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Home My Public Portal About4817 CAMELLIA AVE_Plumbing__ 76A667-CF817 12/59' TEMPLE CHTY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 'T/,P/ J V r WILLIAM A. JENSEN. SUPT of BUILDING _ - - LOCALITY OR FAPPLICANT TO FILL IN NEAREST CROSS ST. , ve Oa NUMBER FIXTURE OR ITEM ) OWNER L. yorre.r f WATER CLOSET , SIL BATH TUB ADDRESS ^/P/ CITY%e.v // C. TEL. NO. SHOWER / ^ LAVATORY CONTRACTOR C:/ ` a 6'. SINK ADDRESS o2,; /I /(•(j-. /✓Ju/,rr �� ' DISHWASHER CITY 4lha� qi'.0 TEL. NO. 07 t.3 CONTRACTOR'S �3.. a STATE 91 LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. G ZO E O ESSED' Y WATER HEATER / - 4 GAS SYSTEM ¢ INDUSTRIAL ' WASTE APPROVAL INSPECTION RECORD 0 U . w _ 4 G' ..APER ITEM OR FIXTURE $ APPROVALS PATE, INSPECTOR'S SIGNAT RE PERMIT $ I 00 UNDER SLAB WORK �1� TOTAL FEE UI J` ROUGH PLUMBING GAS PIPING CI4 .Q� 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION • , • AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ` GAS TEST IR CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIOfL PROPERTY. UTILITY CO.NOTIFIED r SIGNATURE OF PERMITTEE _ FINAL ®r / VALIDATION ROBERT A.WOOD. cK. Y.D. CASH SUPERVISING MECHANICAL ENG'R iAC.D8a76`-G `L� 24 5 D 4.50- °' C.S.a.17 SSM SETH 1-48 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF.L03 ANGELES WM.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRI NO. /y0 o PE MI_O.. fgAS FIXTURES COMPLETE �v CESSPOOL SEPTICTANK - RECEIVED BY READY FOR DATB IBSUfiD � FIRST INSPECTION q /'� MISCELLANEOUS � 2 . APPLICANT FILL IN HEAVILY OUTLINED/PORTION ONLY ROY & ROY PLUMBING- joB ADDRESS2312 T€MPLE CITY, CALIF. � LOCALITY n v ft. AT. 6.081-aL.No. caves ST. �1 �l \. U 9 ' EXPIRES _ 0SG a NAME OF SEPTIC TANK, OR CESSPOOL a MAIL 3 ADDRESS NORTH O CITY TEL NO. 1 E AM THE LEGAL POSSE Q&WR OF L�F QU I T AS ANGELES COUNTY CHRTIRLIIG �.r•LYMaOI � I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. 0 PI f- OWNaII CORRECTIONS SOUTH' J DESCRIPTION- OF WORK a z_ BATH TUB FURNACE 11 MOWER DISHWASHER D , LAVATORY REFRIGERATOR KITCHEN BINK WATERSOFTENHR FLOOR BINK SANDTRAP SLOP SINK FLOOR DRAIN AWASH TRAY URINAL APPROVALS _WATER CLOSET DRINKING FOUNTAIN DATE iwaraeTOR's NAME _WATER HEATER . DENTALLAVATORY ROUGH PLUMBING I I METER GAB SODA FOUNTAIN OUn GAS PIPING I I GAS VENT I CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I I CESSPOO• SEPTICTANK SEWER I I B ' TOTAL FEE o UTILITY CO.NOTIFIEDl 'FINAL / 76A667 (CE-817) - 5/73 I`I-(7 •'� G—�r l /� p T _ APPLICATION FOR PLUMBING--PERMIT, COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO: .. _ ADDRESS HARVEY T: BRANDT, COUNTY ENGINEER„ FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST �.�� f NUMBER FIXTURE OR ITEM IS FEE' CROS$•S/T.' p 1T OWNER I/� -"OuI)MAIL , . WATER CLOSET 1;75 - BATHTUB. 1.75 ADDRESS CITY TEL. NO '�r -r SHOWER - 1.75 _ LAVATORY _ 1.75 GdKCIRC N SINK 1'75 AD10920 E. GRRA/ND AVE, 7 DISHWASHER 1.75 " CI MP LE CI1 in�JCALI-R'NO_ '! 