HomeMy Public PortalAbout6022 BURTON AVE_Plumbing__ 7GA667 •CE#817 4-64
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 6022 Burton
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
San Gabriel
FOR APPLICANT TO FILL IN
NEAREST
CROSS 57. 9
NUMBER FIXTURE OR ITEM EACH FEE OWNER
2) WATER CLOSET 51.25 2 50 MAIL
l� BATH TUB 1.25 1 25 ADDRESS
SHOWER 1.25 J CITY TEL. NO.
LAVATORY 1,25 2 O CONTRACTOR JOSe h Cad i l l i Plumbing
r�
SINK 1.25 1 2r5
111111 7821 E . Garyey Avenue
DISHWASHER 1.25 1 25 "S . n Gabr i e 1 TEL. NO.CU 32842
i CONTRACTOR'S STATE ❑
/ LAUNDRY TUB 1.25 1 . 25 REGISTRATION NO. COUNTY
CLOTHES WASHER 1.25 1 25 DISTRICT NO. GROUP ZONE P OCES'SE,D BY
r WATER HEATER 1.50 1 0
1.50 1 50 INDUSTRIAL
1 0-
-GAS SYSTEM OUTLETS 0
WASTE APPROVAL �
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD V
C
0
H
V
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a
w
Z
APPROVALS ATE NSFEqtTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK S/
A e
ROUGH PLUMBING 5
TOTAL FEE 0 GAS PIPING
1 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 HOT WATER HEATER
PLUMBING.
1 MEREST CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES l
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I Abn THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN. THE ABOVE D//F�/SRIBED RESIDENTIAL PRO T�. UTIL TY CO. NOTIFIED
SIGNATURE ! / �H.• (/�
OF PERMITTE �[�
FINAL
VALIDATION ROBERT A.WOOD
cK.
N.0. CASH SUPERVISING MECHANICAL ENG'R
L 9 9 4�4,G� R 2 6 5 A 1 7.50'
--pppp FOR
PLUMBING
�p p p/�p1� pp�a PERMIT WORKERS'COMPENSATION DECLARATION APPLICATION FOR Ir IL WltBtltlIDING IrERMIT
I hereby, affirm that I have a certificate of consent to self in- 76A667 DPW 4/90
sure,or a certificate of Workers'Compensation Insurance,or a 76ArM7A
certified copy thereof (Sec.-mpa Lob. C.)
- /yy/ COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS [IILJII
Policy No. �� Company �7UL�Kl"/ t��ltts/�
Certified copy is hereby furnished. -rem"
Certified co is filed with t c unt building FOR APPLICANT TO.FILL IN (PRINT OR TYPE) - BUILDING
copy y g inspection ADDRESS l&AQ.T IG
d/eportme t. NUMBER FIXTURE OR ITEM @. FEE LOCALITY
Date�Applicant WATER CLOSET(TOILET) NEAREST
CER IFIC TE OF EXEMPT ROM WORKERS' n
BATH TUB CROSS ST.
COMPENSATIO IN RANCE SHOWER OWNER L ,1��
(This section need not be completed if the work involved by A ^P
the permit is for one hundred dollars ($100)or less.) MAIL
IAVATORV ADDRESS ,�f
1 certify that in the performance of the work for which this per- - SINK. - CITVS 9 TEL. _
mit is issued, shall not employ any person in any manner so -' - I
as to become subject to the Wo ompensation.Laws. DISHWASHER r L' CONTRACTOR ���^T T�
d&M
Date App is CLOTHES WASHER ADDRESS 1`34 Ja Vf C"p0jet A
NOTICE TO APPLICANT: If, offer int this CertWorkers'
Ca of Ex- SWIMMING POOL RECEPTOR �p��
emotion,you should become S ect to the Workers'Co comp- CITY `/'ICK=N A TEL NO. )
lotion provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS v
ly with such provisions or this permit shall be deemed revok- _ STATE LIC.. ^�
ed. WATER HEATER LICENSE NO. 6 CI.455 C-9
LICENSED CONTRACTORS DECLARATION - DISTRICT NO. PROCESSED BY
r� I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS "l_ ✓-
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER '�P"�"c.�
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fect /�1��.� � HOSE BIB DATE -�(3y. ,SO a
icense Number 30(0U Lic. Class=SLC/` O
////��� .sy,�..�� FINAL
Contr�Tr����a"`yt mr.La'�y ate - BY
6
1 am exempt under Sec.
B.BP.C. for this reason Plan check fee D - w
Date. PLUMBING PERMIT ISSUING FEE$ GE Q Z
Signature TOTAL FEE
SINGLE FAMILY applicant
Plan check a
HOME OWNER-BUILDER DECLARATION PP� _
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.51 Business and
Professions Code): - Address '..1 •^-
1, as owner of the property, will do the work and the City Tel. No. Iilt4b7
structure is not intended ar offered for sale(Section 7044, y j i l Y. 1 - 85Business and Professions Code). -�
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
Li t4f,t =ii
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
1_i Lirlt i-i�if{.i
Lender's Name - _ 4-'.O
Lender's Address
I certify that I hove read this application and state that the .D
above information is correct. I agree to comply with oil County
ordinances and Stole lows regulating Plumbing, and hereby
authorize represen'a"ves of this County to enter upon the
bove-me t'ene r eprSt inspection urposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
• nature of Per it ee - Dote