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Home My Public Portal About6216 BURTON AVE_Plumbing__ 76A667-CE*817 2-66 APPLICATION FOR PLUMBING PERMIT COUNTY OF D DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS FjZ Co —Z COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY ��_ J-t P�� FOR APPLICANT TO FILL IN NEARESST.C:ROSS N NUMBER FIXTURE OR ITEM EACH FEE OWNER C. WATER CLOSET $1.25 1"L`U MAIL BATH TUB 1.25 ADDRESS JB CITY Spm �.k L. NO.�'�6SHOWER 1.25 LAVATORY 1.25 CONTRACTORSINK 1.25 ADDRES y�DISHWASHER 1.25 CITY L Z SEL. NO LAUNDRY TUB 125 STATE LIC LICENSE O. CLASS D11CLOTHES WABHEA 1.25 DISTRJLT NO. GRyLP ZONE PROCE WATER HEATER 1.50 ! / � y� GAS SYSTEM OUTLETS "So INDUSTRIAL y WASTE APPROVAL o_ OUTLETS OVER 5 PER SYSTEM .SO INSPECTION RECORD z O F- U w a y Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK TOTAL FEE 3 ROUGH PLUMBING GAS PIPING HEREBY ACKNOWLEDGE IS 1 HAVE READ GRE APPLICATION GAS VENT ANO STATE THAT THE ORDINANCES IS CORRECT AND AGREE E COMPLY WITH ALL COUNTY OROINANCEB ANO STATE LAWS REGULATING HOT WATER HEATER PLU MBIHG. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED qS REQUIRED B LOS E ES COUNTY ANO STATE OF GAS TEST CALIFORNIA OR THAT 1 A THE GAL OWNER OF,AND INTEND TO RESIDE IN. THE ABOVE D CRI ,RRESIDER L PROPERTY. UTILITY CO. NOTIFIED SIGNATURE %//// e OF PERMITTE /"I, FINAL VALIDATI JACK R. ALLEN cH. M.o. cgsH SUPERVISING MECHANICAL ENG-R. : "-' 8250 kDR28 5A 3.50- WORK affirm that I have a certificate DECLARATION APPLICATION FOR PLUMBING PERMIT surereby, affirm that have a certificate of consent to self ra 20-0026 DPW 4/87- �( sure, or a certificate of Workers'Compensation Insurance,ora CE 817(REV, 8/86) certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS - Policy No. Company Certified copy is hereby furnished. BUILDING ,n / FOR APPLICANT TO FILL IN (PRINT OR TYPE) `J Certified copy is filed with the county building inspection ADDRESS / department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' - BATH TUBCROSS ST. / `L COMPENSATION INSURANCESHOWER - OWNER (This section need not be completed if the work involved by MAIL � n fV the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS 2 U 1 1 certify that in the performance of the work for which this per q- i��/� mit is issued, I shall not employ any person in any manner so SINK CITY �J(t lVj TEL. NO.�r (1V as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS emption, you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR saCITY TEL. NO. tion provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM - ly with such provisions or this permit shall be deemed revok- STATE LIC ed. WATER HEATER LICENSE NO, CLASS LICENSED CONTRACTORS DECLARATION - D" ICT NO PROCESSED BY I'hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ✓/^ and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL S VALIDATION Y fact. DATE— License Number Lic. Class p FINA Contractor Date BY lj O oI am exempt under Sec. pj CL B.&P.C. for this reason Plan check fee - , to Date: PLUMBING PERMIT ISSUING FEE $ Q 'U Signature TOTAL FEE ' SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address ��.. :3 5171 1, as owner of the property, will do the work and the City Tel. No. { __rv,4C structure is not intended or offered for sole(Section 7044, - c / Business and,Professions Code). S 16 ry CONSTRUCTION LENDING AGENCY - ASS I hereby affirm that there is a construction lending agency for i"-d the performance of the work for which this permit is issued - G;.�.`•^-'�, a!_f_I (Sec. 3097, Civ. C.). Lender's Name -_:f_�f» 7 r r._,ry! Lender's Address .. �._ pt" yyo 11r 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 tl is County to enter up the - above enrtned property far spectl n purposes - � � — , SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee - Date