBERT A. WOOD. cE./ •.o. CASH SUPERVISING MECHANICAL ENG'R 7BA667-CE817-1157 ANP PF os A TION FOR PLUMBING PERMIT cou1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BDDA55 fJ IOHN A. LADm1E. Cuunty En '•ue,r , CASSATT D. GRIFFIN. Sup tot Building LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. ���" •=N �a�`r NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS y SHOWER CITY I/ TEL NO. LAVATORY CONTRACTOR SINK ADDRESS v DISHWASHER CITY Y/L ,�fJ, TEL. NO.DX-J3�6 LAUNDRY TUB CONTRACTOR'S STATE REGISTRATION NO. (�`j{7 COUNTY CLOTHES WASHER DISTRIC('T�10: GROU ZONE -RSADra�eur� WATER HEATER V �� CI C► ICA' 7 GAS SYSTEM INDUSTRIAL WASTE APPROVAL 1 INSPECTION RECORD APPROVALS @ $1.00 PER ITEM DATE INSPECTORS SIGNATURE / OR FIXTURE $ / UNDER SLAB WORK PERMIT $ L OO ROUGH PLUMBING TOTAL FEE e GAS PIPING GAS VENT 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER L COUNTY ORDINANCES AND STATE LAWS REGULATING . PLUMBING FIXTURES Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF IA OR THAT I AM THE LEGA OWNER OF THE ABOVE UTILITY CO. NOT[FI ED RESIDENTIAL PROPERTY. REM ITTE FINAL ROBERTA.WOOD. ©� VALIDATION SUPERVISING MECHANICAL ENG•R CK M.0. CASH i ',.C� 8 7 r 3 0 5 ,A 3.0 0 «>. WORKERS,COMPENSATION DECLARATION APPLICATION FOR PLUMBING. PERMIT Thereby, afhrmrthat I h6ve�a certificate of consent to'self in- `76A667 DPW:4/8] - E 817 � sure,or a certrficate of Workers'Compensation Insurance,ror a E 817 EV. 8/86)' certified,ca t ereaf (Sec.3800�ab. ` Poli No .J"/� ( r7` o'n- eo� e��C�UNTVOF LOS ANGELES _ - DEPT OF PUBLIC WORKS Certified copy is hereby furnished FOR APPLICANT TO.FILL IN (PRINT OR TYPE) BUILDING 'F. Certified ropy is jiled with the my buil inspection - ADDRESS., deport, t NUMBER FIXTURE OR ITEM @; - FEE 1 WATER CLOSET (TOILET) - LOCALITY Dale A'ppliwn - NEAREST- CERTIFICATE OF EXEMPL 'FROM,W K S' BATH TUB CROSS ST. e 'COMPENSATION INSURANCE F '• SHOWER.. - '-' - - - OWNER _ .(This section need not be completed if the work involved by, MAIL the pemit isfor are hundred dollars (5100)or.less.) LAVATORY r ADDRESS I certify that in the performance of the work for which Ins per- SINK mil is issued; I shall not employ any person in any rnanne rso CITY TEL. NO.` Gas to become subjecYtorihe Workers' Compensation.Laws. DISHWASHER - - - - CONTRACTOR O )� Date `Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT Ifyafter making this Certificate of.Ex: SWIMMING POOL RECEPTOR empiior you should become subject to the Workers Compen- CITY i TEL. NO,7�6�1! scition provisions of the Labor Code, you must'forthwith comp- LAWN SPRINKLER SYSTEM Vwith such provisions or this permit shall be deemed'revok'' STATE / C!) Uc . q ed. t - WATER HEATER _ LICENSE NO. �i( �`J (. CLASS L- LICENSED CONTRACTORS DECLARATION - 'D Rlci juo. PROCESSED BY , I hereby affirm that,l am licensed under provisions of,Chapter GAS SYSTEM OUTLETS Q� T N -9(commencing with Section 7000)of Division 3 o the Business OUTLETS OVER fe�,Professions Code, and my license is.in full f e grid ef- SPER SYSTEM - FINAL VALIDATION i a _ .�- DATE �(' License NumbA917 / lic ClasO Contractor ate QF "'I a R. ptl �pdsrr e - _ Q a Bi for this reason Z"•' Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE - ' .. SINGLE FAMILY '+.0 z'8 5.7 HOME OWNER-BUILDER DECLARATION Plan checkappli�anf ' I hereby offirri I am exempt from the Contractors License ..Name - Low for the,following reason (Section 7031.5, Business and '( o �a 1 6 5 0.. Professions Code):' Address. 0 j, as owner, of the property, will-do the work abd the City - - •Tel. No. structure Is not intended or offered for sale(Section 7044, 87 - ` Business and Professions Code) '. - .' _ CONSTRUCTION LENDING AGENCY - - I herebg affirm that there is a construction lending agency for the performance of work for which this permit'is issued - (SI 3097, Civ. C.). - - - - Lender's_Ndme- Lender's Address - - - FI certify that I have read this;app]ication-and state that the .D above information is correct. Iagree to comply with all County ` or antes and State-laws regulating uih rn f - entotives of this�County.to enter upon the - ' bo' ed property for inspection SEE REVERSE FOR EXPLANATORY• LANGUAGE T not re of PV ittee LAATION 20-0026 ON 1 hereby affi mOtthatHI h veMa certificate of conse t to self insure, 76A6 7A PW 91 89 APPLICATION FOR PLUMBING PERMIT � or a certificate of Workers Compensation Insurance, or a certified copg thereof(Sec.3800 Lab.C.) t 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 G �• ��o y�C J ❑ Certified copy is filed with the county building inspection ADDRESS 7 q department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �y Date Applicant WATER CLOSE NEAREST C CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 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($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as tot' MAIL SINK �. (j ✓ became subject to the Workers' Compensation Laws. .ADDRESS � � A. -d DISWASHERCIT � TEL.NO Date /r —23-VA licam� � � PP CLOTHES WASHER CONTRACTOR ,ta NOTICE TO APPLICANT: If, after making this Certificate of `17W Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS/ ! / provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM (9 t0 /P �T S. / LICENSED CONTRACTORS DECLARATION .CITY I !V I rr TEL.NO y G I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER O (commencing with Section 7000) of Division 3 of the Business and STATEGAS SYSTEM OUTLETS LICENSE NO. C LIC.CLASS / / Q 3 {p-6�- L b U Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED BY OUTLETS OVER ([ c / 5 PER SYSTEM License Number 3 a Lic.Class L-3 G� O FI""` / VALIDATION W E�w .� I ✓O: . ;� a Contractor Cl(0 to DATE 93. (n ❑ I am exempt under Sec. FINAL V AL '71 h - �`Z ?n B.BP.C.for this reason S IT!EI NS Date: Plan check fee D - - TOTAL 72 -75 . m r PLUMBING PERMIT ISSUING FEE$ c Signature �td (J 1_HEC-K - ?r ❑ TOTAL FEE - {.hHN!�= Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I'IlIlI -��I i I hereby affirm that I am exempt from the Contractor's License Law �=%1 '21„4%'i._ for the fallowing reason (Section 7031.5, Business and Professions Address - Code): 1405 P AN ':>rl_f ❑ City Tel. No. I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). D 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 I have read this application and state that the above D information is correct. 1 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 purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date .