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HomeMy Public PortalAbout5413 ENCINITA AVE_Plumbing__ 76A667 (CE-817)-4/72 APPLICATIOr FOR PL MBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _ MAKE CHECKS PAYABLE TO ADDRESS ©`) ,.3 ea s r HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY (/7 /� r FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST i CROSS ST NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1 75 OWNER ! Lp MAIL BATH TUB 1 75 ADDRESS �+ �� i1/ SHOWER 1 75 CITY L� EL NO LAVATORY 1 75 CONTRACTOR SINK 1 75fr ADDRESS DISHWASHER 1 75 CITY TEL NO CLOTHES WASHER 1 75 STATE LIC LICENSE NO CLASS SWIMMING POOL RECEPTOR 1 75 DI ICT NO GROUP FR ESSE BY LAWN SPRINKLER SYSTEM 1 75 O —:Z7 _ WATER HEATER 1 75 INDUSTRIAL D- WASTE APPROVAL G GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD CJ1 OUTLETS OVER 30 / c2. CD LD 5 PER SYSTEM ���� /.�� f. A-(,j r. Z! J .�� ✓/ iAiytp W a N Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE OU APPROVALS DATE INSPECTOR S SIGNATURE Plan check appllca UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION �Dv AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES .3 2h-79 2r In-1 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING GAS TEST < I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE CRIBEDRESIDENTIAL PRO TY FINAL SIGNATU RE OF PERMITTEE FERMI ( ///A111LIDATION cK MO CASH PLAN CHECK V (DATION CK M 0 CASH 231 1J SD 76A667 (CE-817)-4/72 APPLICATIO FOR PLIMBING PERMIT COUNTY OF LOS ANGELES • DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION _ MAKE CHECKS PAYABLE TO ADDRESS pJ HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY ; 1 !/ FOR APPLICANT TO FILL IN (PRINT OR TYPE NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST n WATER CLOSET 1 75 OWNER L/ � MAIL zr BATH TUB 1 75 ADDRESS SHOWER 1 75 CITY L NO _ LAVATORY 1 75 CONTRACTOR s / SINK 1 75 ADDRESS GSC/ DISHWASHER 1 75 CITY TEL NO CLOTHES WASHER 1 75 STATE LIC SWIMMING POOL RECEPTOR 1 75 LICENSE NO CLASS ESSED LAWN SPRINKLER 70q SYSTEM 1 75 NO GROUP ZONE BY -TWATER HEATER 1 75 INDUSTRIAL / po WASTE APPROVAL C GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD V OUTLETS OVER L7C 5 PER SYSTEM 30 p v W O.. N Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING 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 ORDINANCES AND STATE LAWS REGULATING �� PLUMBING GAS TEST r W IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REOU I RED BY LO 5 ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE D RIBED RESIDENTIAL PROP RT FINAL SIGNATU RE "L OF PERMITTEE PERMIT VALIDATION CK M 0 CASH PLAN CHECK VVIDATION CK M O CASH 0 > 5-OCT 26 5 � 3 4.7 5A°8 1 4 WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certified copy thereof (Sec 3800, b C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Ncee :Sig xnpany , cL_ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET LOCALITY Date S� �� Applicant � � NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less) LAVATORY ADDRESS sYt[ v I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITYtj�o TEL NO/)Q C� so as to become subject to the Workers'Compensation Laws DISHWASHER vvtC w CONTRACTOR Date Applicant ! CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of you s , Exem tionhould become subject to the Workers' SWIMMING POOL RECEPTOR Exemption, Y I CITY TEL N Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM 7�� with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICSNO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS J �y (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER C� >. and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION CL DATE V License Numbe� `� —Lic Class + (1 FIN cc Date � 0),1/-19Y BContractor V ❑ I am exempt under Sec uL a B&P C for this reason 111111. Z Plan check fee Date 0 PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that 1 am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and Professions Code) City Tel No 1 4&2 A ❑ 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) # oI oo 0 5 Ii CONSTRUCTION LENDING AGENCY 2loio 2 2 5 0 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued o oio 2 2 5 0 s (Sec 3097, Civ C ) 052'4'-84 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 representatives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date