HomeMy Public PortalAbout5214 CAMELLIA AVE_Plumbing__ 76A667 -CE}f`817 2-62
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION r7.
JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING A /,, , Z
FOR APPLICANT TO FILL IN AREST
OSS ST.
NUMBER FIXTURE OR ITEM EACH FEE NER
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CIT TEL. NO.
2
LAVATORY1.25 CONTRACT
SINK 1.25Al
ADDRESS da
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUBCONT TE
CTOR'S ST
1.25
REGISTRATION NO. �+�- COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROC ED BY
WATER HEATER 1.50 —(� 5 C A-1
GAS SYSTEM OUTLETS 1.50 U INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD a-
i s.
O
+' U
0
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER+t*�R6 WORK
ROUGH PLUMBING
TOTAL FEE (J f1
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNT)x--ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
2.1
I HEREBY CER IF THAT I AM ROPERLY REGISTERED AND/OR PLUMBING FIXTURES _
LICENSED AS EQU RED Y LOS G COUNTY AND STATE OF
CALIFORNIA OR T T I M T G WNEfND INTEND TO GAS TEST
RESIDE IN,THE AB E RTv. UTILITY CO. NOTIFIED --- -----'- -
SIGNATUR -OF PERM ITTE
ALIDATION ROBERT A. WOOD
DCK. W O. CASH SUPERVISING MECHANICAL ENG'R
.I',l 0 0 9 6 3 FEB 15 5 0 1 0.0 0- `'
` _~ WOPJCEtl'S COMPENSATION DECLARATION 20-0028 DPW 9/E9
hereby afflrr6%h&t I have ■ certtloate of consent to sell Insure, 7a`W7A APPLICATION FOR PLUMBING PERMIT
or-a oKfjowa'of Worker's Compensation Insuraroce, or a certMed
copy thereof(86c.3800 Lab.C.)'
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
Po16cy No. Comparry
❑ CertlM1ed copy Is hereby tumlahed
FOR APPIJC.wi TO F01 IN(PRINT OR TYPq BInLDdJO � /Ll
F] Cer -
UW oopy fe filed with the cbunty building tnepection ADDFlESB 1
depart—IL NUMBER IMLIFE OR ITEM O FEE LOCALITY
Data t WATER CLOSET NEAREST
CERTIFICATE OF l7)IPTION FFIOM WORI<ERS' CROSS 8T.
COMPENSATION INSURANCE HATH TZ1e
AssEasoR
Mile eeotlon need not be completed if dw work Irtvotved by the SHOWER UAP BOOK PAGE PARCEL
permtt Is for one hundred dotlars($1110)or less") OWNER
er
I ctify that In the performance of the work for which this permit LAVATORY
Is Issued, I shall not employ any person In any manner so as togt ML
become eub}eot to the Worker' Compensation Laws. ADDRESS
Di8WASHER CITY TEL NO.
Date ApAllo-Tt CLOTlIFS WASHER
NOTICE TO APPLICANT: If, after making this Certlfloate of CONTRACTOR
Exemption,you should beoome subject to the Workers' Compensation 8WDA11ING POOL RECEPTOR ADDRESS
of the Labor Code, you must forthwith comply with such
provlebna or this permit shall be deemed revoked. LAWN SPFUNKLEFI SYSTB1
LICENSED CONTRACTORS DECLAFLATkDN CITY / TEL NO.
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(oommencing with Section 7000) of DFvlslon 3 of the Buslnea and STATE LIC'
Profeaakxm Code,and my Iloensa Is In full force and effect. GAS SYSTBI OUTLETS LXAD48E NO. CLASS
OUTLETS OVER DU TAICT NO. PROCESSED BY
6 PER SYSTEM O O
Lberrse Number Llo Class L,4VAf#1tV TRAY TV
DATE LI
Q�� �Z VADATION
DATE o
Corritactor Dm
RNAL
❑ 1 am exempt under Seo. 8
B.BP.C.for this reason
Plan check fee,
Data. ,
PLUMOING PERMIT ISSUING FEE;
SkFwture
❑ TOTAL FEE
C
Plan a"applkant -
SItJGLE FAMILY w` 7
HOME OWNEI:-BUILDER DE;CLARATFON Name Fri- •1 .i
I hereby affirm that I am exempt from the Contractor's Licence Law -**--??n�y r
for the follow-IN reason (8ection 7031.6, Business and Professions Address 6607 28AC
C+
Code): ITEMS
Ctty
1,as owner of the property,will do the work and the structure Tel.No. ,x,11 1 I G�7
la not Intended or offered for sale (Seotlon 7044, Buslnea TI�T#Lu Q0
and Professions Code). , C�EtK '8.130
CONSTRUCTION LENDING AGENCY � Al
I hereby affirm that there la a construction lending agency for the
pertormarwe of the work for which this permit Is Issued (Seo. 3097,
Gly.C.) OWL-0031 1?/1t9/91,
Lenders Name 49-78 f 8 1 AM 1LI'.41
Lender's Address
I oertlfy that I have read thla application and state that the above ►
Informatlon to oorrect. I agree to comply with all County ordlnanoea
and State laws regulating Plumbing, and hereby authorize
representatlwa of this County to enter upon the above-mentioned
property for InspoMo purpoeea. SEE REVERSE FOR EXPLANATORY LANGUAGE