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Home My Public Portal About5718 CAMELLIA AVE_Plumbing__ T&wssT (ai-017( _ ren APPLICATION FOR' PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: FNECAREST ING ESS HARVEY T. BRANDT, COUNTY ENGINEER LITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) S ST. L NUMBER FIXTURE OR ITEM 0 FEE WATER CLOSET 2.00 OWNER I> G MAI L . BATH TUB 2.00 ADDRESS �s1 SHOWER 2.00 CI fJ TEL. NO. LAVATORY 2,00 CONTRACTOR SINK 2,00 ADDRESS DISHWASHER 2.00 CITY TEL NO. CLOTHES WASHER 2.00 STATE LIC SWIMMING POOL RECEPTOR 2.00 LICENSE NO. CLASS DIST ICT NO GROUPn77� PRO SSED BY LAWN SPRINKLER SYSTEM 2,00 O�? T /G l WATER HEATER2 .00 Wag7b4AOVAL GAS SYSTEM OUTLETS 2.00 INSPECTION RECORD S UTLETSOVER 5 PER YSTEM •30 W LNCl- C11) Z Plan check fee Soo Reverse PLUMBING PERMIT ISSUING FEE 8 o TOTAL FEE 0z Q APPROVALS DATE INSPECYOR'e e1uNA7uAc Plan chock applicant UNDER SLAB WORK Nagle ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER I HERESY ACKNOWLEDGE THAT I HAVE READ .THIS APPLICATION AND STAT[ THAT THE AGOV[ IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY 0RDINANCEI AND STATE LAWS REGULATING PLUM eI NG. GAS TEST I HZRESY CERTIFY THAT I AM PROPERLY REGISTERED-AND/OR UTILITY CO. NOTIFIED LICENSED AS REGUIRED EY LOS ANGELS! COUNTY AND •TAT[ OF _ CALIFORNIA OR THAT I AM THE LEGAL OWNER O.F, X b fk Yt Nb TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL OPERTY, •� FINAL •�.= 1,. 91 0 NA TZJ R E OF PERMITTED PERMIT VALIDATION cK. M CASH PLAN-CHECK VALIDATION C0. CASH + �� ` 6 3 30 5 U 1 0.5 &A—J WORKERS'COMPENSATION DECARATION APPLICATION FOR PLUMBING PERMIT I hefeby affirm that I have a certificate of consent to self 20-0028 DPW 6/87 insure, or a certlficdte of Workers' Compensation losurance, 7BA567A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS P❑0114 No. ' Company Cert Hied copy is herby furnished. 'FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS S S NG Certified copy Is filed with the county building Irspec- NUMBER RXTUREOR ITEM Q FEE tlort department. LOCAry Date Appllr;ant 1KATER CLOSET N EAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER C !•I'L (This sect-km need not be completed if*a work krvolved by MAIL the perm"Is for one hundred dollars(:100)or less.) LAVATORY ADDRESS $ I certify that I�,the performance of the work for which this I } permlt Is Issued I shall not-employ any Person In any nner SINK CITY TEL NO. so as to become subject to the Workers Compen to Laws. ' DtSFNVpSFifR Q' CONTRACTORs B �.. Date 7 Z7 Appilcant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this C cafe of Exemption,, you should-become sub lee toorkers' SWLM+A'ING POOL RECEPTOR CITY TEL NO. Compensation provlllons of the Labor Code, you utt forth- LAWN SPRIWLER SYSTEM with cdmply with such provisions or this permit shall be. STATE LIC_ deemed revoked., WATIN HEATER LKINSE NO. CLASS LICENSED CONTRACTORS DECLARATION �I 7RICT�NQr1 BY I hereby affirm that I am IlcerAed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Sectk n 7000)of Division 3 of the Bualness OUTLETS OVER and Profession*Code,and m license is M full force and effect. S PER SYSTEM' FINAL y Dr p VALIDATION DATE License Number I Ic. Class Q FI Contractor Date BY 1 am exempt under Sec. _ Wt B.aP.C. for this reason Cn Plan check fee N Z Date. PLUMBING PERMIT ISSUING F13; Signature ' TOTAL FIS SINGLE FAMILY Plan check applicant 5 ' HOME OWNER-BUILDER DECLARATION - Nam T t.. I hereby affirm that I am exempt from the Contractor ` Contractor's License T . Law for the following reason (Section 7031.5, Business and Add 3307 ' 22.50 ProfesalorA Code): qty Tel. No. 1 ITEMS'. 