HomeMy Public PortalAbout6240, 6242, 6246 BURTON AVE_Plumbing__ ✓ DEPARTMENT OF COUNTY ENGINEER I L u 5w B 0 m G
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER A ADDRESS �Z�Z 1\Ir1Y`TC71'1
FOR APPLICANT TO FILL IN LOCALITY
BUILDING CROSS r� / `�q NEAREST
ADDRESS 2Z4�// CROS$
e
DISTRICT N0. GROUPTZONE c' PERMIT N0.
LOCALITYNEAREST
/
CROSS ST. V� ` RECEIVED BY Randy far Inspection DAT`E ISSUEb
OWNER I� s 1 !-1_A-M
MAIL �/ �' ✓'f 1/�/ WASTE INDUSTRIAL I
ADDRESS /. 2-444 �'{��y��]" WASTE
CITY 544qd,6rrac_P TEL.NO.f476 A a 4 -7 INSPECTION RECORD
PLUMBER
ADDRESS � - -
t CITY TEL.NO.
p STATE
LICENSE NO. O COUNTY J
PERMIT FEES Q
z
o' NUMBER TYPE OF FIXTURE OR ITEM FEE Q
/ WATER CLOSET(TOILET) ® 0.80 S �—D/O Et
BATH TUB @ 0.80 x O O
SHOWER @ 0.80
/ LAVATORY (WASH BASIN) @ 0.80 C�
KITCHEN SINK @ 0.80 _
LAUNDRY TUB OR TRAY @ 0.80
SLOPSINK @ 0.80
FLOORSINK @ 0.80 4
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
T URINAL @ 0.80 _
GASSYSTEM-----I.......OUTLETS @ 1.00 / r70 •
WATER HEATER @ 1.00 _
MISCELLANEOUS _
APPROVALS
DATEp� INSPECTOR'S SIGNATURE
UNDER SLAB WORK IA /1*W
PERMIT f1 00 ROUGH PLUMBING
TOTAL FEE ZIAGAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES V—/
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED i
ANO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE\OF CALIFORNIA OR�THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE �
OFPERMITTEE..............._......_.._.........._.._.........._......_.._.._.._.._.._..... n
FINAL —14'-d r
70A667 UBS 17 1/53
OB5.17 3.99 APPLICATION FOR .PLUMBING .PERMIT
S.II
DIVISION OF BUILDING AND SAFETY
Department of County Engineer ..
County of Los Angeles BUILDING ��� '�� ,,`,
WM. J. FOX. COUNTY ENGINEER ADDRESS y 2.`-ICL 1141: N IST' 1V
CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST ' r
1/ CROSS ST. '/ 1-1-0 WV 7/
OWNER Y )AIL / I- .1 `�7 -{/'C./ ,., / _ DISTR`ICT NO. GROUP ZONE READY FOR INSPECTION
_ADDRESS Y Z 4'/� // • A�/ i� -/
� D INDUSTRIAL
TEL.NO.? 4C /4 1 WASTE APPROVAL
.PLUMBER e-urrLD-r- INSPECTION RECORD
ADDRESS
CITY TEL.NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) S
BATH TUB _
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
PnY �r
TOTAL N0. fa 0.80 APPROVALS
DATE INSPECTOR'SSIGNATURE
GAS SYSTEM_OU TLETS (a 1.00 _
WATER HEATER @ 1.00 UNDER SLAB WORK _
PERMIT 5 t 00
ROUGH PLUMBING
_
y GAS PIPING.
TOTAL FEE P-
GAS VENT
IH
.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION OT.WATER HEATER .
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS; ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM/T111IIIE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBED RESID NT L TY. •4•f. Q ✓� �. �1//!^bis •��_ dv7 wJ�A.!
SIGNATURE
OFPERMITTEE I ' L/ FINAL
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION R. A. WOOD.CHIEF PLBG. INSPECTOR
��0 8 6;' 2 5 OCT 4 3 2.0 011
WORKERS'COMPENSATION DECLARATION A tmlm LOCA 4I®I,\OIFOR PLUMBING
SO O A❑AIDI1a A.}°� PERMIT MIT
I hereby affirm that I have a certificate of consent to self 76A6M7A /`ri l�Il�� PP''99 I1I1 �O DCII II�� YY''ll If"6YJCHEID Otl`�9 Ir IG O'(!VO Y
insure, or a certificate of Workers' Compensatiop surance CE 017(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lab. C. C COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy Nap_!JK d Company Cy
Certified copy is hereby furnished. //
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / /�
��1��1{/Certified copy is filed with the county building iNUMBER . FIXTURE OR ITEM � FIE
ADORESS (� No. R //
/ � tion deparlmenL
S ta�iF•
WATER CLOSET LOCALITY
Dale Applicant NEAREST
CE TIFICATE OF EXEMPTION FRWORKERS' BATH TUB CROSS ST.
COMPENSATION INSU NCE SHOWER OWNER RS. CDGK
(This section need not be completed if the work Involved by MAIL Cg
�[/ 7�m
the permit is for one hundred dollars ($100)or less.) I LAVATORY ✓ ADDRESS ✓LTC act. - rysvij
1 certify that in the performance of the work for which this
permit is issued, I shall nor employ any person in any manner SINK ..� CITY 5'A,rr G6ag TEL. NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER 'CONTRACTOR ��`FrCrf'
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of �� W. AaE'
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY �. �Q✓/uA TEL N 6D_,/`q
Y7S'
STATE 'LIC
with comply with such provisions or this permit shall be .
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT N OCESSED BY
I hereby affirm that 1 am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS r
(commencing with Section 7000) of Division 3 of the BusinessOUTLETS OVER Y
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALd
q DATE 4 �'q"�¢— VALIDATION O
Li s umb r .7 Lic Class � ou PN u
/ ' C—a^v�AK w� FINAL O
ContractorlAlD &IOff Date 1&/913 BY r,
V
❑ I am exempt under Sec. S
N
B.BP.C. for this reason
?
Date: Pian checkfee D PLUMBING PERMIT ISSUING FEE$ -
Signature '
TOTAL FEE
Plan check applicant '04865-A 4 8 9
SINGLE FAMILY A
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address
Law for the fallowing reason (Section 7031.5, Business and °.4
Professions Code): City Tel. No. f b 510
❑ I, as owner of the property, will do the work and the °'O ° (j trj,s/i x
structure is not intended or offered for sale (Section D
7044, Business and Professions Code). Q R' + v
.3 0-8 3
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for s
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 - D
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representmives of, this County to enter upon the
above- tioned operty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
0
S gnature of Pe 11
ee Date