HomeMy Public PortalAbout5327 CAMELLIA AVE_Plumbing__ OOUSTY OF LOS ANSE] APPLICATION FOR PER_IC3
D PLUMBING 1
`-� DIVISION OF BUILDING & SAFF.'TY
WILLIAM L FOX. Umaty ESp1pow
FOR APPLICANT TO FILL IN
iEebw Plumbing & Hes�ng 7 ��
PLUMBER RECKIVJFD KY FIRST IDrY TOR DATIC 12 U[D
AD DRrSiR SM SCUM PRi LAROSE AW-ROW CALWORNtA
TaImpha»ELMO 84M BUILDING
GIT. T[L. No. ADDREMB
DOUNTY { —
UCKNE3E No, LOMAL(TY
NEAREKT
PERB T FEES OROBB NT.
lfUM�L11 TYPE 17F FI XTU Rt DN FTbkd FEE OWNER
AIL 1
WATER CLORET(TOIL 0 0.60 * fAAMDDREM
BATH TUE 0 0,60TY No
SHOWER 0 0.150 I HEREBY ACKNOWLE-DO[ T AT I VIE READ THIS
LAVATORY (WASH BASIN) 0.60 APPLICATION AND STATE THAT TH H E IN CORRECT
AND ACRE[ TO COMPLY WITH ALL U ORDINANCES
KITCHEN BINK 0.150 AND STATE LAWS REGULATING P NE G.
1 CERTIFY THA 1 P L.
H KOV[ VALID LO•
LAUNDRY TUR OR TRAY 0 0.15O ANGELES COUN . OR THE LEGAL OWNER
OF TH[ RE. P ESCRIB ABOVE.
UArg fYETE OUTLETS a O.EO
SIGNATURE OF
WATER HEATER 17 1
0.60 PERMITTE
SLOP SINK a aeO INSPE ION RECORD
FLOOR RINK Q 0.150 L t�
Ft OOR DRAIN 0.150 -.
r
DISHWASHER O 0.60
DRINKING FOUNTAIN 0 0.150
URINAL O CL no Q
HOUR[ HEWER 0 0.60 Z
IBCELLANE
APPROVALS
D TI INS R7 NMI[
ROUGH PLUNKING '
OAB PIPING
GAE VENT
CEWPOOL 1,00 CESE300L
SEPTIO TANKS SEPTIC TANK
DRAIN ( ) PIT ( ) 7.00 SEWER
PERMIT 1.0n GAa TEST 3 :r/i
UTILITY OD.NOTIFIED
TOTAL FEE E �
TUM DR8#17 11/0= vllr
"""
,l.L4 APPLICATION FOR PLUMBING PERMIT 77
DH.,T �4
PIYISION OF BUILDING AND SAFETY
Deparwmad ofCv-stTEnubum
Cott of Las 'Anvol" BUILDING
VM.J. FOX. CouNTY ENGINam ADDRE"
CASISATT D.GRIMM. Suri OF tu,Lorwa
STY
FOE APPIJCJLNT TO FELL IN NEACROSREST
OWN[R 1 , S olermICT NO. 6 UP ZONE RIADT Pon,Rsp[CTION
HAIL j'
ADDRE8S.7 P m
INDUSTRIAL
WASTE APPROVAL
PLUHB[R , INSP'=ON BECO�
ADDRC v e
CITY TEL NO. r
LICENSE NO. AL4400/
NUMNR TY"OF FIXTURX OR ITEM F�
WAT"CL.01Ct (Tokorns
B TI-I TUR
SHOWER.
LAVATORY (WASH 0"IN)
KITCHEN SINK
DISHWABHER
LAUNDRY TUB OR TRAY
CL07HISS WA ER
T T NO o.eo APPEOVALS
_ PATE INSI'EGTOR'S SIGN-ATURE,
QAS SYSTEMOU 1.00
LINDM SLAB WORK
WATER HEATER 0 1.00
ROUGH PLUMBING
PERMIT II 1 00 GA-6 PIPING
TOTAL FEE oAd VeNT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBS G FIXTLIPLEg
PLUM-B1NG.
