HomeMy Public PortalAbout6029 CAMELLIA AVE_Plumbing__ OOUfTY OF LOS "GELES APPLICATIOM FM PERT
DIVISION OF BIIII.DING & SAFETY
WILUA■ J. Fox O*"ty EaffIMr PLUMBING 1
rqA mgwp NK IT N U.
APPLICANT TO FILL IN � .
PW O R p IVB READY FORT[ t f ICD
. F1R1T mwKi T1OW .— o
AD DII�
r> _ ■UILDINIS
OITY TEL. ADDRQi
COUNTY _ LD `
O
�a N EAR EST
P�r FEES DROUN ST.
NUM�O! TYPE OF FDmm OR RaF't[ GwH
MAIL
WATER OLOarr(TOILET) ■O + ADDRESS
BATH TU■ AD - QI TEL. No.
MH01V[R ! 60 1 H[ AC KN [ THAT 1 HAV[ READ THIS
R
LAVATOY (WASH WIN) 0. O APPLICAT N AND STA THAT THE ADOV[ IN DORR[CT
AND AGREE TD COMPLY WITH ALL DOUNTY CRDIN.AHO[f
KITOH[N MINK 60 AND STAT[ LAWS RIGULATIMG PLUMBING.
1 CERTIFY THAT I POMIMME THE AVOW VALID LOM
LAUNDRY TUN OR TRAY 60 ANGEL.Ef HCOUNTY V [NEE. OR I AM TH[ LEGAL OWNER
OF THE REJiID[NTI P OP[RTY DKX0 I0ED AfQVE.
GAN SYfT[u OLr L[TO Q 60 ��
WATER HEATER 60 ■IfPER RET['
OLOF MINK 60 INSPECTION RECORD
FLOOR MINK 60
FLOOR DRAIN CkIlD
DI■HWAaHVK Ol.O
DRINKING FOUNTAIN 60
URINAL 6C
HOUBE f[W[R 50
M I fo ELJJA H EO LIf O
O
APPROVALS
DATE IN!•PeTOA'111 M.U19
R13UMH PLUMMIMG
DAf PIPING
a" VENT
OEREPOOL 1.00 DKJN POOL
=rT1O TANKI 0[TTIO TANK
DRAIN ( PIT 49 1.00 fEW[R
PHRMrr 1.00 MAX TETT
UTILITY 00.NOTIFIED
TOTAL FEE •
71"OT DSS#1T L/52
D.W.r7 IPM NWIV w APPLICATION FOR P$ iIrl'
DEPARTMENT OF BUILDING AND SAFETY
a COUNTY OF LOB ANGELES PLUMBING 1
WM.J. FrOX, CHIOr QdGINm!
NATURE OF INSTAX�� DISTRICT No. GROUP I ZONE PERMrr NO.
ROUGH FIXTURES Mri rm 0
HEATOI CM POOL 80MC TANK BY FFORI R ION DAM ISSUED
t
APPlAF,L2 FILL IN H$AVILY OUTLINED PbRTION ONLY
JOB
HAMS gsa, ADDRUM
ADDRESS
IxLOCALITY
NEAREST
CITY TIO._No. CROP ST.
COUNTY
CERT.No. / Q�IRL NAME
LOCATION OF-SEPTIC TANS, OR CESSPOOL MAIL
ADD RJSSS
NORTH
CITY TIO_NO.
1 AM t Tr ZMA POWURMOR OF ,
t AIlKWX LO
ANGES Tr
CXXTM OF
_,nc.
AII AM
L THE LXG q.OINNOI O!THE PROI.OITY DESCKMED
f -
o*r�
CORRECTIONS
SOUTH
DESCRIPTION OF WORK z
Tk Tun FURNAOZ o
� pC
OWOi ^UWWAS HER O
—LAVATOPtY p WRICKRATOR
OV SINK WATER SOFT>dom
FLOOR SINK BAND TRAP
SINK ______FLOOR DMAIN
VFA +t TRAY VIRINAL APPROVALS
WATIOR CLOSET r+RINKING FOUNTAIN
DATE tltSTICTD!'S wwMi
WATKR HEATER DQITAL LAVATORY
ROUGH rLU1/S1N49
ETA a" mOmA FOUNTAIN GAS PIPING
OU' I.
SAS VOFr
cEeirYOOL
TOTAL NUMSER OF FIXTURES 8KPTIC TANK
IC TANK Ww"
• f�
!/
TOTAL FQE uTIL1TY co.NOTIPIIm
�a
I
IF
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificat of consent to self 20-0025 DPW 6/87
+ Insyr� or a 4ertiflcate of Worker' Co nation Insurance, 7&A687A
ura ce3�wco
(Sec. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
•
Policy mpanY14 4
New
Certlfled copy Is hereby furnis ed.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUI D J
Certified copy Is filed with the county building Infpec- N
nt. NUMBER FTXTURE OR ITEM d FEE
e�tAppllSan WATERCLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS Si.
COMPENSATION INSURANCE �-, SHOWER OWE
(This section reed not be completed IF the Mork Irnwhned by MAIL
1 the permit Is for ore hundred donors ($100)or less.) LAVATORY Q ADO Z l/
I certify that in the performance of the work for which this
permit Is Issued, I shall not employ any person In any manner SI NIC CffY
so as to become subject to the Workers Compensation Laws. DISHWASHER
CONTRACTOR
Date AT Ilcant CLOTHES WAST ER ry
NOTICE TO APPLICANT: If, after making this Certtficate of !
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Cgmpensation provisions of the Labor Code, you must forth- LAWN SMINKLER SYSTEM
with comply with wch provisions or this permit shall be STATELIC
deemed revoked. WATER HEATER NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am Ilceraed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commenting with $Action 7000)of Dlvlslon 3 of the Business OUTLETS OVER
and Professions Code,and.my license b h full ft5 PER SYSTEM FINAL
DATE i VALlpAT10N
license .m 6fV�r Ic. Class
Contract Uat/' 3/- B"A`
❑ I am exempt under Sec. '
B.dP.C. for this reason plan check fee Z
Date. PLUMBING PERMIT ISSUING FEES IJ
Signature
TOTAL FEE
SINGLE FAMILY Plan check applicant 5
FLOW OWNER-BUILDER DECLARATION Name ACCT.-4
I hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business andAdd7 , 118.50
Professions Code): Clfy Tel. No. ' �. ' 1 ITEMS •
❑ I, as owner of the property, will do the work and the �
structure Is not Intended or offered for sale (Section JTOTAL 118
704, Business and Professions Code) OECK,
113.50CONSTRUCTION LENDING AGENCY
I hereby affirm that there Is a construction lending agency for cwkaX00
the pe,forrnonce of the work for which this permit Is Issued
(Sec. 3097, Civ. C-).
Lender's Name 001DID—OW1 12 IS/'89
Lenders Address 7601 1 AM10:53
1 certify that I have read this application and state that the ►
above Inforrttatlon Is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
uthorize repre3entatives of this County to enter upon the
bo me Ion property for Inspect on purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
gnature of Permittee Date