HomeMy Public PortalAbout5821 CAMELLIA AVE_Plumbing__ r
70A567-CE*817 10-57
APPLICATIONFOR LU -
P MBIN PERMOr
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGUMM
BUMDING AND SAFETY DIVLSIONI
JOHN A. LAMBIE. COUNTY ENGIN[[R
COLEMAN W. J.ENKINS. SUPT. of RUILDING LOCAI1TT
FOR APPLICANT TO FILL IN R OR TYPE CROW ST.
NUMBER FIXTI,IRES OR ITEM EACH FETE
OW143M -
WATER CLosict 1.30 HATT -
RATH TUB 1.90 ADD72W
BHOWER 1.80 CITT ` XO
LAVATORY 1.90
SINK 1.90 ADDEW
DINTWABHER 1.30 CIT! 71FIi+ �f0. �J
CLOTHES WASHER 1.30 (TATE LIC
LICE" NO. CLASS
SWUMENG POOL RECEPTOR 1,50 DISTRICT NO. Gm6up ZON[ rRQCI(p[P_*Y._.
LAWN SPRNKLE12 SYSTEM 2.00 [ �
WATER HEADER 1,10 nmurruAL
Wkffm ApF*OvAL
GAS SYSTEM O-UTL$TS 1.30 IImPECTIOm IECORD
OUTLET8 OVER 30
HI SYSTEH
Plan chee-k fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FI;E ; 2 0.0
TOTAL FEE
APPROVALS DATE I)•1SPCCTQII•S■IOItATti
Plan Check applicant UNDER SLAB WORK
Nma ROUGH PLUMBING
Addrees GAS PIPING
GASVENT - - -
Clty Tel. No.
NOT WATER NEATER
I )- I y //CKNOWa
L[Di TWA= 1 C HAVRSAAD THIS APPUGATION
AND STC AT[ THAT TH[ AAOV16 CORI�CT AND AGRIQ TO r. M -Ly PLUMBING FIXTURE
WITH ALL, CDUNTY ORDINAMCWf AND STATC 4AWS RidULATIMO OAS TEST
PLUMBING.
I slummy CL7ITIFY THAT 1 AM PROP[RLY RK91WTKMD AMDbOR UTILITY CO.NOTIFIED
U CCNMM AS P=UIRCD NY LA f AN LCB COUNTY AMD STAT= OF
CALIFORNIA OR THAT 1 AM THC OWNIR OF AND IMTffid TO
ROIDC IN,THC A10VC RS'JI PROP[*TY. FINAL
SIGNATUR� JACK R. ALLFEN, pfi
UPGVISING MEC1-IANICAL
OF r[RM1i1w
PERM r VALIDATIONS CK. M.0. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
: zr' 6 0 73.t3 =22
rr WORKERS'chavejOAT10ic DECLARATION DPW 4187 APPLICATION FOR PLUMBING PERMIT
^xj{fdt t[flrrfi thaT I have ceitiflmte of consent to self In- 76A667A
sore or a cerHflcate o�Workbrs'Compensatlon Insurance,ora CE 817(REVg/136)
c� fled d4?-y thereof (Sec. 3800,lab. C. -
Policy No �70Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
❑ Certified copy Is hereby furnished.
Certified co Is filed with ih coon building In FOR APPIJGANT TO FILL IN(PRINT OR TYPE) BUILDING /
copy ty q spectlon ADbRESS
department. NUMBER FIXTURE OR fTEMI Fg
_ LOCALITY
Date' ' Appllcan , WATER CLOSET(TOILET) tVEAREST
CEf2T1FICATE OF EXEMP710N FROM WO KERS' /
EWTH TUB CROSS ST.
COMPENSATION.INSURANCE SHOWER OWNER
(this soct4on nwd not be completed If the work Involved by
MAIL
the permit Is for oneftundred dollars ($100)-or{ess.) LAVATORY ADDRESS //�_ _ �
I certify thQt In the performance of the work for which this per- ' /
mit Is luded, I shall not employ any person In any manner toSINKf�7
as to become subject to tfie Workers'Compensation Laws. /
DISHWASHERcyzCONTRACTOR
.jei
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption,you shouldbecome subjectto the Workers'Compen OT
y NO� /)/
sation provisions of 4he Labor Code,you must forthwith compp- LAWN SPRINKLER SYSTEM l��F�
Iy with such provisions or this permit shall be deemed revok- / STATE LIC
ed. WATER HEATER LICENSE tJ0 CLASS
LICENSED CONTRACTORS DECLARATION DISTR PR2,7 BY
I hereby affirm that kam licensed under provisions of Chapter GAS SYSTEM OtITLtfS r s✓//0�
9(commencing with Sectlon 7000)of Division 3 of the Business CKITLETS OVER
and Professions Code, and my license is In full force and of- 5 PER SYSTEM FINADATE L `Z 69 VALI TION }
/�J a
License Nunr�
ibe -SV'79 LIC. Class AR—/` O
U
Contract o� Date.T �c.Y'I BY p
F..
0 .I am exempt under Sec. U
W
B.BP.C. for this reason IL
Plan checkfee ► z
Data: PLUMBING PERMIT ISSUING,F�E$
Signature TOTAL FEE -2 9 7 3,6 A
SINGLEFAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant # 0 0 o to 0 5
1 hereby affirm that I am exempt from the Contractor's License Name I o o 8 a 5 0
Law for the following reason (Sectlon 7031:5, Buslness and _
Professlons Code): Address o o 0 8 a 5 0
I, as owner of the property, will do-the work and the City I Tel. No. Q S3.1 -1-88
structure Is not Intended or offered for sale(Section 70.44;
Business and Professions Code). ,
CONSTRUCTION LENDING AGENCY.
I hereby affirm that thgre Is a construction lending agency for
the petfoTnance of the work for which this permit Is Issued
(Sec. 3097, Civ. C.).
Lenders Name
Lender's Address,
j I certify that I have read this application and state that the ►
above Information Is correct..)agreeto comply with all County
ordinances and S laws regulating Plumbing, and hereby
author presentat v this County to enter upon the
I a mentioned pr, In I pedlon purposes.
✓�j�.�.r� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perm ee Date