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HomeMy Public PortalAbout9921 BROADWAY_Plumbing__ D.S.S:Io 35M SETS 1106 APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFETY PLUMBING 1 ' COUNTY OFF LOS LOS ANGELES WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRSI NO. ROU O E PERMIT O... ROUGH FIXTURES I� COMPLETE 'V J� �Y 7 '��� / READY FOR HEATER CESSPOOL SEPTIC TANK RECEIVED BY DATE 188U ED // p/� FIRST INSPECTION /_�_ �^ GAS MISCELLANEOUS �/`/L/� �% APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY �F�NAME3 /'I P!_U4« If C1.FCM1C JOB Co. ADDRESS c - � . c � LOCALITY(fCA V C CITY PIC TEL.NO.} ^l'//9 CROBB BT. COUNTY S' Q y, NAME CERT.No. T"O.7 / IXPIRES LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRE8e NORTH O CITY TEL.No. IAM THE LEGAL POSSESSOR OF THE ABOVE LOB ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. % OWNER '1 CORRECTIONS SOUTH J / DESCRIPTION OF WORK i BATH TUB FURNACE 13 SHOWER DISHWASHER D / LAVATORY REFRIGERATOR KITCHEN BINK WATER SOFTENER FLOOR SINK SANOTRAP GLOP OINK FLOOR DRAIN ___Z__WASH TRAY URINAL APPROVALS / WATER CLOSET DRINKING FOUNTAIN DATE IneveeTOR'•MwM¢ / WATER HEATER DENTAL LAVATORY I �- �'_ y p I ✓ e h S � ROUGH PLUMBING / METEIIL GA8 SODA FOUNTAIN I I •1 / OUTL GAB PIPING GAS VENT I I CESSPOOL I I SEPTIC TANK I I TOTAL NUMBER OF FIXTU RES r i I I CESSPOOL SEPTIC TANK SEWER Ic 77 B C C UTILITY CO.NOTIFIED TOTAL FEE FINAL D.E.S. 17 25N SETS '-" APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY �. COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER PLUMBING NATURE OF INSTALLATION DISTRICT NO. GROUP ZO P RMI NO. ROUGH FIXTURES 11-11_SOMPLETE �5_ 'f �Q�>J HEATER I_I CESSPOOL SEPTIC TANK RECEIyP� BY READS FOR DAT 8 GAS MISCELLANEOUS �/}L(� FIRST INSPECTION APPLICANT y/FILL �I/NHEAVILY OUTLINED PORTION ONLY JOB K NAME ©. lA1 \ O�CJ�.WI.J ADDRESS m ADDRESS Z `Ly \\1�-.ai+R. LOCALITY f p � }-- LAREST y CITY `(_X -y'&"q TEL.No. CROSS ST. 1 J p�k COUNTY CERT.No. EXPIRES W 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 COUNTY CERTIFICATgg..,,OF GUALIPIC TION. PLUMHHR 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. % OWNER y CORRECTIONS SOUTH J DESCRIPTION OF WORK i BATH TUB FURNACE SHOWER DISHWASHER D LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SANDTRAP GLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTALLAVATORY ROUGH PLUMBING I i METER GAS SODA FOUNTAIN GAS PIPING ( I OUTL pAS VENT I I CESSPOOL If.- o I �.r � Qer 4 TOTAL NUMBEROFFIXTURESSEPTIC TANK I I CESSPOOI SEPTICTANK 00 SEWER I S � UTILITY CO.NOTIFIED OI I TOTAL FEE / d FINAL 7GA667-CE0817 4-67 APPLICATION FOR PLUMB ' G PER , T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BuILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS Si J NUMBER FIXTURE OR ITEM (EACH 51.25 FEE OWNER J WATER CLOBET MAIL BATH TUB 1.25 ADDRESS SHOWER _ 1.25 CITY TEL. NO. LAVATORY 1,25 .CONTRACTOR SINK 1.25 ADDRESS DISHWASHER 1.25 C / TEL. NO. �, — 6. LAUNDRY iUB 1.25 STATE LIC LICENSE NO. CLASS CLOTHES WASHER 125 ,D�rrI,,STRICT NOy GROUPI ZONE j PROCE�S(g/D�/B�V WATER HEATER 1.50 i GAS SYSTEM OUTLETS I.50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD O}. O U C O U W d h Z_ I � APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT JS Z 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE ,J� GAS PIPING HEREBY ACKNOWLEDGE THAT RAVE RETOLiCAT10N GAS VENT ANOSTATE THAT THE ABOVE IS CORRECT AND COMPLYWITH ALL COUNTY ORDINANCES ANO STATE ULATING HOT WATER HEATER ^LUMBING.HEREBY CERTIFY THAT 1 AM PROPERLY RAND/OR PLUMBING FIXTURES LICENSEDAS REQUIRED BY LOS ANGELES COUSTATE O GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER TEND TRESIDE IN. THE ABOVE D SCRIBEO RESIDENTIAL PUTILITY CO. NOTIFIED SIGNATURE / A OF PERMITTEE / FINAL 6VALIDATION JACK R. ALLEN 1 IT o. CASH SUPERVISING MECHANICAL ENG-R. 33. 