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Home My Public Portal About5133 CAMELLIA AVE_Plumbing__ s 76A667 (CE-817) - 175 �� / •" APPLICATION #O PLU BING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER Al BUILDING AND SAFETY DIVISION F MAKE CHECKS PAYABLE TO: HARVEY T. BRANDT, COUNTY ENGINEER FOR APPLICANT TO FILL IN (PRINT OR TYPE) . NUMBER FIXTURE OR ITEM @ F S OWNER WATER CLOSET 2.00 MAIL BATH TUB 2.00 ADDRE s SHOWER 2.00 CITY TEL. NO. � ] LAVATORY 2.00 CONTRACTOR LI SINK 2.00 ADDRESS c DISHWASHER 2.00 fWASTE TEL. NO. CLOTHES WASHER 2.00 LIC �� J,2 CLASS SWIMMING POOL RECEPTOR 2.00 GROUP7NE PRO ESSEC? BY LAWN SPRINKLER SYSTEM 2.00q1 WATER HEATER 2.00 VAL a GAS SYSTEM OUTLETS 2.00 INSPECTION RECORD U OUTLETS OVER 5 PER SYSTEM .30 O U W a N Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE 00 APPROVALS DATE INSPECTOR'5 SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING - Address GAS PIPING City Tel. NO. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ •THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DES RIBS RESIDENTIAL PAOPERTY. FINAL SIGNATURE OF PERMITTEE PERMIT VALIDATION CK. M.O. CA - j PLAN CHECK V ATION CK. M.0. CASH s s a u-'JUN 19 S ® 1 0.0 0 •�i8 I 79A667 -CE#817 4-6+ • �I APPLICATION FOR PLUMBING PE MIT I'uII COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS 5133 N. Camellia JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER David Berg WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS 5133 N. Camellia SHOWER 1.25 CITY Temple City TEL. NO. LAVATORY 1.25 CONTRACTOR SINK 1.25 ADDRESS 1350 E Las Tunas Drive DISHWASHER 1.25 CITYSan Gahripl TEL. NO. 2 g6-1141 CONTCTOR'S STATE LAUNDRY TUB 1.25 EG SRAT ON NO. 2 2 17 5 1 C-2 0 COUNTY p CLOTHES WASHER 1.25 DISTRICT NO. GRZONE PR S BY WATER HEATER1.50 �5 , a I GAS SYSTEM 1 OUTLETS 1'50 I FO WINDUSTRIAL ASE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V 0 V W a N Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT TH ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COU DINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CE TIFY THM O ERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS R QUIR Y AN LES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THA1 H AL OWNER OF,AND INTEND TO RESIDE IN,THE A 01 SCRI R DENTIAL PROPS RT UTILITY CO. NOTIFIED SIGNATURE OF PERMITT LIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENG'R Lklo 7592 DEC 0 5 D 3.50 tK WORKERS'COMPENSATION DECLARATION 74J%647A I hereby &Mm that I have : certificate of conse t to self CC 017 (2-•0e) APPLICATION FOR PLUMBING PERMIT Insure, or a certlflcate of Workers'Compensation Insurance,or , n certified copy thereof(Sec.3800,Lab,e COUNTY of LOS AN EtE$ z $UI LDFNG AND SAFETY Policy No..Comparly�CJ,_ JJ tJ LI Certlfled copy is hereby furnished. FOR APPLICANT TO FILL IN (PKINT OR TYPE) BUILDING v Erpertifled copy to tile&wlth th un q11NUMBER FIXTURE OR TEEM � FEE ADDRE$8 CLO$ET `le � WATERLOCALLTY t Data tic ant N E A R ES T - CERTIFICATE OF EXEMPTION FRABAT]-I TUB GFiOSB M WORKE"' •$T. 4.4 COMPENSATION fNSURANCE SHOWER OWNE19 LAVATORY' MAIL ('I`his aectlon, heed not be compfeted if the wotk hrohed ADDRE" by the petrh{t Is for One hundred doHm ($100) cr len.) SINK CITY TEL. N ti codify that lh the performance of the-work for which this 019HWASHER CONTRACtOR U - pbrhih is Issued, I Thal]not employ any person in any manner C, CC to as to become subject to the Workers' Compensation'Laws. CLOTHES WASHER ADDFI-(=" 0 Drte Applicant BWLMMING POOL RECEPTOR IU— NOTICE TO APPLICANT: If, after gykin� this Certificate of CITY TEL NO � OpW,, Exemption, you should becAme 1ub)a4i to the Workers' LAWN BPF�INKLERSY8TEM STATE LIC. 05 Compensation prQvis)ons of the Labot Cody, you must forth- LICENSE NO. CL Z with Comply with such provlsiobs or this permtt shall be WATER HEATER _ deemed revoked. GAS$Y$TeM OUTLETS DISTMT NO. b BY LICENSED CONTRACTORS DECLARATION OUTLET&OVER ��CJ I hereby affirm that I am 11censedunder provisions ofChapter 5 P SYSTEM 9 (commehclns with Section 7000)of Dirfsion 3 of the Busi- FINAL nese and Professions Code, and my license Is-in full force spa DATE '`� � VAI}apATION effect. rmAL PY License Numb ic.Clara- -✓ QY Contract I ■m exempt from the licensing regpirements at I am a PIER cher*foe Ucensed architect or a registered prpfeadonal en&eer PLUMBING PERMIT ISSUING FEE acting In my profbWo)lal capacity (Secttori 7051, But: Labs+and Profeedods Code}, [TOTAL FES Lic.or RCg.No. Data Plan check■ppl}cant HOME OWNER-BUILDER DECLARATION Nam' I hereby affirman that I m exempt from the Contractor's Addran x.3`6 5 7,A u . 