HomeMy Public PortalAbout5222 DOREEN AVE_Plumbing__ D.B.S.-It 25M SETS Iz-as APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING
Wm. J. FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUPDIY FOR ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE S� / �/ � ; -/
HEATER I_I CESSPOOL SEPTIC TANK �RB^CfIVE_D_BY FIRST INSPECTION OATH IBEUED
GAB MISCELLANEOUS _-+� a /�
APPL CANT FILL I HEA LY OUTLINED PORTION ONLY
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d, NAME Y /J ADORE88 Dc I C
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G ADDRESSA LOCALITY
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NEAREST
TEL
y CITY TEL.NO. CROSS BT.
COUNTY n
CERT.NO. EXPIRES J NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
ADDRESS
NORTH O
CITY TEL.No.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFIC��F QUALIFICATION.
-•// PLUMOER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
OWN"
CORRECTIONS
i
SOUTH d
DESCRIPTION OF WORK
cb
ATM TUB FURNACE �
ROWER DISHWASHER O
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOPTBNER
FLOOR BINK BAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME
WATER HEATER ^ENTAL LAVATORY ROUGH PLUMBING
METER' GAB SODA FOUNTAIN GAS PIPING
OUTL
GAS VENT
L
CESSPOOL
TOTAL NUMBER OF FIXTURES / SEPTIC TANK
CESSPOOL SEPTIC TANK SEWER J
S / UTILITY CO.NOTIPIBD nom/
TOTAL FEE (/ , .' KT-7
PINAL
76A667-CEn BIT 6-65
APPLICATION FOR PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JEN KINS. SUPT, OF BUILDING LOCAL
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OW R
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS OZ
CI
SHOWER 1.25
LAVATORY 1.25
CONTRACTOR �-
SINE 1.25 ADDRES �Q
DISHWASHER 1.25 '12IX�NO.
LAUNDRY TUB 1.25 L10EN5 STATE
O. /lo.�r
CLASS
CLOTHES WASHER 1.25 DISTRIC NO GR Z E OCE
T
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1'50 INDUSTRIAL a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD V
s
O
�, ( W
D.
Z
IT
PPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S UNDER SLAB WORK
OUGH PLUMBING
TOTAL FEEGAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ TH45 GAS VENT
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE Y
WITH
ALL COUNTY ORDINANCES AND STATE LAWS HOT WATER HEATER
PLUMBING.
HEREBY CERTIFY T AM PR ERLY REGISTERR LUMBNG FIXTURES
LICENSED AS REOUI BY LOS ANG ES COUNTY ANF AS TEST
CALIFORNIA OR TH 1 AM THE O R OF.ANO
RESIDE IN. TEE AB VE O SID NTI L PROPERTTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
CK/./ M.O. CASH
`5 2 4 4' JUN 3 5 0 3.25- 17
`L412fZ1/ii�r/
WORKERS' `OMPENSATL7N DECLARATION APPLICATION FOR PLUMBING PERMIT
!'1c. 76A667 DPW 4/8] n
I hereby, affirm thaYl have a certificate of cdhsen+to:elf in- ]6A66]A 'IILfII
sti or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified copy thereof (Sec. 3800, Lab. C.)
�;947,�q,., COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. � Company
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
Certified copy is filed with the co un uildi ginspeg' nn ADDRESS 2.22,
�_depa tme t. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY mez6p d
Date Applicant - 3 WATER CLOSET(TOILET) 2Z NEAREST D r�✓Lil� Q ,y T
71 CERTIFICATE OF EXEMPTION FROM WORKE BATH TUB CROSS ST. l
COMPENSATION INSURANCE SHOWEROWNER
(This section need not be completed if the work involved by MAIL �L
the permit is for one hundred dollars ($100)or less.) LAVATORY ` J ADDRESS {
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so / SINK --,7 try CITY Cts/PLT_ TEL NO.
as to become subject to the Workers'Compensation Laws. / DISHWASHER 7 6 " UJB
CONTRACTOR
Dale Applicant CLOTHES WASHER l�
NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS
SWIMMING
emption, you should become subject to the WoWorkers'Compen- POOL RECEPTOR
CITY .I wA TEL. NO.
lotion provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SVSTEM
ly with such provisions or this perm itshall be deemed revok- � STATE �l/ LIC.
ed. ! WATER HEATER s,� LICENSE NO. :312) "" L7 CLASS i
LICENSED CONTRACTORS DECLARATION �/ DISTRICT NO. ROCESSED BV
I hereby affirm that I am licensed undes provisions of Chapter � GAS SYSTEM OUTLETS -v �p17
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER O
and Professions Code, and my license is in full force and ef- 5 PER SYSTEMa- FINAL VALIDATI
fecl, A11 a
License Number =1�1 �L�CJLic Class ['11) O
U
FINAL G
CoMracto S Date BY t O
r H
❑ am exempt under Sec. W
B.BP.C. for this re n ► Ot
N
— Plan check fee Z
41 10Dat Q
PLUMBING PERMIT ISSUING FEE$ /3 �
Signature TOTAL FEE
SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION pP 5
1 hereby affirm that I am exempt from the Contractor's License Name -
Law for the following reason (Section 7031.5, Business and ACCT..`
Professions Code): Address
3J07 14E.00
I, as owner of the property, will do the work and the City Tel. No. 1 ITEMS
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). Poo. TOTAL 148
CONSTRUCTION LENDING AGENCY CHECK 143.DO
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CHrun7G rill)
(Sec. 3097, Civ. C.).
Lender's Name WLtl7 �r"`11 v ��Si(I
Lender's Address X178 1 AM 10 75
I certify that I have read this application and state that the
above inform ion is correct. agree to comply with all County ,
ordinances State
ws agree lumbinq, and hereby
auIhoriz p esenm vel of 1hi o,ty to enter upon the
above- ned pr erty spa
on pur les.
p SEE REVERSE FOR EXPLANATORY LANGUAGE
1
Sig not r o Perm.tee Dat