HomeMy Public PortalAbout5021 DOREEN AVE_Plumbing__ APPLICATION FO&PERMIT
DEPARTMENT OF BUILDING AND SAFETY - 1
AFETY PLUMBING
COUNTY OF LOS ANGELES Poi
WM. J. .FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. G.ROUP ZONE ryPERMIT NO.
ROUGH V LJ/ 6
PLUMBING FIXTURES COMPLETE c.�
RECEIVED BY. READY .FOR DATE ISSUED
HEATER CESSPOOL SEPTICTAI-J—i GAS /� FIRST INSPECTION /— /
MISCELLANEOUS lC1rz-
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
K NAME _.r n ODw�,JwJ ,J ( ADDRESS Jj ��/� / / e�f�jj.,(./�,.,
mm ADDRESS Q J/ // J'iI I LOCALITY � 0OY,, - / J/
R CITY 0
TEL�.� CROSSS T. �3V/y{n� /h DA> 7f
COUNTY
CERT. No. EXPIRESI G NAME
M
LOCATION OF SEPTIC.TANK, OR CESSPOOL Z MAIL
9 7-
3 .. . //
NORTH O
CITY' TEL.No.
'y 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
I ANGELES COUNTYCERTIFICATE O OUALI FICATION.
—_IPL UMBER
/
1 AM THE LEGAL OWNER OF THE-PROPERTY DESCRIBED
- ABOVE. -
W
OWNER
__C ORRECTIONS
• SOUTH - J
DESCRIPTION OF WORK z
_
-BAT H TUB FURNACE � -
SHOWERDIBH WASHER 0
' LAVATORY - REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK � SANDTRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS ,
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTORS NAME
WATER HEATER DENTAL LAVATORY , ROUGH PLUMBING -
—METER—GAS SODA FOUNTAIN GAS PIPING
OUTL
GAS VENT
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
i
l� /f
—._LCESSPOOI- SEPTIC TANK � � SEWER
'STT UTILITY CO. NOTIFIED
TOTAL FEE / DO FINAL
WORKERS'COMPENSATION DECLARATION APPLICATION
mPLICASION FOR PLUMBING PEMIT
I hereby affirm that I have a certificate of consent to self 76AM7A
insure, or a certificate of Workers' Comp lation Insurance, CE 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, L ) COUNTY OF LOS ANGELES IL ING AN FETY
Policy No. Company
❑
Certified copy is hereby'furnished. _
r--�/ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ,F
54—tion
copy is Filed with the county 4,nspec - ADDRESS �/7tion department. NUMBER FIXTUREOR ITEM <@ FEELOCALITY
Date l>/'W-- ApplicanP WATER CLOSETNEAREST
CERTIFICATE OF EXEMPTION FROM WBATH TUB CROSS ST.
COMPENSATION INSURANCE - OWNER
(This section need not be completed if the work involved by SHOWER
the permit is for one hundred:dollars ($100)or less.) LAVATORY MAIL
ADDRESS
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 CITY TEL. NO wO'cY
"1 !itj
so as to become subject to the Workers'Compensation• Laws. DISHWASHER _CONTRALTO ♦�
Date Applicant CLOTHES WASHER ADDRESS' ! L7
NOTICE TO APPLICANT: If, after making this Certificate of
Exemplion, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL. NOyy7D7�
LAWN SPRINKLER SYSTEM P
with comply with such provisions or this permit shall be STATE LIC. 7/
deemed revoked. I I WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR ESSED BY
I hereby affirm that t am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS cc
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER `.JiO6e
and Professions Code, and my license is..in full force and effect. 5 PER SYSTEM FINALpp 116 DATE �r 9 VALIDATION v
License Num LIc. Class I cc
F �• 0
Contractors — Date lzlcLl B U
❑ I on, exe pd
B.BP.C. for this reason "a i9y, Z
Date: plan check fee �7yy i > - Lt "
PLUMBING PERMIT 155UI $ 'Y /
Signature '
;MEET
Plan
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION I Name
I hereby affirm that I am exempt from the Contractor's License Address
Low for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No. m m o 0 0 d
❑ I, as owner of the property, will do the work and the I r
structure is not intended or offered for sale (Section21m )' e 50
7044, Business and Professions Code). s
CONSTRUCTION LENDING AGENCY '}i4, 2 �.XQ
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 State laws regulating Plumbing, and hereby
authorize representor' of this County to enter upon the
above-menf ned pr per y for inspection purposes.
_ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signor a of Permittee /ore