11 License Low for the fpUowing reason (Section.7031.5, Busl- City T.I.N8.2 neand Professions Code): - nt, n4 owner of the property, am e�cclnatxely co4tncting # o 0 0 o e 5 with 14=med contractors to construct the project 2 b to 1 2-50 (Section 7044,Business and Prefesalons Code). e 12505 CONSTJ�UCTION LENDING AGENCY I hereby affirm that there is a construclion lending.jaency 0 4, V.5—8 2' for the-performance,of the work for wWch this pertt)it is Issued(Sec.P097,Civ.C.). Lender's Name Lander's Address I certify that I have read this application and state that the above Infgrmitlon Is correct,r agree to comply with all County ordtnanC" and,$tate laws regulating Plumbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE authorise reprawntativ¢s of tbis Co t to enter upon the ibovo- sed o r 4 P 'Signa Lure of Perm1 Dgte WORKERS'COMPENSATION DECLARATION 76Aia7A I'hereby afnwm that,` have r certificate of consent to self CK 817 11-00) APPLICATION FOR PLUMBING PERMIT- -Insure,of a ctfificate of Workers'Compensation Insurance,or a 0rttned copy thereof(Sec.3800,L b.C �� GOUNTY OF WS ANG LES � BUl WING-AND SAFETY Polley NO. Ogmpagy S F-1 Certified copy Y hereby furnished. v / FOR APPLIOANT TO FILL, IN (PRINT OR TYPE) BV+1-g1N0CartMi t ADDRESS J �y m copy Is Med with th coun undtng inspection NL*ABER FIXTURE OR rrEJ�A • FEE: LOCALI ` OJ. CkX Date Applicant WATEFI CLQSET NEAREST ' BATH TUB CROSIE�ST. 1 CERTI)'ICA'I'E OF E7CEMPTIO FROM WORKERS' SHOWER OWNER COMPENSATION INSURANCE LAV ATOfIY MAIL (Thh section need not be leW if the work tavotved ADDRE89 by the• pe=tt is for one hundred dollen (#100) or lea.) SINK �s CITY TP-L. NO,-,$44 I certify that in the performance of the work Yor which this DISHWASHER permit is issued, I shall not employ any person in lily manner CONTRACTOR �'� - so is to become subject to the Workers' Compensation Laws. CLOTH E8 WASHER ADDRESS W t)ate _ Applicant- SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of OITY TEL. NO.Z O Exemption t you should �66bme sub)ect to the Workers' LAWN SPRINKLER SYSTEM STATE LIC, Compensatl8p provisions of the Labor Code, you must forth- WATER HATER LICENSE N LIC, With comply with such provisions or this _permit shall be DISTRICT NO.�/.SP E88 BY deemed rgvok&rL OA'8 SYSTEM 0UiTLFTS U LICENSED CO'N`I'"CT'ORS DECLARATIQN OLrrLETS OVER I hereby affirm thit I am licensed under provisions of Chapter B PER SYSTEM 9 (commencing with SKtton 7000) of DtvNion 3 of the Busf- r[NAL r /rj nese and Professions Code, and dty license Is in full force and DATE T 1 6 v VALIDATION DATION effect. r FINAL LlcenseNumb ¢ Llc.Class- � BY Contractor Data -t—,Z-4m QI ink axem from the licensing requtrements as I am a plan Check fee Hcensed architect or ■ redstered professional engineer PLUMBINOPERMIT ISStHN.OFEE acting Id my profesaloua] capacity -(Section 7051, Bus- Ineq and Pro fesalons.Coda). TOTAL Fpt- Lie.or Reg.No. Date Plan check■ppllcaAt C , HOME OWNER-BUILDER DECLARATION Name. ;��3 2 Q 7 A - I hereby affirm, that I am aNenW from IhO Contractor's Address4!a34l '#'040 o e o License Law for the following reason (Sectioo.7031.5, Buri- City T.I.No. : . Pets and Professions Code): 63 F-1 .1, as oivda a of the property, m exclusively contracting ntracng 2 °'o ) 2 5 0 with licensed 'contractors. Co construct the project } 5 O 0.0 0 (Section 7044, Business and•Professions Code)- 09'- CON9�'RUETION LENDING AGENCY 3082 I hereby affirm that thore is a construction Ibnding agency for the performance of the work for which tats plsmtt is Issued(Sec.3097,Civ.C.). Lender's Name Lender's Addteas I certify that I have read this appllatlop and state that the above information is correct.I agree to Comply with all County ordinances, and State laws rag-Uating Plumbing, and hereby $E'E REVERSE FOR EXPLANATORY LANGUAGE, authorise reprowntatNes of this County to enter upon the above- tioned pro for pet purposes. tare of ee Data