'Z? CLOTHES WASHER 1.75 LIC LCENCLASS 1.75 EN SO. /! ��(6 ' SWIMMING POOL RECEPTOR - "I 1 ' DISTRICT,N O. GROUP 20NE P ESSE BY LAWN SPRINKLER SYSTEM 1.75 iK�7 Q T ' WATER HEATER 1.75 INDUSTRIAL ' _ WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD U OUTLETS OVER .5 PER SYSTEM _ O F— d Plan check Fee ;See Reverse PLUMBING.PERMIT ISSUING FEE S 3 0o - TOTAL FEE. q--)6 APPROVALS DATE INSPEC16.'s SIGHASDNF Plan Check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER HEREBY ACBN OWL EOGE'THAT I HAVE READ THIS APPLICATION" AND STATE COUNTY ORDINANCES S CORRECT,AND AGREE E COMPLY- PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING PLUMBING. GAS TEST ' IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSEDAS REOUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 'RES OR IN THE ABOVE DESCRIBED RESIDE TIAL PROPERTY. FINAL 3. 1 SIGNATURE 1/ � /ln'-, /_,/1 OF PERMITTEE {. -ice PERMIT'VALIDATION cX. M.D. cnsn PLAN CHECK VALIDATION Ca. M.G. cA 5 9;ZMAR 27 5 D' 4.7 5 e99 . tf O�XERS^ COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT hererrf shot I have o certificate of consent to self 76A567A insures Yertificate of Workers' Compensation Insurance, CE 817(REV. 10/BI) or o c copy thereof (Sec. 3800, Lab. C) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy$1111 • Company ❑ t,e�j�Is11 copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ed•copy is filed with the county building inspec- ADDRESS ❑ ' ' ,1lilpyrtmenl. NUMBER FIXTURE OR ITEM C• FEE LOCALITY : WATER CLOSET Date v _Applicant NEAREST fFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER _� (Thisyy�yy,��en�heed not be completed if the work involved by SHOWER MAIL _ the 0/T11fR06 for one hundred dollars ($100)or less.) LAVATORY ADDRESS I Ceti f Jhdr in the performance of the work for which this perch iyyYt►'lyued, I shall not employ any person in any manner SINK CITY TEL. NO. so a;14 .�etome subject to the Workers' Compensation Laws. DISHWASHER CONTRACTOR Date i,.,,. Applicant CLOTHES WASHER ADDRESS NOT }O,/TPLICANT: It, after making this Certificate of Exemplfica toJ should become subject to the Workers' SWIMMING POOL RECEPTOR CompepilatjaA LAWN SPRINKLER SYSTEM provisions of the Labor Code, you must forth- CITY TEL NO. with Corypgy with such provisions or this permit shall be STATE LIC, deemsid teiroked. WATER HEATER, LICENSE NO. CLASS 410ENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I herNy dff7rm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (cam ng with Section 7000)of Division 3 of the Business OUTLETS OVER. a- a and Prions Code,and my license is in full force and effect. 5 PER SYSTEM. FINAL VALIDATION O ��.(, DATE V ucens?"IsIer Lo Class ' w FINAL LL Conkalldt f' Date BY } a ❑ rdm exempt under Sec. Q g.SP C. for this reason O Plan check fee polo. It.Date: PLUMBING PERMIT ISSUING FEE$ w Lute ~ TOTAL FEE s ss r Plan check applicant SINGLE FAMILY WMF OWNER BUILDER DECLARATION Name r s I hereby Awrin that I am exempt from the Contractor's License Address Low.fw IIII#'following reason (Section 7031.5, Business and Profoslioh4aCode) : - City Tel. No. ❑ ' :., k oy�vtner of the property, will do the work and the is not intended or offered for sale (Section , /eyt��s.�in,ess and Professions Code). k °fii 41STRUCTION LENDING AGENCY her that there is a construction lending agency for the lie of the work for which this permit i5 issued (Sec. r Civ. C). Lende�'Y�VQme ' Len less I ce�i ^ Y have read this application and state that the , above ation is correct. I agree to comply with all County or�ho olid State laws regulating Plumbing, and hereby autfl5 representatives of this County to enter upon the .above Ido ad property for inspection purposes. - _TSEE REVERSE FOR EXPLANATORY LANGUAGE x. SgrsI oil Permittee Date