HomeMy Public PortalAbout9420 CAMINO REAL AVE_Plumbing__ 7"067 17 0-.w APPLICATION FOR PEHZUT
DEPARTMENT OF BUIMING AND SAFETY
COUNTY OF LOS ANGELESPLUMBING
1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRIIQT NO. GROUP ZONE PERMIT NO.
PLUMBER ^� = : VSD BY READY FOR DA
FIRlIT INIMP<CTION - -�
ADDRtBS
BUILDING
CITY TEL NO. ADDRX99
COUNTY LOCALITY
C O NO I d
NCARE9T
PERIM FEES CROSS HT.
Mumu TYr[of FlZTURI OR ITEM FEE OWNER
MAIL
WATER CLOOCT TOILIZT 0.150 ADDRESS
CATH TUB 0.50 C TEL NO.
9HOWER 0.50 I Iy-t}Z ACKNOWUEDGK THAT t HAVE RXAb THIS
LAVATORY WASH BASIN 0.80 APPLICATION AND STATE THAT THE ABOVE 10 CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING.
KITCH¢N SINK O.BO I CERTIFY THAT 1 POSSE!! THE AMOVE VALID LOS
LAUNDRY TUC OR TRAY 0.50 .A14GXLKB COUNTY LICENSIC, OR I All THE LkGAL OWNJR
OF THE RESIDENTIAL TROP DEfCRISm Atom
GMW'9'T9+ OUTLETH O.DO BIGNATU E OF
WATIDt HEATER 0.150
GLOP SINK 0.150 INSPECTIQN RECORD
FLOOR OINK 0.60
FLOOR DRAIN 0.60
DISHWASHER 0.50
DRI KING FOUNTAIN 0.50
URIUArr 0.60 J
HOUSE•OWER 0.50
MISC921ANEOUO (�
a
O
APPROVALS
DATE INSPECTOR'• MAT[=
ROUGH PLUMBING
a" PIPING
GAS VENT
C EST•POOL 1.00 C X"POO L
B DTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1-22 SEWER
PERMIT 1.00 G" TEST
UTILITY CO. NOTIFIED
TOTAL FEE -7`
FINAL
r
7.A.dIl7.?7 11-17 APPLICATION FOR PERBUT
r'DEPARTMEN'T OFF LOS AN AND SAFETY PLUMBING i
COUNTY OF LOS ANGELES
WILLIAM J. FOX, OHIEF IINOINK[R
FOR APPLICANT TO FILL IN DISTR 13R.OUP I ;?E PERMIT NrG
PLUMBER �<.LY 11Ft PLUM-WIr4a R[O[IV[DX [ADY'F'OIE ATL 1 BU[D�
0.
FI RBT IN20P9 STIQN `
017 sMAGNOLIA ,�/
AD DR 13M
■UILDIN13 O
CITY TL L. No. ADDREB O
COUNTYO ` 3 e 40LOCALITY
YY H CAR E!♦T
PEM24EIT FEES cRQSa ST.
Hums" TYF[QF Frxru 17[OR ITEM FEL OWNER
MAIL
WATER OLOBIT(TOILCT) Q 0.513 E ADDR[=i
BATH TUB Q 0.60
CITY TEL Mo.
■HdWER Q 0.60 1 HKIRKSOrADICHOWL]IDGe THAT I HAVE ROAD THIS
LAVATORY (WASH BASIN) Q 0.40 APPLICATION AND 49TATK THAT THE ABOVE IN OORRLCT
AND AGRQ TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN OINK Q 0.60 AND BTATL LAWS REGULATING PLUMBING.
I OKRTIFY THAT I PQUMK® THI ASOVL VALID LOB
LAUNDRY TUS OR TRAY Q 0.60 ANGELES COUNTY LIOEHBE, OR I AM THK LEGAL OWNER
OF TH[ RLIIDLNTIAL P OP DCSCRI ED AlQVL
OAS <YZTL T
ULET0. 0
7 Q 8
SIGNATURE OF
WATR HEATER Q 80 PER
E0. MITTxd T�
SLOP SINK Q 0.60 ECiTI
INSPON RECORD-CORD
R ■
FLOOI t4 K Q 0.60
FLOOR DRAIN Q 0.60
HS0.
