HomeMy Public PortalAbout5233 CAMELLIA AVE_Plumbing__ 76A667 ,7 s-49® APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
PLUMBER RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS
_. BUILDING
CITY TEL. NO. ADDRESS
COUNTY
LICENSE NO. EXPIRES LOCALITY
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) @ 0.60 $ I ADDRESS
BATHTUB @ 0.50 CITY TEL. NO.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LAVATORY (WASH BASIN) @ 0.50 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING.
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
SIGNATURE OF
WATER HEATER @ 0.50 PERMITTEE
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN .@ 0.50
URINAL @ 0.50 ..I
HOUSESEWER @ 0.501 Q
.Z
MISCELLANEOUS
Q'
I
APPROVALS
1 DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.001 CESSPOOL
1 SEPTIC TANK: SEPTIC TANK
I DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT . I 1.00 GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE $
FINAL
DECLARATION of
7al817 APPLICATION FOR PLUMING PERMIT.
I hereby.nfftrm that 14t+� i certificate of consegtt to self c�air (i�ol _
insure, or a certifleate of Workers'Cothpansation Insurance,or
a opy thereof(Sec.3800,La )
COUNTY OF LOS ANGELE BUI LDLNO AND SAFETY
+� Policy �mpnnY
` ;�rttflbd copy is hereby furnished. �—y>�� FO APPLICANT TO PILL IN (PRINT OR TYPE) BUILDING
ADDRESS
0 Certified copy Y filed with the county building Inspection NUMBER FIXTURE OR ITEM FF,E
department. WATER CLOSET LOCALITY !
Data". Applicant A.REST
j - BP,TH TUB QROSS ST. i
CERTIFICATE O-F EXEMPTION FROM WORKERS' +
COMPENSATION INSURANCE SHOWER OWNER z,
MAIL
(This section need not be �p let�ed if the work inrohed LAvArogY d� ADDRESS
by the pvm1t Is for one ha wired ddlars (S I QO) or leM.) SINK CITY TEL.Na.
I certify that in the performance of the work for*11fth this
peris issued, I ihaII not employ any.person In tiny manner DISHWASHER CONTRACTOR
mit t
so-as to become subject to the Workers' Compensation Laws. ' CLOTHES WASHER ADDRESS
eal
Date_____Applicant SW(MMINQ POOL RECEPTOR
NOTICE TO APPLICANT.-If, after maldngIt" Certificate of CIT ' ,q TEL.NO
Exemption, you should become subject to the Workers' LAWN SN11NKLER SYSTEM STATE Lrc.
Compensation provisions of the Labor Co",you must forth- T LICENB NO. C
with cgmply with such.provisions or this permit shall ba WATER HEATER
deemed revoked DIST CT NO. O SSED
QAS SYSTEM OUTLETS �J
LICENSED CONTR-ACTORS DELI APATIONOLJTLETB OVER
1 hereby affirm that I nm ljcensed under ptovistom bf Chapter FI YSTE �
9 (commencing with Section 7000) of Dlvftion 3 of the Bust- ter/ Q J
neat and Professions Code, and try license Is In full forcer and DATE Tz / FfJ
YALI
effect.
FINAL,
Licansa Number Lic,0ass� &Y
Contractor Data
El I tial exeinp.t from the licensin&requirements as I am a PlOn check fee
•licensed mhltect or r kogfstereQ profeadottal anjinear PLUMBING PERMIT ISSUING FEE#
4cting in my profba clonal Capacity (tS.6ctlon 7051, Bus,
ipeas and Psofesslons Coda). TOTAL FIE
Lic.or Rai.No.T Data Plan check applicant
HOME OWNER-BUILDER DECLARATION ams
I hafeby sffl-m that I ►m exempt from the Contractor's AddraM
License Law for the following reason (Section 7031.x, Bud- City Tel.Nb. -2,3'0 6'6 A
neat and Professions Code):
I owner of tont property, oti
am exclusively contrang 1• // /
Q
with
ljcensed contractors to conrtnigt the project
(Section 70A-4, $aline.s and Professions Code). ,
2 -b, - 2.QH0
CONSTRUCTION LENDING AGENCY ° 2 Q b 0$
I hereby affirm that the» is a constrpctlon lending agency '
for the pefform4ice of the -work for which this parmit Is 0 22'6.—8 2,
issued(Sec.3097,Ctv.C.). A
Lender'sa
NmQ
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 SEE REVERSH FOR F-XPLANATQRY LANGUAGE
ordinances and State laws regWating P1uIn-bf'ng, and hereby
authorize representatives of this County to enter upon the
above- tioned pro y for Inspection purposes-
ST
gnxtureO Permitt Data