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Home My Public Portal About8863 ELM AVE_Plumbing__ 76A667 (CE-817) — 5/73 L--(—N`"'•" -. APPLICATIONAOR F'fLU.iV�IBIfVG PERiI.I"' - COUNTY OF LOS ANGELES , DEPARTMENT OF COUNTY ENGINEER BUILDING AND.SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING.,��j j c ADDRESS HARVEY'T. BRANDT", COUNTY ENGINEER LOCALITY• -FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST >' CROSS 5 GCi✓: a NUMBER FIXTURE OR ITEM @ FEE OWNER - WATER CLOSET v 1.75 it.75 MAI L• BATH TUB A DRE SHOWER' 1.75 CITY LAVATORY 1.75 CONTRACT SINK' 1.75 ADDRESS DISHWASHER 1,75 �TA ry TEL. NOCLOTHES WASHER" 1.75 LIC' LICENSE N6. CLASS'', SWIMMING POOL RECEPTOR 1,75 DISTRICT.NO. GROUP ONE' ' OCESSED BY LAWN SPRINKLER SYSTEM 1.75' WATER HEATER 1.75 INDUSTRIAL' WASTE APPROVAL a. GAS SYSTEM OUTLETS 1,:75 NSPECTION'RECORD O OUTLETS OVER 5 PER SYSTEM 30 L O, F— Lu Plan.check fee. See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL.FEE APPROVA LS• DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER'SLAB W013K Name ROUGH PLUMBING" [fes+� ✓ � f Address - - .GAS,PIPI,NG City. -.�Tel,. NO. - GAS VENT .:,,,, HOT WATER HEATER +. - I HEREBY ACKNOWLEDGE THAT'I HAVE READ THIS APPLICATION. AND STATE THAT-THE ABOVE IS CORRECT AND AGREE TO COMPLY ;PLUMBING FIXTURES - WITH ALL COUNTY ORDINAN C.ES AND STATE LAWS REGULATING PLUMBING. � � � � � -:GAS TEST I HEREBY CERTIFY THAT LIAM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUI RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT [.AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL SIGNATURE � •i ' OF PERMITTEE); e"z6� - PERMIT VALIDATIONC K. M.0. cASH `/,�� 'PLAN CHECK VALIDATION • CK. M.O. CASH 6 0 51Z;NOV 4 "5 ,v 8.2 5 76A667 .CE.#1317 2-62 APPLICATION R®R` PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT.OF COUNTY ENGINEER ^� BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN, SUPT OF BUILDING _� LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER - FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY ; TEL. NO. 6 LAVATORY 1.25 CONTRACTOR SINK 1.25 ADDRESS DISHWASHER 1.25 CITY TEL. NO. LAUNDRY_TUB 1.25 CONTRACTOR'S STATE ❑ REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GRO NE PRW ES B WATER HEATER 1.50 ITO GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD d O u z F- V . Lu A. Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK n ROUGH PLUMBING TOTAL FEE GAS PIPING a `` I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT ' WITH ALL COUNTY ORDINANCESAND STATE LAWS REGULATING { HOT WATER HEATER PLUMBING. ?' 3' I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF v CALIFORNIA' OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST RESIDE IN,THE ABOVE DESCRIBED ESIDENTIgAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE / f OF PERMITTEEqnj FINAL VALIDATIODROBERT A. WOOD CK. M.0. /CASH SUPERVISING MECHANICALENG'R n 74 2 FEB 5 A 6.% 5~ ;iso WORKER'S COMPENSATION DECLARATION 7DPW 9/89 6A667A Irl!= L�OI��Il� `�®� PLUMBING U" ��n@lll�� I Hereby affirm that I have a certificate of consent to self insure, . or a certificate of Worker's Compensation Insurance, or,a certified copy thereof(Sec.3800 Lab.C.) COUNTY.OF LOS ANGELES DEPT.OF PUBLIC WORKS ' DEPT. OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS j y/Y!'