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Home My Public Portal About6120 CAMELLIA AVE_Plumbing__ T6AeeT-CZ #817 2-e2 TEMPLE C97V APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BU J . AD> DWI BION J N M I OUNTY ENGIN[¢R WILLIAM A. JENSEN, h1PT OF DLIILDING LO CALITT z__�� FOR APPLICANT TO FILL IN XEAEM NUMBER FIXTURE OR ITEM EACH FEE CHOU ST. CWM3 � fi WATER CLOSET Si33 MATT BATH TUR 125 ADDHEB$ SHOWER 1.75 C1TT NO. LAVATORT IM SDQ 1.25 ADDRESS DISHWASHER 1.25 cTT LAIIlfDH7 TUB 135 REEa�A OTI0g1' NO. � � coUXTIT e CLOTHES WASHER 135 DIST I N GROUP PR DY WATER 1.50 -GAS OIITIETB 150 INDUSTRIAL WASTE APPROVAL OUTLLTB OVER 5 PER STBTEI( .70 ON RECORD V 9x 0 G W APPROVALS DATE INSPECTOR'S SIONATURS PERMIT S 2 00 UNDER BLAB WORK ROUGH PLUMBING TOTAL FEE 175 GAS PIPING I HlUtmY ACKNOWULDOE THAT 1 HAV[ READ THIS APPLICATION AND STAT[ THAT THR AIOVI 15 CORRECT AND AOI lIX TO COMPLY OAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLU MS I N G. HOT WATER HEATER I HEImY CERTIFY THAT I AM PROPERLY REGISTER AND/optPLUMBING FIXTURES U CKNSKD AS REQUIRED RY LOB ANGZLIS COUNTY AND STAT[ OF GAS TEST CAUFORNIA OR THAT I AM THE LXQAL OWNER ,AND INTEND TO RZ•IDK IN,THE ABOVK DESCRIMD RE111IDENT1 PERTY. UTILITYCO.NOTIFIED SIGNATURE OF PER MITTI[ FINAL 0AMDATION ROBERT A. WOOD M.0. CASH SUPERVISING MECHANICAL ENO'R L1�,o 1 1 6 412 OCT 8 5 D 3.5 0 q WORNM'COMPENSATION DECLARAnoN APPLICATION FOR PLUMBING PERMIT I_k afflrm that I have a certificate of consent to self 76A667A �Insure �a certificate of Workers' C6mpenscrtlon Insurance, CE 817(REV. 10181) or a certified copy thereof(Sec 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certffled copy Is hereby furnished. FOR APPUCAM TO RLL IN(PRINT OR TYPE) BUILDING ADDRESS Q L� Certified copy Is filed with the county building Inspec- tion department. NUMBER FIXTURE OR REM O FEE LOCALLITY Dat ApplIgan WATER CLOSET NEARST 6.4k R . CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CRCSS'`T• COMPENSATION INSURANCE (This section ed not be completed If the work Imrohred by SHOWER ML G ruwr77 M the perFntt Is for one hundred dollars($100k or leu.) LAVATORY ADDRESS N (' 14 I certify that In the performance of the work for which this permit Is Issued, I shall not employ anyPerson In any manner SINK CITYEVE TEL NO-,2 so as to become subject To the WoOrkers Compensation Laws. DISHWA.SFER O fla �� Arpllcont L CLOTHES WASHER WNTRACTOR ADDRESS 1404 TO APPUCANT: If, after making this Certificate of sy Poe RECEPTORExemption, you should become subject to the Workers' ` Compensation provisions of the Labor Code, yoo must forth- LAWN SPRINKLER SYSTEMCRY TEL with comply with such provisions or this permit shall be STATE LIC_ deemed revoked. `yATEER HEATER NO LICENSED CONTRACTORS DECLARATION DISTRICT Y I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS O (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER Z,41— CL and Pr6fessIons Code,and my license is In full force and effect. 5 PER SYSTEM FDATE VALIDATIO V f License Number fic. Class 21. p� FI O Contractor Date B r G F-1W I am exempt under Sec. H B.BP.C_for this rea}on Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ O � Slghature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractors License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ® I, as owner of the property, will do the work and the structure Is not Intended 9r offered for sale (Section 1 7041, Business and Professions Code)_ $3 7 5 0 A CONSTRUCTION LENDING AGENCY I hereby arm that there Is a construction lending agency for 0 5 ffi the performance of the work for which this permit Is Issued (Sec. 3097, Cl v. C.) / d o 1 b 5 0 Lender's Name o o'0 1 650 Lenders dress U 0. 1 3-86 1 certify that I have read this application and state that the , above Information I}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 property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date