5 9� .FEB 19 5 .D' 350- • , 76A667-CE817-11-57 APPLICATION FOR PLUMBING PERMIT co DEPARTMENT OF COUNTY ENGINEER - -- BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Evg neer ADDRESS CASSATT D. GRIFFIN, Sup t of Building LOCALITY x.. . ` FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM WATER CLOSET OWNER MAIL HATH TUB ADDRESS SHOWER CITY TEL. NO. LAVATORY CONTRACTOR SINK ADDRESS DISHWASHER CITY NO.� LAUNDRY TUB CO RACTOR'S �J STATE REGISTRATION NO. Q Z COUNTY ❑ CLOTHES WASHER DISTRICT NO, GROUP ONE READY FOR INSPECTION WATER HEATER --.I/— 19 GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD APPROVALS @ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE OR FDCTURE $ O UNDER SLAB WORK PERMIT $ �, 00 ROUGH PLUMBING TOTAL FEE QQ GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - GASVENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES TY AND STATE OF CALIFORNIA OR THAT I AM TH N R OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL PROP SIGNATURE FINAL d OF PERMITTE ROBERTA. OOD. ®F VALIDATION SUPERVISINGIMECHANICAL ENG'R CK. Y.O. CASH LACO 5 5 1 0 P OCT 6 5 A 6.0 0 M WORKERS CI have COMPENSATIONDECLARATION of corse yU C. c&t7A APPLICATION FOR PLUMBING PERMIT {� I hereby-affirm that I have a certificate of consent to self ]6A667A u Insure, or a certi Sicate of Workers' Compensation Insurance, CE 817(REV. 10/81) or crcernfied.copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company . rt ified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Er Certified copy is filed with the county building inspec- ADDRESS do department. NUMBER FIXTURE OR ITEM @ FEE t LOCALITY WATER CLOSET Dale � Applieant r '� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' � BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less,) LAVATORY MAIL ,�,. ADDRESS I certify that in the performance of the work for which this ,.+. -� r permit is issued, I shall not employ any person in any manner SINK CITY C 7 TEL. NO. _ 7 so as to become subject to the Workers'Compensation Laws. DISHWASHER '®t �? / _ %✓ CONTRACTOR VZ�C/ Date Applicant CLOTHES WASHER ! ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR � ��� � ) y / Compensation provisions of the Labor Code, you must forth- CITY /7 µf'e�/c- 9' TEL. NO. / �/ with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM K. STATE D LIC. deemed revoked. WATER HEATER LICENSE NO. .1110? (OOV LICENSED CONTRACTORS DECLARATIONDISTRICT O- PR ERRED BY I hereby affirm that I am licensed under provisions of Chapter 9 a GAS SYSTEM OUTLETS a O (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is,in full force and effect. 5 PER SYSTEM FINAL VALIDATION \License Number 22-O Y B 2— tic. Class C 2 0 DAT 0 0 FI L U. Contractor O 91 )001reb )VVY te ZO—/6—S'G 0 I am exempt under Sec. F U B.BP.C. for this reason LU Plan check fee , n. D tiJ PLUMBING PERMIT ISSUING FEE$ /� Sd Z Signature - TOTAL FEE SINGLE FAMILY Plan check applicant r HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® 2 5 6 9,0 A 7044, Business and Professions Code). e e o 0 0 5 CONSTRUCTION LENDING AGENCYTA 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued / 1— 1 (Sec. 3097, Civ. C,). z / T� - e o o 16505 Lender's Name S,3�a �� ( 0 17 Y 8 6 Lender's Address I certify that I have read this application and state that the '. � .�� ► 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 4gntate ioned praperly fo�r '{sp c" purposes. //,�✓ SEE REVERSE FOR EXPLANATORY LANGUAGE Perini e(f a Date