HomeMy Public PortalAbout6018 CAMELLIA AVE_Plumbing__ 76A667•CE#817 9/63
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
• BUILDING AND SAFETY DIVISION BUILDING
ADDRESS 6018 Camilli ve
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY Temple Cit
FOR APPLICANT TO FILL IN NEAREST Woodrift
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $1.25 6 25 Howard Hansen
MAIL
5 BATH TUB 1.25 6 25 ADDRESS
SHOWER 1.25 CITY TEL. NO.
5 LAVATORY 1.25 6 �5 CONTRACTOR Owen Bros Plumbing
5 SINK 1.25 6 25 ADDRESS 4265 R• Baldwin
DISHWASHER 1.25 CITY El Monte TEL. No. 40-0078
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. COUNTY ❑
1 CLOTHES WASHER 1.25 DISTRICT O. GR UP ZONE PROCESSED BY
6 WATER HEATER 1.50 9 00
GAS SYSTEM OUTLETS 1'50 INDUSTRIAL a
WASTE APPROVAL Q
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
� 0
,< t I-
s.Q V
4 a
U
N
z
"vi 7
APPROVALS DATE. INSPECTOR'S SIGNATURE
UNDER SLAB WORK `'•,�'�' �""`
PERMIT s 2 00
ROUGH PLUMBING -
TOTAL FEE 2
37 5 .
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER " y �..+G,,`
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES j l
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE AD? DUE RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE i y
OF PERMITTEE ✓
FINAL I I ��
V LIDATION ROBERT A. WOOD
CK. M.D. CASH SUPERVISING MECHANICAL ENG'R
_
5
ivfl
3 1 5 7 .428 5 3 7.% �.
I
� �4OflKEfi'SCOMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT
76A667A
I hereby affirm that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab.C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. —
Company
❑ Certified copy is hereby furnished. /� y
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS f O-A ? - �% A V '
F-1Certified copy is filed with the county building inspection
department. NUMBER FIXTURE OR ITEM @ FEE n
LOCALITY
Date Applicant WATER CLOSET NEARESTp�
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. tt/t�o-DA�
COMPENSATION INSURANCE BATH TUB
ASSESSOR
(This section need not be completed if the work involved by the
SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) LAVATORY OWNERLt V E P�A A/ 14
I certify that in the performance of the work for which this permit MAIL �1 '�r
is issued, I shall not employ any person in any manner so as to SINK ADDRESS r -v N Y-C49PC D/Q
become subject to the Workers'Compensation Laws.
DISWASHER CITY /! �� TEL.NO. 2S
Date Applicant CLOTHES WASHER CONTRACTOR l✓
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS4• /�L fig- z
provisions of the Labor Code, you must forthwith comply with such t-��. '
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.NO. }
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER O
(commencing with Section 7000 of Division 3 of the Business and STATE LIC.
( 9 ) LICENSE NO. CLASS
Professions Cade,and my license is in full force and effect. GAS SYSTEM OUTLETS f-� V
OUTLETS OVER DISTRICT NO.n PROCESSED BY cc
5 PER SYSTEM GG Q
License Number Lic.Class
FINAL VALIDATIONW
DATE
0-
Contractor
Contractor Date Cl)
TFIN
ElI am exempt under Sec. _ BY AL gp Z
B.&P.C.for this reason �
Date:
Plan check fee 101. 7z
Signature PLUMBING PERMIT ISSUING FEE$ S7 O
TOTAL FEE q b, Q Y
❑ Plan check applicant1
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
1 hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions Address
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 i
and Professions Code). ,
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,
Civ.C.)
Lender's Name
Lender's Address
I certify that I 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
representatives of this County to enter upon the above-mentioned
proper for inspec on urposes. / SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of PermitteeDV ate