HomeMy Public PortalAbout5419 CAMBURY AVE_Plumbing__ ,OAG" n e-50 ip APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
" t COUNTY OF LOS ANGELES .
WILLIAM J. FOX, CHIEF ENGINEER
O
FOR APPLICANT TO FILL IN DISTRIC NO. GRUPOMIT NO.
.,�. � � ZONE PERgGo37-�
PLUMBJALLEY BOULEVARD PLUMBING CO, I RECEIVED BY READY FOR DATE ISSUED
' I�7� FIRST INSPECTION T
ADDRESSpw00 EAST VALLEY BLVD. Y�Z.5/
BUILDNG
CITY ROSEtv1EAD TELT NO.T. 2-271 ADDREISS -1111/
COUNTY 93M 6.30-,s—/ LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES CROSS ST. J
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER // qV
MAIL
IIWATER CLOSET (TOILET) @ O.SO S 7 D AD DREGS /�J.t /y `'/1 .✓/[!L
BATH TUB @ 0.50 T 0 CITY lLdCp L 4f' TEL. NO./fl 9-42 b Y
�— SHOWER @ 0.501 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING.
KITCHEN SINK @ O.501 �� I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE:
GAS SYSTEM OUTLETS @ 0.50 I lef
SIGNATURE
WATER HEATER @ 0.501 PERMITTEE
SLOP SINK @ o.so 11INSPECTION RECD U
FLOOR SINK @ O.SO OR
FLOOR DRAIN @ O.SO 1
DISHWASHER @ 0.501
DRINKING FOUNTAIN @ O.SOI
URINAL ty 0.501 J
HOUSE SEWER @ 0.501 Q
MISCELLANEOUS O
Fr
J Q
I
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
` GAS PIPING
GAS VENT
I CESSPOOL @ 1.001 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( @ 1.001 SEWER 1
PERMIT . 1.00 GAS TEST
TOTAL FEE B UTILITY CO. NOTIFIED //i✓ !1
y FINAL G —
-
WORKERS'Chove* a e,* DECLARATION APPLICATION FOR �LL➢AflBI�C9 PERMIT t
§0-OD26DPW 4/8] - n
• hereby, certificate
That hove a cerompetificate at o ns su to self r a 7CA667A tilull
sure)or a certificate of Workers'Compensation Insurance,ora CE 817(REV.'8/86)'-'-- _ e
certified copy thereof (Sec 3800 Lab C )� ;. - ..COUNTY OF LOS'ANGELES • DEPT. OF PUBLIC WORKS. -
Policy No: Company.- '
❑' Certified copy is hereby furnished;
FOR APPLICANT TO FILL IN (PRINT OR-TYPE) BUILDING
•Certified copy is filed with the county building inspection ADDRESS L�
NUMBER FIXTURE OR ITEM FEE LOCALITY
;'Date - : Applicant WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' HATH TUB CROSS ST.
' COMPENSATION INSURANCE' OWNER
SHOWER
(This section need not be completed if th'e.workinvolved by MAIL -
the permit is for one hundred dollars ($100) or lass.) LAVATORY ADDRESS
Lcertify that in the performance of the'work-for whichthls'piI SINK - '
mit is issued, I shall not employ any pe on in any manner so CITY _ e _ TEL. NO,
as fo become Hct to Ihe,.Workers' mpensatic wz. DISHWASHER,
^r owe 7 CONTRACTOR ' v \
Date✓{'J�1 Applicant / CLOTHES WASHER L'' ADDRESS vv
NOTICE TO APPLICANT: If, after making this deAficale of Ex-
emption,
x- SWIMMING POOL RECEPTOR -
emption,.yourshould become subject to,the Workers'Compen- CITY TEL. NO.,qfl
sotion provisions of the Labor Code;you must forthwith comp-
ly with such provisions or this permit sholl.be deemed revok- STATEQ O� LIC. i
WATER HEATER LICENSE NO. (J CLASS
LICENSED CONTRACTORS.DECLARATION - DISTRICT NO. ESSED Y
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS or-
and ,
9(commencing with Section 7000)of Division 3 of the Business - a OUTLETS OVER
fe ,Professions Code, and my license is in full force and ef- 5'PER SYSTEM FINAL V DATION a
0649 � _ DATE
License Number Li<. Class
FINAL 1 U
Contractor ' C/CJA�7 l• Date CO� _ _ BY p
❑ I am exempt under Sec.
B.BP.C. for this r son
Plan check fee. z
. Dat PLUMBING PERMIT ISSUING FEE S
Signature-
-
ignature SINGLE F M Y TOTAL FEE ;20 9 2 4 A 1
-
' - HOME OWNER-BUILDE DECLARATION •Plan check applicant .• �'� eye a-a 5 '
I hereby affirm that I amexempt from the Contractor's license Name - 1" -�) to • 3 p,5 0
Law for the following reason (Section 7031.5, Business and '
Professions Code): ' ' Address • e • 34,5 0 v
I, as owner of the.property, will do,the work'andtheCity Tel. No. '( Q 1 7._8 8
structure is not intended ar offered for sale(Section 7044; "
' Business and Professions Code). - D
CONSTRUCTION LENDING AGENCY - - - -
I'hereby affirm that there is o construction lending agency for _ r ,
tIII performance of the work for which this permit is issued 1` '
(Sec..3097, Civ. C.), r
Lender's Name 7
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 - D '
orcin nces and State laws regulating Plumbing, and hereby - - -
auth ize iepriasentati sof th' County,to enter upon the
abo - entioned r er for nspectibn purposes. -
CU ^' SEE REVERSE FOR EXPLANATORY LANGUAGE
Si nature of PJ r ittee Date '