HomeMy Public PortalAbout5128 DALEVIEW AVE_Plumbing__ +75A 66] -CE=81]2-62 J �G
APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING j/J
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS .L2
WILLIAM A. JENSEN. SUP Y OF BVILDING L ��
LOCALITY
FOR APPLICANT TO FILL IN NEAREST.
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE OWNER / Y- I / .a
2 WATER CLOSET 11.25 MAIL l/ / Lc! /V
BATH TUB 1,25 ADDRESS / C.
SHOWER 1.25 CITY TEL. NO.
,�. LAVATORY 1.25 CONTRACTOR
/
SINK - I,yS ADDRESSJA ju
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY 'IUB I y5 CONTRACTOR'S STATE ❑
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE �ESSED BY J
1
/ WATER HEATER L50 � ,
GAS SYSTEM OUTLETS L50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM _00 I INSPECTION RECORD O
z
APPROVALS (DATE IN♦S�P.E/C'TOR.BU SSII.RANRE
PERMIT $ p OO UNDER SLAB WORK
,/�
ROUGH PLUMBING
TOTAL FEE ,S L',_o GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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
PLUMBING. _
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE
CRIBEO gESIDENT L OPERTY. UTILITY CO.NOTIFIED ' /f3
SIGNATURE I
OF PERMITTEE A,�KJ •�I
FINAL
ATION ROBERT AfWOOD
CASH SUPERVISING MECHANICAL ENG'R
LAL;o 3 6 4 2Q; AUG 2 9 5 D 1 5.00-
+- WPiRKERS' COMPENSATION DECLARATION A PLUMBINGPPL10�T5®N FOR PLUMBINGPERMIT .
hereb affirm that I have'a cerhfimte cf,consent to self m 20.0026 DPW 41 87 /'9
sure"+br a certificate of Workers''Com per,sotI on Insurance,ora CE8I7(REV 8/86) -
certifii> copy,thereof (Sec 3800 Lab C. -•, (/ ' _ ..
'Policy No GS�eti�'Z �O�GCt3T�"-�-'P/ COUNTY OF LOS,ANGELES � DEPT: OF PUBLIC:WORKS '•
•�' - ; t , BU I1DINc
''Certified copy is hereby f urn fished ..
'FOR APPLICANT TO FILL IN (PRINT OR TVPE) /
�f�I/�''Certified copy is filed with-ihe county building inspection ADDRESS
' depo fm enLl•, NUMBER FIXTURE OR ITEM@ FEE LOCALITY '
Date f Applicdnh-J WATER CLOSET(TOILET) NEAREST y" ..
BATHTUB - CROSS ST. Ff221 q.�ATA90
--- CERTIFICATE OF,EXEMPTION FROM _KERS' r -
COMPENSATION INSURANCE SHOWER OWNER i -
(This secti(in'need not•be.completed if the work.involved by. - MAIL - - - •..
the permit is for one hundred dollars (11100)or less.) - LAVATORY' - ADDRESS. .y
I,certif_y that in the performance of the Work for which this per- - '
mitis issued, I•shall+not employ any person in ony mannenso'_ : 'SINK CITY TEi..NCF.
astobecome.subject to the Workers' Compensation Laws-: - DISHWASHER
'4- 1 91 CONTRACTOR' �•
Date �Applicant CLOTHES WASHER -
NADDRESS O - _
NOTICE TO APPLICANT If, after making this Certificate of E:- -. ,SWIMMING POOL RECEPTOR � -
emption,you should become subject to the We Compen- - - 'CITY - TEL. NO. -
safion provisions,of the Labor Code, you must forthw th comp- LAWN SPRINKLER SYSTEM - _ 7
ly with such provisiomnor this permit shall be deemed 7evok- - STATE '� �7 LIG.
ea..• _ ,WATER HEATER LICENSE NO. �'j l4 /. CLASS
r,LICENSED CONTRACTORS'DECLARATION - - - DISTRICT NO. PROCESSED BY
.So
hhereby offirm'ihat I am licensed•unOUTLETS
Prov iiionspFChapte'r GAS SYSTEM
, ,9(commencing with Sectwri 7000)of Division 3 of the Business' OUTLETS OVER .,
and'Profess,ons"Code and mis in full'force.and of 5 PER SYSTEM-
fact., rFINAL' VALIDATION a
.. y'license - DATE -
License Number 7 Lic. Class {-.-��-�"' ' O
U
t. FINAL' - 2
Contractor BY p
' 1 ham rapt under. c.
B 8P c for this reason - Plan check fee " - D - a '
Dote: - -;PLUMBING PERMIT. SSUING-FEE-if
ev
;Signature _ -
. . , , TOTAL FEE - - ,
- .SINGLE FAMILY.. -
j" HOME OWNER-BUILDER DECLARATION Plancheck applicant -
hereby offirm,that:I am exempt from the Controctor's.License Name - - "-
Law for the following reason (Section'7031.5, and c_ 1{:;L,
Professions Code):, *�`' - 'Address +.
❑ I; as owner of the property, will'dor,the work and the City, .f Tel. No. -
structure is not intended.or offered•for sale(Section 764,-' - ,. i'_l1_.
{ "Business and Professions Code). Ifa)A
n 'CONSTRUCTION LENDING AGENCY, ,,- fit-
I hereby affirm that there is a construction.lending agency for - - % '
the performance ofRthe work for which th is'permit is Issued , ;;;j.iHtfVt D-10(Sec,•3097, Civ. C. - -+ . i
Lenders Nome - • ,. t I> i,]�
Lenders-Address ' '
1 certifq,that I have read this application and state.that the - -
above informatiomis correct l agree to comply with all County
ordmbrices and State laws regulating.Plumbing, and hereby.
authorizerepresentatives'of this County toenter upon the
06bJe- + ntioned proY er or.inspect' n purposes.' - - •- a
+_� SEE'REVERSE FOR EXPLANATORY LANGUAGE
7
Signature f ermitiee Date