HomeMy Public PortalAbout5843 CAMELLIA AVE_Plumbing__ DEPARTMENT OF BUILDING AND SAFETY " APPLICATION FOR PERMIT
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COUNTY OF LOS ANGII.ffi
WILLIAM J. FOX, CHIEF ENGIN[R
ING 1
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
bz3-77
PLUMBER RECEIVED SY READY FOR DATE ISSUED
{{ FIRM'INSPECTION
ADDRESS f . r'�--t
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BUILDING
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COUNTY LOCALITY `-
N EA R EJ•T
PEHMTI FEES CROS OT.
TYH Or FIZTURI OR ITKm F[E OWNER
MAIL J L1
WATZ}2 CLOSET TOILET O ADDRESS C
lb CATH TUE O C TY TIL NO.
y 6HOWE Lq O• I H[RRY ACKNO [ THAT I HAV[ RILAD THIS
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LAVATORY WASH BASIN) O. APTLICATION AND 6TATE THAT THE ABOVE 18 CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN[INK O. O STAT[ LAW[ REGULATING PLUMBING.
1 CERTIFY THAT I POBS[SS TH[ ABOVE VALID LOB
LAUNDRY TUB OR TRAY 0 P.
_O TH6KRESIDHNTIAL PROPER COUNTY LlCffNSIL OR D6o M THK LEGAL OWNR
GASiYST OUTLYTS SIGNATURE OF
WATERNIED
H T[R O.CO P[RMITTY
SLOP SINK 0.60 INSP .CYTON RECORD Cl
FLOOR SINK 0.50
Z r u ..,s .L• v��o
FLOOR DRAIN 0.150
DISHWASHER 0.60
DRINKING FOUNTAIN 0.60 /AI `f -'s +
URINAL 0.60
HOUSE SEWER 0.6 s- �!
MISCELLAN[OU6
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APPROVJUZ
AT[ 1NST[CTO
ROUGH PLUMBING fra L/ 1
GAS PIPING 3
GAS V KN'r
C"SPOOL 1,00 CESSPOOL
SEPTIC TANKi SffTIC TANK
DRAIN ( ) PIT ( ) Q 1.00 SEW
PERMIT . 1.00 GM TEST l J—b Q P Q L) 14
UTILITY CO. NOTIFIED n
TOTAL FEE
FINAL ."
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APPLICATION FOR PLUMBING PERMIT
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MPARTMB T OF COUNTY ENS
BUILDING AND SAFEYtt Dri=ON BV=]Jra
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6 ADD
, aBIFi' v!��dlaq LOCA
FOR APPLICANT TO FELL IN
NUMB" FIXTURE OR ITEM o*mm �
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G7.0mmWAS DISTRICT NO. �p1JPP ED BY
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APPROVALS BATE IltdPIrCTOit'd dlallA'CURR
PERmrr f 1100 UNDER BLAIN WORK
TOTAL FEE f Q ROUGH PLUMBING
GA8 PIPING
I HER ACIIOWLII1a1 THAT 1 HAY[ "AD TM5 A"UCATIOR
ID
ASTAT; THAT THX AM" IS CORUCT AAD AGM 70 COMPLY GAB VRNT
LITH ALL COU)ITT ORDIMAYCIS AID STS LAfI RIWLAnzQ
PLUNK24L HOT WATER HEATER
I HIIRIDT CIl7IFY THA I AN FROFIRLT RIQRSTn= AXWOR PLUMBING FIXTUREB
LIctmm AS RIQUI d ]11�fiLl1 CO M /,tD STATIL OF GAS 7HBT
CALIFORItIA OR T" I LLGAL 0 OF THX AHOY[
DIS MMM RL91DE TTAl. F LITY CO.NOTIFIED
SIGNATURE /
OR PE tmI orie-, Z�
FINAL
VAI.IA.
Ca. ..0. Gf.. jSUPEu�ExQ htECH MECAL EIa'u
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4247n NC 14 5 A 3.00
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} 'WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
f hereby uftl)m that I have a certificate of consent to $elf 7&1.667A
Insure, or a certtflcate of Workers' Compensation Insurance, CL 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Pollcy No.—Company
❑ Certified copy Is hereby furnished.
❑ FOR APPLICANT TO FiLL IN(PRINT OR TYPE) BUILDING
Certified copy Is filed with the county bvilding Inspec- ADDI SS 7J!
tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY
Date Appll4ant WATER CLOSFr
CERTIFIG4TE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST S
COMPENSATION INSURANCE SHgWER OWNIE2 MAI keP-AJ el'/
(This section need not be cornp4efed if the work 11mrolwd by MAIL ^
11—
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the permit Is for oni hundred dollars (;100)or less.) LAVATORY. AD rQ
I certify that In the performance of the work for which this
permR Is Issued, I shall not employ any Parton In any manner CITY 11 TEL NO.
to as to become subject tq the Work Compensation Laws, hy
CONTRACTOR
Date i1cant CLOTHES WASI-1E2 ADDRESS
NOTICE TO APPLICANT: If, after making this CertiflGate QJVSWIMMItJGPOOI TOR
Exemption,- you should become subject to the Worker' C TEL NO
Compehsatlon provlslcns of the Labor Code, you muss forth- LAWN SPRINKLER SYSTEM
with comply with such provision's or this permlt shall be STATE L10
deemed revoked. )NATER HEATER Q NO. CLASS
LICENSED CONTRACTORS DECLARATION . DISTRKJ_NO. By
I hereby affirm that I am licensed under provtslor*of Chapter 9 GAS SYSTEM OUTLETS F�Y
(commencing with Section 7000)of DIvIslon 3 of the Buslnea OVER �.
and professions Code,and my license is In full force and effect.
5PER FINAL vAu AnoN
DATE
License Number I Ic. Class 2 U
FINAL
Contractor Date BY
❑ I am exempt under Sec. W
B.BP.C. for this reason-
Plan check fee —
Date: PLUMBING PERMIT ISSUING FEE$
Signature
TOTa,Lr� 5 13523A
Plan check applicant # 0 0 0 0 0 5
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name I o - 2250
1 hereby affirm that I am exempt from the Contrpctor's License
Law for the following regsoh (Section 7031.5, Busloeu ani wren s o 0 22506
rI
Ions Code): Clty Tel. No. I �,2 —$5
, as owner of the property, will do the work and the
structure Is not Intended or offered for sale (Section ,
7044, Business and Profeulons Codel_
CONSTRUCT10N LENDING AGENCY
I hereby affirm that them Is a construction lending agahcy for
ithe performance of the work 6 which this permit Is Issued
(Sec. 3097, Olv. C.).
Lenders Name'
Lender's Addreu
I certify,thot I have read this application and state that the ►
above Infbrrratlon Is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
abov mention property Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
gnarure of Permittee Date