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Home My Public Portal About5203 CAMELLIA AVE_Plumbing__F".1- 917 4-64 / 'J Al APPLICATION, FOR PLUMBING PERMITCOUNTY ' IGVT DEPA�RTTy7µRMIN OF W yT��IVISION i JOIyN LAMBITyEN31N[IR ADDRESS WIWAM A. JiKilik SuFT OF lU1LDINO Locmm -rx AA FOR APPLICANT TO FILL IN MZAEWErr NUMMKR FIXTIURIOR ITEM [ACH FQ owls 13 ,+ WATER CLOY= Sim HAIL _ RATS TUI I= ADDIEW -L Ad CITT `3 ]ISO. SHOWER 1.75 LAVATORT In C CTO t Sam 1.75 111SHWASHER 17Jf CCIT r mo. 41f-'f-d; LAUADET TUR 135 -irlumR11TIom to. CODUNn I CLOTS WAR 135 DIl MCT- r N[, F [qED Y WATER HEATER 1.50 (/)i /J GAS 6T3TEH OQTLETS E WASTE APPZOVAL Q OUTLETS OVER 5 PER STSTEN 70 DISPE=ON RECORD v OC I APPROVALS DATr" I'MIPECT04R. •10 TURK PERMIT i Q Op UNDER BLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING Ki I —Y AC-- THAT I HAVE READ THIS APPUCATION GAS VENT AND STAT[ THAT THR A10VK IN CO RRKCT AND AGMIX TO COUPLr wrrH ALL COUNTY 0f DINCXM AND ETATK LAWN HOT WATER HEATER FLUMSAHW R IN*. I HXR Y CSFTIFRER>m Y THAT I AM FROF[ LY RZOISTAND/OR PLUMBING FIXTURES UCZNSm AS RSQUIRiD ■Y LOS ANOELSS COUNTY AND STAT[ OP G"TEST CAUFORNIA OR THAT I AM,THK L 1[0AOWNm1 O AND INTEND TO RSSID41 IN,TH[AUOVS D�DNWIIAL F RTP, UTILITY CO.NOTIFIED •IGNATURE OF PERMITTEE FINAL 0. C ROBERT A. WOOD m. cK M.o. wat+ SUPERVISING MECHANICAL ENO'R LACO 3762-01JUL 19 5 D 3.25- 78AW-{ten 8-W APPLICATION FOR PLUMBING PERMIT, COUNTY OF MM AGMES MARTUM" Of COUNTY ENGOO R BUILDING SAFETYDrvffiox �°CABT■N3 CmMIT A.DD�sTTD. Low c.._ FOR APPLICANT TO FILL IN NHAHFST I CROW ST. NUMBER PIXMRE blt 1Tmi _ OWNER WAM GLOM OWN WATH TUB - ADDHrae CITT Tm- A0. / iHORLH LAVATo87 CONTRACTOR 4&C-of-4,417 ezlto� ADDEM DzaawA� CPI! N0. 7iUaDHT TOD fiF. UFMTION NO. 1l Z/ COUIIT! Q,O'ISm WAm DLBTRICTNO. GROUP ZONE BY WA=E== GAS/Tail[ IIIDBETHIAL WASTE EPPHOVXL G / nt5PBC77ON RECORD ^r? /h17,,<-) l::fo r,6-r .AP IROVAL.s DATE IRMMR'S SIOPUTUH PERMIT X1 2 00 uNDMR OLAM WORK TOTAL FEEROUGH FLUxeINCI Cto O"PIPING I HEItIBT ACE1107LEDQE THAT i HAYS Rm Ms ArpurAT7011 AID STATE THAT THE ADM lE COEIIECT A.ND AGREE TO CDMPLT G"VENT LITH ALL ODur T ORPla1•ECEE AID ETATE LAZE nauL.ATIIa PLDYRMQ. HOT WATER HEATER I HIAEDY CE➢TIFL THAT I AN MOPIMLT RISISTKM AXD R PLUMBING FIXTUREg LICEEMM AS It UIIKD BY ANGLLE; COUITT AND STATE OF GAH T'HST CAIIFOREIA OR THAT I LE 071III Or THE ADM DEfCIIIGD REKID Q0 UTILITY CO.NOT]FrIKD aIGNATURIK OP'rEltMl9 L4 FINAL m► A WATION RoBERT a WOOD, QE K.0. QAw SUPERVISING MECHANICAL EN(rft LACD7 6-0-7$ tit i t 5 A 3.0 0 76A667 (CE-817)- 5/73 / 666///�� APPLICATIONF PLUMBING PE MIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER wi BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: ADDRESS 5203 Camellia. Ave* HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Tsple City FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. La. Roma Dr. NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1.75 OWNER C, Jackson MAIL BATH TUB 1.75 ADDRESS sane SHOWER 1.75 CITY TEL. NO. 2$T-3174 LAVATORY 1,75 CONTRACTOR PaCif c, 1"tallers SINK 1.75 ADDRESS E Grmd DISHWASHER 1.75 CITY City TEL. No-442r C o CLOTHES WASHER 1.75 STATEQUO LIC LICENSE NO211898 CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP00NEk----PfOCESSFD BY. LAWN SPRINKLER SYSTEM 1.75 { y— WATER HEATER 1.75 INDUSTRIAL Vr WASTE APPROVAL >- GAS SYSTEM OUTLETS 1.75 NSPECTION RECORD OUTLETS OVER 5 PER SYSTEM .30 i O U W N Plan check fee See Reverse f PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER 41 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO 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 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DES/C/,g�(�B ED REIDEN1r IA,L PROPERTY. FINAL 16-23- SIGNATURE ^'-� .