1, as owner of the property, will do the work and the end � structure Is not Intended or offered for sale (Section , 'TOTAL I AL 22.50 7044, Business and Prbfessions Code). CONSTRUCTION LENDING AGENCY CWCK 22.50 1 hereby affirm that there Is a construction lending agenty for GtAWE s00 the performance of the work for which this permit Is Issued (Sec. X97, Clv. C.). Lenders Name OD -OMI 7/27/89 Lender's Address 4699 1 All 842 I certify that I Dave read this appllcgtlon and state that the ► above Information is correct. 1 agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize repreZentatives of this County to enter upon the above-mention pr for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P I Date .. T I✓ - 7 V WORJ(ER;COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I herebjnaffirm that I have a certificate of corsenf to self 76A667A �� Inwre,�r d certificate of Workers' Compensation Insurance, CL 817(REV. 10/81) or a I py f (Sec. 3800, Lab. C-) COUNTY OF LOS ANGELES / r BUILDING AND SAFETY Polio. Company ❑ Certified copy Is+x"eby furnished. J , / FOR APPLK-NJT TO F14L IN(PRINT OR TYPE) BUILDING Certified copy Is filed with the c my building Inspec- ADDRESS tion rttnenf. NUMBER FIXRIREOR fTEM O FEE LOCALFY C E �/T Date (' Applltant WATER CLOSET NEA" CERTIFICATE OF EXEMPTI FROM RS' BATH TUB CROSS ST. SGL COMPENSATION RANCE SHOVE OWNER (This section creed not be completed ff the work Involved by MAIL the permit Is for one hundred dollars (:100)or lees.) LAVATORY ADDS I certify that In the perforrhance of the woFk for which this permit Is Issued, I shall not employ any Person In arty manner S4NX cnY G/ 7y TE `* so ad to become subject to the Workefs Compermation Laws. DISHWASHER cnNrRA<� sa Dote Applicant CLOTHIES WASHER Sa Alf DRE NOTICE TO APPLICANT: if, after making this Certificate of ADSS rod a�V e�[/s Exemption, you should become subject to the Workers' SWIMMING POOL ROTOR TEL Compensatlon provlslons of the Labor Code, you must forth- ❑TY � X957 17f�/ LAWN SPR INKLER.SYSTEM with comply with such proYlslons or this permit shall be STATELIC jdeemed revoked. WATER HEATER LICENSENO. C —y LICENSED CONTRACTORS DECLARATION DfSTR1Ci NO BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the BusJnmm OVER and Professions Code,andQmy liceennse Js In full force,andeffect. 5 FINAL VALIDA71ON License Number 7� / ! G' D DATE V Elc. Class_ FIIq k � Contractor Date 7 BY O ❑ I am exempt under Sec ' N B.BP.C. for this reason Plan check fee — Date: PLUMBING PERMIT ISSUING FEE; Slgrature TQTAL FEE d Plan check applicant SINGIE FAMILY HOME OWNER-BUILDER DECLARATION Name F 2738'A I hereby afflrm that I am exempt from the Contractors License Law for the following reason (Section 7031.5, Bus'lrmss and Addrew t o 0 0 0 o'5 professions Code): City ' Tel. No. 2 0 o 3 Q 5 0 ❑ I, as owner of the property, will do the work and the structure Is not Intended or offered for sale (Section — 3C, 506 7044, Buslness and Professlona Code). r CONSTRUCTION LENDING AGENCY 07. 16-84 1 hereby affirm that there Is a construction lending agency for . the performance of the work for which this permit Is Issued 1 (Sec. 3097, Cly. C.). Lenders Name LendeCs Address I certify that I have read this application and state that the Poo. Information Is correct. I agree to comply with all County ordinances arld tate Iqw. regulating Plumbing, and hereby dothorize r9 ntatives of this County to enter upon the above-m t property for Inspection purposes. EEE REVERSE FOR EXPLANATORY LANGUAGE SIgrFJ'J Perlm Date