HomeMy Public PortalAbout5328 CAMELLIA AVE_Plumbing__ � � U M � 1 t� G 1
{ DEPARTMENT OF DOUNTY ENCO VEEE
DMSION OF BUILDING AND SAFETY PERMR APPLICATION
OOUNTY OF IAS ANGla, BUILDING
WILLIAM J. FCX, CouNTY ENnINEER ADDBESB
FOR APPIUC T TO RLL IN
LOCALITY
BUILDING NEAREST
ADDRfi88 .y � CROSS ST
LOCALITY ��r CC�� DISTRICT, 0^ GROUP ZONE PERMIT N/0.
NEAREST
CROSS ST. REOEIV Q BY RMdy for IpHatloo ATE ISSUE
OWNER a>fj{J/(�!a ✓ //�
NAIL INDUSTRIAL
ADDRESS 7- WASTE APPROVAL
CITY 44 TEL NO.Z)o—6 x 7ff. INSPECTION RECORD
PLUMBER Le— Cp
ADDRESS 1� � fr
G A
CITY I-L ,r TEL No. 7�YI�L
0 STATE
LICENSE NO. / Z`f nzOuN
_ J
PERMIT FEES Z
NuMRR M[ OF FIXTURX OR IT[M F" Q
WATER CLOSET(TOILET) ! sm 146 O
C
J BATH TUB 0 0-so d
f SHOWER ! SAO elo
LAVATORY(WASH BASIN) Q am 60
KITCHEN SINK Q 0.80
LAUNDRY TUB OR TRAY Q 0.60
SLOP SINK Q 0.6*
FLOOR SINK ! em
FLOOR DRAIN ! 0-m
DISHWASHER • 0.80
DRINKING FOUNTAIN ! 081
URINAL 0."
GAS SYSTEM OUTLETS IX4 c'Ia
WATER HEATER
MISCELLANEOUS
APPROVALS
DATE ["PECTOR.8 SIGNATURE
UNDER SLAB WORK
PERMIT s 1 00 ROUGH PLUMBING
O GAS PIPING n
TOTAL FEE 71
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- a"VENT
CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES f+,'
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY OAS TEST lo
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE D I D RESIDENT] PBOP UTILITY 00.NOTIFIED
SIGNATURE L1rt�{J
OFPERMITT `1
FINAL
T&A6a7 DBS 1T 1/63
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
S afflrfh that I have a certificate of consent to self 76A667A
In$0l o�a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
(or a certlfled copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company .
Certified copy Is hereby furnlshed.
❑ FOR APPLJCANT TO FlLL IN(PRINT OR TYPE) BUILDING
Certified copy Is filed with the county building Inspec-
tion department. NUMBER FIXTURE OR ITEM O FEE LOCALITY
WATER QOSEF
Date Appllrant rEAREST / a
CERTIFICATE OF EMPTK?N FROM WORKERS' BATHTUB
UROSS ST.
EX
COMPENSATION INSURANCE OWNER
need _
(This section not be completed If the work Involved by MAIL
the pwmh Is for one hundred dollop (=100)or leu.) LAVATORY AWRESS C
I certify that In the performance of the work for which this �
pwmlt Is Issued, I shall-not employ any n I r SING T- NO':::� rp�
so as to become subject to the W t Di$HWASFtER
OONTR.4CTOR
Date -3('r Applic.01 CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of SWIhuwP1G POOL Rl�FTOR
Exemption, you should become subject to the Workers'
CITY TEL NO
Cbmpensatlon provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC
deemed revoked. WATER HEATER UBiSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRK7 NO.
I hereby affirm that I arr)licensed urxJerIslons of Chapter 9 OAS SYSTEM OUTLETS 6O -
(commencing with Section 7000) of Dir slon 3 of the Busmen OUTLETS OVER !
and Professions Code,and my Ikenw Is in full force and effect. 5 PER SYSTEM
DAVE VAL ATION y
License Number Llc. Class ~� p
FI 8.
Contractor Date Ott
Q
❑ I am exempt under Sec. - I—
B.BP.C. for this reQson Plan check fee U
to
Date PLUMBING PERMrr ISSUING FEE= a 9 7 4 4 A Z
Signature .
TOTAL l� # 0,0 0 0 0 5
SINGLE FAMILY Plan check applicant I o.o 2 2 5 0
HOME OWNER-BUILDER DECLARATION Name a'a a 2 2 5 0 65
I hereby affirm that 18m exempt from the Contractors License
Law for the following reason (Section 7031.5, Buslness and dress 060,11 388
Professions Code): City Tel. No.
❑ I, as owner of the property, will do the work and the
structure Is not Intended or offered for sale (Section ,
7044, Business and Professions Cade).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for
the performance of the work for which this permit Is Issued
(Sec. 3097, Cly. C.}
Londer's Name
Landers Address
I certify that I have read this application and state that the poll'.
Information Is correct. I agree to comply with all County
ordinances and State laws raclulatLog Plumbing, and hereby
authorize r as I unty to enter upon the
me tl for Ion purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
x - ( •189
ature o Perm Data