`S SIGNATURE / J' / �CC IIVV O F P E R M I T T E /'•-./\ PERMIT VALIDATION CK. O. CASH PLAN CHECK VALIDATION CK. M.O. CASH ,f 2 5 0 r At 19 5 U 4.75 •'Jv �NgRKERS'COMPENSATION DECLARATION DPW 4187 APPLICATION F B T �ftereby,:a�flrm that I have-a certificate of consent to self In- 76 66,7A CAT ON OR SLUM ING PERMIT sure,or a certificate of Workers'Compensation Insurance,Or a CE 817(REV. 8%86) I I coTtlfied copy thereof (Sec. 3800, Lab. C.) ` ' LJ Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBL14 ,V!(ORKS QCertified copy is hereby furnished. f-012 Al'RJCAW ITO FILL IN(PRINT 017 TYPE) BUILDING A Certified copy Is flied with the county bullding Ihspectlon NUMBER FIXTURE OR 1TJ M ® FEE ADDRESS (� department. LOCALITY T` WATER CLOSET(r01LEf) jr Date Applicant / NEST CERTIFICAA OF EXEMPTION FROM WORKERS' ! BATH TUB CROSS ST. C , COMPENSATION INSURANCE SHOWER OWNER (This soctlon need not be completed If the work Involved by MAIL ^ the permit Is for one hundred dollars (;100)or leas.) LAVAT04ZY ADDRESS I certify that In the performance of the work for which this per- SINK mit rs Issued, I shall not employ any pe n In any manner so CITY �- TEL NO. as to beco esu act to the Work mpen Vtl DISHWASHER CONTRACTOR Date O Applicant - CLOTHES WASHER NOTICE T ADPL CANS: If, after m Ino this Certlflca} of Ex- ADDRESS emptlon,you should biome sub(ect to the Workers'Compen- SWIMMING POOL RAPTOR MJ CITY TEL NO. s -r atlon provlslons.of the Labor C e, you must forthwith comp- LAWN'�NKLER SYSTEM ly with such provlslons or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICTS BY I herebyaffirm that I am llcen GAS SYSTEM OUTLETS eed under provisions of Chapter 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fact Profeulons Code, and my license is In full force and of- s PER SYSTEM. FINAL VALI TION a DATE O I-Icense Number Lic. Class U FINAL Contractor Date BYJf� O I am exempt under Sec. W B.BP.C. for this reason , Plan check fee Date' PLUMBING PERMIT ISSUING FEE$ Slgnatur-e TOTAL FEE SINGLE FAMILY1 0 3, 1 A HOME OWNER-BUILDER DECLARATIOfJ Plan check applicant ; # 00 .,005 1 hereby affirm that I am exempt from the Contractor's License Nome Law for the following reason (Section 7031.5, Business and I e - 28.50 Profession Code): Address I, as owner of the property, will do the work and the City Tel. No. 0 0 02 a5 06 structure Is not Intended or offered for sale(Section 7Q44, _ - Busineu and Profeuions Code). Poo- CONSTRUCTION CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of tl(@ work for which this permit Is Issued (Sdc. '1097, Civ. C.). Lender's Name Lender's,Address I certify that I have read this appllcotlon,and state that the , bbove Information Is correct. I agree to comply with all County ordinances and State laws regu9ating Plumbing, and hereby authorize representatives of this County-to enter upon the boy -mentloned'pr for Inapectlon purposes. VV SEE REVERSE FOR EXPLANATORY LANGUAGE SfdnOtL of Permittee Date