� ��" • F-1Certifiedcopy is filed with the county building inspection � department. NUMBER FIXTURE OR ITEM Q FEE LOCALITYC 1 e p0•1? e f Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE BATH TUB ASSESSOR - (This section need not be completed if the work involved by theSHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY IC OI F (/vf/t is issued, I shall not employ any person in any mannet so as toMAIL SINK ADDRESS become subject to the Workers'Compensation Laws. DISWASHER ,L CITY c,-'f TEL.NO. Date y Applicant / CLOTHES WASHER NO CE TO APPLICANT: If, afte akin is Certi icate of CONTRACTOR �� Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM - LICENSED CONTRACTORS DECLARATION CITY TEL.NO. } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER CL (commencing with Section 7000) of Division 3 of the Business and / STATE LIC. 0 GAS SYSTEM / OUTLETS LICENSE NO. CLASS V Professions Code,and my license is in full force and effect. jy / OUTLETS OVER DISTRICT NO. C-�I�PROCESSED BY 5 PER SYSTEM License Number Lic.ClassNSD U FINAL DATE VALIDATION LLI � �-.•�� Contractor Date IL� IL Elam exempt under Sec. BWAL/��4�(lx��— B.&P.C.for this reason �/ d Plan check fee Date: ?;-• d PLUMBING PERMIT ISSUING FEE$ 40 Signature TOTAL FEE 7 i El Plan check applicant ] i N _ 8= 20, SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address ?.i t't„iHG Code): City Tel./No. I, as owner of the property,will do the,work and the structure is not intended or offered for sale (Section 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 State laws regulating Plumbing, and hereby authorize ® l representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sjgkfure Permittee ' Date �- I WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 /� p �aq,5� �p 76A667A AI PP OltiA 11 MN, FOR PLU0tfll•��1 G .Ir ERIltlll�� I he affirm that I have+a certificate of consent to,self insure, or a certificate of Worker's Compensation Insurance, or a certified � copy thereof(Sec.3800 Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS - DEPT.OF PUBLIC WORKS DIV. 'Policy No.— �Company ❑ Certified copy is'hereby furnished. I FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑' Certified copy is filed with the county building inspection ADDRESS department.- NUMBER FIXTURE OR ITEM Q FEE - LOCALITY C 1' Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. , COMPENSATION INSURANCE ASSESSOR MAP BOOK PAGE PARCEL (This section need not.be completed if the work involved by the SHOWER' permit is for one hundred dollars($100)or less.) OWNER I.cer if y that in the performance of the work for,which this permit LAVATORY - MAIL is ' sued, I shall not employ,any person in any manner so as to SINK ADDRESS IP �J G'rn 57, /come subject-to the Workers' Compensation Laws. DISWASHER CITY '!E. ( TEL.NO. Date I t-4 6 '5L Applicant "/ CLOTHES WASHER NOTICE TO APPLICANT: If, afte akin this Certificate of CONTRACTOR. Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR - - provisions of the Labor Code, you must forthwith comply with such " ADDRESS provisions or this permit shall'be deemed revoked. i LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. 1 hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER, (commencing with Section 7000)of Division 3 of the Business and r STATE LIC. Professions Code,and my license is in full force and effect. ' GAS SYSTEM C AV OUTLETS 1 LICENSE NO. CLASS (� OUTLETS OVER ! - DICT NO. + PROCESSED BY O 5 PER SYSTEM (�y� License Number Lic.Class V FINAL (D DATE / A ATION W Contractor Date CL (n ❑ 1 am exempt under Sec. FINBY AL �/ Z B.&P.C.for this reason Date: Pian check fee Signature PLUMBING PERMIT ISSUING FEE$ TOTAL FEE 41 5!S7 � ❑ Plan check applicant, - '„} - SINGLE FAMILY *,::.;• HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law ,;-- =' for the following reason (Section 7031.5, Business and Professions. Address — Code): City ' Tel.No. TENIE I, as owner of the property,will do the work and the structure <<r-:•._., 35 . is not intended or offered for sale (Section 7044, Business .t'IL m and Professions Code). f„. ii,' y „„ 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, _ r Civ.C.) JUL.—�-t h�3 J Lender's Name ) ;iy :1;: Lender's Address 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 - representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ' atur Permittee Date