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Home My Public Portal About4817 DOREEN AVE_Plumbing__ 76A667 (CE-817)-4/72 ✓/ APPLICATION AOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO. AUILDING DDRESS 1 � v r HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY 1 FOR APPLICANT TO FILL IN IPRINT OR TYPE) NEAREST ) S ST. .' UsC( NUMBER FIXTURE OR ITEM @ FEE CROS ? WATER CLOSET 1.75 OWNER MAIL BATH TUB 1.75 ADDRESS e SHOWER 1,75 CITY p � TEL. NO. LAVATORY 1,75 CONTRACTOR V. ��J�is 64(bjN-L SINK 1.75 ADDRESS 11.2g DISHWASHER 1.75 CITY Lf7(%�4i. TEL. NO166;/11/ CLOTHES WASHER 1'75TINDUSTRIAL NSE NO. ,STATE ��/ � CLASS LIC SWIMMING POOL RECEPTOR 1.75 ISTRICT NO. GROUP N F CESS BY LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1.75OVAIGAS SYSTEM OUTLET$ 1.75 INSPECTION RECORD U OUTLETS OVER 5 PER SYSTEM .30 O H U W O.. N Z Plan Check fee See Reverse PLUMBING PERMIT ISSUING FEE 5 3 t TOTAL FEE PROVALS DATE INSPECTOR's slcNAro RE Plan check applicant SLAB WORK Name PLUMBING Address ING City Tel. No. NT TER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIC AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CONG FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGUL PLUMBING. ST HEREBY CERTIFY THAT AM PROPERLY REGISTERED ANO/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO4 4Z I 4Z 4Z RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL !u/-/ , �" ` SIGNATURE n /� ( 1/ OF PERMITTEE � 1 /•J PERMIT VALID TIQN cK. .D. cnsH PLAN CHECK VALIDATION CK. M.O. CASH /�` 'I 340 -3 `5 GCT 1 ( 5 D 4 .754 c 76A667 (CE-6171-4172 } - APPLICATION FOR PLUMBING PERMIT �1 COUNTY OF LOS ANGELES u DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYA[3 LE TO: ADDflEss HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY 1" FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST J�` /� CROSS ST. # NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1.75 75 OWNER QIRv MAIL BATH TUB 1.75 ADDRESS Q SHOWER 1.75 1 CJS— CITY04L TEL. NO. LAVATORY 1.75 /5 CONTRACTO r, Lewis / ///�� '� um SINK 1.75 L ,. �� ADDRESS G e hm%a I DISHWASHER 1.75 CITY FL rz TEL. NO. p CLOTHES WASHER 1.75 STATEc� C ^45 .a CLASS SWIMMING POOL RECEPTOR 1.75 LICENSE NO."' LAWN SPRINKLER SYSTEM 1.75 DISTRIC NO, GR; O P I ZONE CESSi�D`� WATER HEATER 1'75 INDUSTAPPROV AL WASTEa GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD U OUTLETS OVER 5 PER SYSTEM .30 O H U W 1 H Z Plan check fee Sae R.,.,s. PLUMBING PERMIT ISSUING FEE 5 3 00 TOTAL FEE n-c� APPROVALS DATE I Pee TOR'q si GNAru RE Plan check applicant UNDER SLAB WORK -3 Zr e Name ROUGH PLUMBING Address GAS PIPING City Tel. NO. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AM STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR UTILITY CO. NOTFIED LI CENS EO AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER F' ANO INTEND TO RESIDE IN THE ABOVE DESCRIBED PE51 NTIA P OPERTY. FINAL / SIGNATURE OF PERMITTEE PERMIT VALIDATION cK. M.o. c4sH PLAN CHECK VALIDATION CK. M.D. CASH I IT_ 3 1 9 9-;3 SEP 14 5 D 8.2 5 A ]b A66>IT (CE 01,]61 -6/77 APPLICATION FOR PLUMBING PERMIT . BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS 1v Al ST WATERCLOSET LOCALITY �M C BATH TUB NEAREST CROSS ST. L/ SHOWER OWNER 'r LAVATORY Al MAIL ADDRESS Al O F� Y SINK CITY TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS' �- 1 77 SWIMMING POOL RECEPTOR CITY" f.'n.� �'' TEL.NO. ,d LAWN SPRINKLER SYSTEM �i STATE LIC. WATER HEATER LICENSE NO. 179 ,0 CLASS DISTRICT NO. GROUP ZO E PR SSED BY GAS SYSTEM OUTLETS Z- �.� S - 08 �, _D .y OUTLETS OVER tUl 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD U W a N Z Plan check fee PLUMBING PERMIT ISSUING FEE$ `7 TOTALFEE 12-.9 Plan check applicant APPROVALS DATE INSPECTOWS SIGNATURE Name UNDER L 8 WORK - -? Addre55 42, ROUGH PLUMBING City Tel,No.� GAS eIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL zi i PLAN CHECK VALIDATION CK. M.o. CASH PERMIT VALIDATION - K. 6 4 5�'AUG 23 5 U �/ 2 2.0 0 n . TION WORKERS't I have a certificate of corse APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, ar a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) ' .1 or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS �� N. Ori-'Cn U C_ lion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. C COMPENSATION INSURANCE OWNER __X0A 1 (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars $100 or less. MAIL P ( ) I LAVATORY ADDRESS 1 /�L-C/1 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITYM 1 TEL. NO. (/Q I— so as to become subject to the Workers'Compensation Laws. ii DISHWASHER 1 •--an i CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must Forth- CITY TEL. NO. with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM . STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS / (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER r6/ y and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL0. DATE VALID ION O License Number Lic. Class / V AL Q FINAL � Contractor Date By ❑ I am exempt under Sec. 023 14 fe NY d N 8.8P.C. for this reason Plan check fee pool PLUMBING PERMIT ISSUING FEE$ U Q Signature all :2156. 1 A TOTAL FEE �} e o e o 0 5 Plan check applicant SINGLE FAMILY l a - 27.00 HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's License e o - 271 Law for the Following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. 0 219-85 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section S 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name 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 Stale 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 / atu e f Pei y dote