DINWAHER Q 80
JRK
DRININC FbUNTAIN Q 0.60
4ar vn
URINAL Q 0.60
t
HOUSE 6KWER Q 0.60 Z
MIBCELLANKOUB WK
` Q
0
APPROVALS
DATE IHdPCLTI7R'■ c
ROUGH PLUMBING
GA1 PIPING
MAS VENT
QESNPOOL Q 1.00 OCSSIPOOL
SEPTIO TANKt ■OPTIC TANK
DRAIN ( ) PIT, ( ) Q 7.00 ■EWKR
PERMIT . . I 1.00 GAS TEST
TOTAL FEE
UTILITY CO.NOTIFIED
INHAL
� � Sa
. WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I her•by,aff,IF�h the l have c certificate of consent ro »H 20-OOze DPW 6187"
I.ro,��a urtlflcat• of Worker' Compensation Insurance, 76AS67A
or a tFtlfled copy thereof (Sec, 3900, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Icy No, Company
a Certified copy Is hereby fum hed. FOR APPUCANT TO PILL IN(PRINT OR TYPE) SUILD4NO
❑ Certified copy Is filed with the county building Inspec-
ADDRM
tron department. NUMBIER FlXTUREOR ITEM O RT
LOC.UJfY
DatAppllSant WATER CLOW
Date NLASMT
CERTIFICATE OF EXEM MONO FROM WORKERS' JBATH TUB CRM:r,
COMPENSATION INSURANCE OWN
ER
CMIs seclill"need hO be acmplot d If the work InvoK d by WER CZ IQ
!e
the permit 1s for one hundred dollars (;100)dr Is".) LAVATORY MAIL
I certify that In the performance of the work for which this CITY N0. '` 1
permit Islowed, I shall not employ qny Person Iranyy manner 7
so as to become sub(ect to the Workers Compensation Laws. DISI-IWASHEt /e
At
Date � H E
llcant CLOTHES WASR ADDRESS i`
NOTICE TO APPLKAW: If, after making this Certlfl" of SWIMNIItJfi POOL RECEPTOR
Exemption, .you should become sub(ett to the .WQrken � TEL NO.
Compensation provlslons'of the Labor Code, you must forth- LAWN SPRMER SYSTEM
with comply with such provisions or this permit shall be STATE LIG
deemed revoked. WATER HEATER No. CLASS P1
LICENSED CONTRACTORS DECLAk1ATION BY
1 hereby affirm that l am Ilceaied under provisions of Chapter 9 GAS SYSTEM OUTMTS
(commencing with Section 7000) of Dlvtsioh 3 of the 9uslne" OUTLETS OM r
and Professlorn Code,andmy license Is ht full force Qrx.effect. 5 PER SYSTEM- FINAL 5-1 D V DAnoN
DATE --
1lcense Numbor I Ic. Class
FINAL q
Contractor Date BY C/
❑ t am exempt under Sec.
B.BP.C. for this reason. Plan check feel
Date: PLUMBING PERMIT ISSUING FEE;
Slpnaturw
TQTA1 T:EE 43 bo
Plan check applicant 5
SINGLE FAMILY
HOME OWNER$UILDER DECLARATION Name ACCT 11T
I hereby affirm that I am exempt from the Contractors License
Law for the following reason (Section 70.41.5, Buslnea and Address 3307 43.00
Profeeslons Code): City Tel. No. 1 ITEMS
❑ I, as owner of the property, will do the work and t1he
structure Is not Intended or offered for sale (SecHoriPooTOTAL 43 . 00
7044, 0usingw and Professlons Cbde� 10
CDECK43■1
CONSTRUCTION LENDING AGENCY t
I hereby affirm that there Is a construction lending agency for ■
00
the perfomiange of the work for whlch this permit Is Issued
{Seg. 3097,Cl Y. C}
001OD-QG011 7/18/90
Lenders Name
Lender's Address 1 7"f1 8: 1
1 certify that I have read this application and ittatp that thea
above InfornwHon Is correct. l agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize'reprelentatives of this Couaty to enter upon the
above-mentioned property for Inspection purposes.
SSE REVERSE FOR EXPLANATORY L/1f+lQdJAGE
�FD
Slgnatur f Perm ttee Date