I HEREBY CERTI1r�Y1' THAT I AM ,PROPERJ.Y REGISTERED AND/OSI OAS TEST
LIC"SED AS REQUIRES) BY IAS ANGELES COUNTY D STATE OF UTILITY CO. NOTIFIED
CALIFORNIA OR THAT I AM THE GAL 1( 7iBOYE
DESCRIBED REfID PROPERTY
A
SIGNATURE
OF PERHITT I' AL
WILLIAM J.FO COUNTY ENGINKXR VALIDATION
-61 Nowa9241R DEC1� 3 X20 n
_ •
' [T
EPUTT
m
t T r
WORKERS'COMPENSATION DECIARATION DPW4/87 APPLICATION FOR PLUMBING PERMIT r�1'
I hefty, af#IT that I�ave d certificate of consent to self In- 76A667A '1 I
Burr qaq, to of Workers'Compensation Insurance,or a CE 817(REV. 8/86) lul
cerltfted co theruaf (Sec. 3mpanab. C. yy COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No.� Company ��'�� ���
Certlfled copy Is hereby furnished.
FOR APPLICANT TO RLL IN (PRINT OR TYPE) BUILDING L Z ^ -
(�iCertlfled copCA y Is filed with the county building In"Olon AD ESS t..)
L� depart a t. NUMBER FIXTURE OR ITEM ® FEE LOCALITY
Data -Applicant /Y!L �Yr+ WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF D(EN%PTION FROM WORKERS'
BATH TUB CROSS'ST.
COMPENSATION INSURANCESLOWER_ OWNER
(This section need not be completed N the work Involved by MAIL
the porrnFt Is for one hundred-dollars ($100)or leas.) LAVATORY 00 ADDRESS J{L
I certlfy that In the performance of the work for which this per- If 'y
' mlt Is Issued, I shall not employ any person In any manner so CTfY Ci /
SINX
,
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACT
Date Apphcant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR ADDRESS {7
emptlon,you should become subject t6 the Workers'Compen- CITY TEL I
satlon provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this,permit shall be deemed revok- STA LIC.
ed. WATER HEATER 1,10ENtSE NO. 13
LICENSED CONTRACTORS DECLARATIONGA5 SYSTEMOUTLETS
O DISTRICT NO. BY
I hereby affirm that I am licensed under provisions of Chapter
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Prafesslons Code, and my license Is In full force and ef- s PFR SYSTEM FINAL �J VALIDATION >'
fact. DA �C�/
License Number Llc. Clau�— U V
p FI
f I Q
Contract-Li /� F�brDnte O
❑ I am exempt under Sec. WW
B.BP.C. for this reasonCO
an check dee ► XX
Date: PlPLUMBING PERMIT ISSUING FEE;
'# O O e ..0 5
Signature TOTAL FEE
SINGLE FAMILY ) o 25 O
HOME OWNER-BUILDER DECLARATION Plan check applicant
I heraj y affirm that I am exempt from the ContracfoC s License Name o e o 2 a 5 O i .
Law for the folldwIng reason (Section 7031.5, Buslnea and
Profeulons Code): Addresq 0 2 O 2"8 8
I, as owner of the property, will do the work and the City Tel. No.
structure Is not Intended or offered for sale(Section 7044,
Business and Professlons Code). ,
CONSTRUCTION LENDING AGENCY
I hereby affirm thoi there Is a construction lending agency for
the performance of the work for which this permit Is Issued
(Sec. 3097, Civ. C.).
Lenderi Name
Lender's Address
I certify thot.1 have read this application and state that the ►
above Information Is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize reprj2sentalivas of Is County to nt upon the
above-ment props I Ion pu
SEE REVERSE FOR EXPLANATORY LANGUAGE
nature of Permittee Date