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HomeMy Public PortalAbout6131 CAMELLIA AVE_Plumbing__ D.B.17 8.41 Z3M APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT 7NO. ROUGH PLUMBING FIXTURES COMPLETE RECEIVED BY READY FOR DATE ISSUED HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB C NAME(.r d ADDRESS ADDRESS_ 13 S, S�'--N �® © LOCALITY aCITY *, TEL.No CROSBS T. COUNTY �.. CERT.No. - EXPIRES ,���G` NAME W LOCATION OF SEPTIC TANK, OR CESSPOOL 3 AMAIL DDRESS NORTH O CITY TEL.No. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. - PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. F N W 3 1 OWNER CORRECTIONS i SOUTH DESCRIPTION OF WORK \f i BATH TUB FURNACE SHOWER DISHWASHER — � r LAVATORY REFRIGERATOR - —KITCHEN SINK WATER SOFTENER —FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME —WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I II - _—METER—GAS _SODA FOUNTAIN GAS PIPING 1 ---�"�-G•q�-i►.L� GAS VENT � CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOL SEPTIC TANK SEWER UTILITY CO. NOTIFIED I TOTAL FEE FINAL k 22 -LC- D.R.S.47 25M SETS 6-46 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES �L� �' � WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZO E PERMIT NO. ROUGH FIXTURES COMPLETE _ HEATER CESSPOOL SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION GAS- MISCELLANEOUS APPLICANY FILL IN HEAVILY OUTLINED PORTION ONLY JA C NAME - .s ADDRESS O ADDRESSLOCALITY E NEAREST 'I CITYTEL.No. CROSS ST. a164 ork- COUNTY / CERT.No. EXPIRES K NAME W LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRESS NORTH O CITY TEL.No. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGEL EB COUNTY CERTIFICAT.OF QUA A1„IfjiC N. PLUMORR I ACA THE LEGAL OWNER OF THE PROPERTY DESCRIBED �g ABOVE. W D 3 i OWNER CORRECTIONS SOUTH DESCRIPTION OF WORK z BATH TUB FURNACE ❑ c SHOWER DISHWASHER ❑ LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING _METER- GA8 SODA FOUNTAIN GAS PIPING OUTL CTAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK CF_SSPOOI QEPTIC TANK V-!'i SEWER UTILITY CO.NOTIFIED TOTAL. FEE FINAL WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that,I have a certificate of consent to self 20-0026 DPW 6/87 insVre, of a certificate ofWorkers' Co p nsation Insurance, 76A667A or a certifi op9thereof (Sec. 38 C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy N / Comp �� tC0 ertified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING J Camellia Ave . ertified copy is filed with e county building inspec- ADDRESS NUMBER FIXTURE OR ITEM C FEE department. LOCALITY Temple City WATER CLOSET Applica NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB _ CROSS ST. COMPENSATION INSURANCE OWNERAngelo Cubba SHOWER (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars ($100)or less.) !� LAVATORY ADDRESS 2011 Carolwood Dr . certify that in the performance of the work for which this ✓ permit is issued, I shall not employ any person in any manner SINK CITY Arcadia TEL NO 355-1874 so as to become subject to the Workers' Compensation Laws. / DISHWASHER D CONTRACTORFrankMarrone & Sons Date Applicant CLOTHES WASHER ADDRESS 9 8 6 O Lower Azusa Rd. NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY E 1 Monte TEL. No.444-2548 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATERLICENSE NO.3 9 7 8 8 4 CLASS C 3 6 LICENSED CONTRACTORS DECLARATION 1 SYSTEM OUTLETS DISTRICTO.,/ ROCES ED BY Q ' /' ; , I hereby affirm that I am licensed under provisions of Chapter 9 GAS (J i� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full far�j an effect. 5 PER SYSTEM FINAL o�lj�d�l1 Ci 3 DATE VALIDATION 0 License N mber / a / Lic. Class _ U ��� Q L;.S (� "Y / 0 Contract Date d Q ❑ 0 I am exempt under Sec. W B.&P.C. for this reason EL Plan check fee Date: z PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE U Plan check applicant D O SINGLE FAMILY _t HOME OWNER-BUILDER DECLARATION Name i��:i:�.ir I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address 33307 132.0'_ Professions Code): City Tel. No. 1 ITEMS ❑ I, as owner of the property, will do the work and the C structure is not intended or offered for sale (Section TOTAL 132 . 00 7044, Business and Professions Code). 01111 ':HEC 1}2.00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHANGE .011 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). 171300-0001 111?0/Ve.9 Lender's Name 77165 1 M11.05 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 thorize representatives of this County to enter upon the V29-yA7T nti property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature Permittee Date