HomeMy Public PortalAbout6254 BURTON AVE_Plumbing__ 76A667-CE817-8-58
ANPPF ICATIION FOR PLUMBING PERMIT
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DEPARTMENT OF COUNTY ENGINEER - -
BUILDING AND SAFETY DIVISION BUMDING /
]JOHN A. LAMBIE, County Engine., ADDRESS
RI
CASSATT D. GRIFFIN, Sup t of Building LOCALIT�
TO
FOR APPLICANT FILL IN NEAREST /
CROSS ST.
NUMBER FIXTURE OR ITEM
OWNER J _
WATER CLOSET MAII.
BATH TUB ADDRESS
SHOWER CITY TEL. NO.
LAVATORY CONTRACTOR ll/[7l, K� �
SINE ADDRESS U S GG
DISHWASHER CITY /;?Ip,�'73EL. NO.
CONTRACTOR'S y STATE
LAUNDRY TDB REGISTRATION NO. /.Z/dg J COUNTY
CLOTHES WASHER DISTRICT O. GROUP I ZONE ESSED BY
WATER HEATER y
1 GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
d
APPROVALS
@ $1.00 PER ITEM •"J
OR FIXTURE 3 ( DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT S 2100 ROUGH PLUMBING
TOTAL FEE GAS PIPING - 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT ,mss
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER 7W.
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES �{
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - GAS TEST — /- �.•
LICENSED AS REQUIRED BY LOS./ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1,41A /THE LEGAL OWNER OF THE ABOVE . UTILITY CO.NOTIFIED ILI
DESCRIBED RESIDENT iP/RROP//ERTY.
SIGNATURE
OF PERM ITTE
ROBERT A.WOOD.
®, VALIDATION SUPERVISING MECHANICAL ENG'R
Ctt. Y.o. CA$H
LA'I 9 84 4', X-L 21 5 A 9.00 �.
WORKERS'COMPENSATION DECLARATION APPLICATION
PPLIC TION FOR PLUMBING
PERMIT
I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPN/4/90 Pri Y9 YCI r 6YJCNE OCI
sure,or a certificate of Workers"Compensation Insur nce,or a 76A667A y _
certified copy
�thereof
(S�ecc. 3800, Lab. s - [llLllll
Polic G� 9�yompany c n!/ COUNTY OF LOS`ANGELES DEPT. OF PUBLIC WORKS
Certified copy is hereby furnished.
F-1
7BATH
APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS
deport ent. _ NUMBERFIXTURE OR ITEM @ FEE
LOCALITY . _
Dtlte�Applicanr .aNP /� r //l�NB7"!C CLOSET(TOILET) NEAREST _ `
CERTIFICATE OF EXEMPTION FROM WORKERS' UB CROSS Si. WG�C
COMPENSATION INSURANCE SHOWER OWNER 4J,EL
(This section need not be completed If the work involved by - MAIL - /nL
the permit Is for one hundred dollars ($100)or less.) LAVATORY - ADDRESS O s3 Y'f o
I certify that in the performance of the work for which this per- SINK '
mit is issued, I shall not employ any person in any manner so CIN PLF TELNO. lI -` -
as to become subject to the Workers Compensation Laws. DISHWASHER ✓ C ,
CONTRACTOR 01` g E !{.
Date- Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTORGk 6 O 04 J 43,
emption,you should become subject to the Workers'Compen- CITYTEL. NO.
sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS �A '
ly with such provisions or this permit shall be deemed revok- - STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS - n
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and ef. 5 PER SYSTEM
tettFINAL 'T/— VALIDATION
. HOSE BIB DATE
License Number Lit Class
G FINAL U
Contracto s?O. . .r C.resYlg. ate 8Y •7 -) T
I am exempt under Sec. h
6.8P.G for this reason IIEII_.
Plan check fee D ;(IIHL 41 - 8.
1 ra L W
.FUJI
Date"T PLUMBING PERMIT ISSUING FEE$ a� CHECK z
't 1.`;J
Signature �" TOTAL FEE IF{AWiE ,III-i
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 _. 0_I[I_t-1_1!01 7f?y�?u
Professions Code): _ Address }II(II �. Fi� i:11
❑• I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044,
Business and Professions Code).
CONSTRUCTION LENDING AGENCY - D
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued ..
(Sec. 3097, Ci, C.).
Lender's Name -
Lender's Address !
I certify that d this application and state that the D
above mfor lion is c ct..I agree to comply with all County
ordinanc and St aws iequlatin lumbing, and hereby
author' �e tallyy s of this my to It
upon the
obav menti fopeity ectio poses.
SEE.REVERSE FOR EXPLANATORY LANGUAGE
pture of rmittee Dote