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HomeMy Public PortalAbout5703 ENCINITA AVE_Plumbing__ Girt' OIL TC--InPLj C0—y 7OA657-CU17 6-BD APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAM BI E. COUNTY ENGINEER ADDRESS WILLIAM A. JENSEN. SUPT GF BUILDING _ _ LOCALITY FOR APPLICANT TO FILL. IN NEARESTEr. i. NUMBER FIXTURE OR ITEM u OWNER L � v WATER CLOSET MAN, I RATH TUB ADDRESS= SHOWER CITY TEL. NO. LAVATORY CONTRACTOR Alert Plb . & Ht¢ � I SINE ADDRESS 13933 S Crenshaw Pi ' cHawthorne TM ND• tTY 0 'I DISHWASHER CONTRACTOR'S LAUNDRY TUB REGISTRATION NO. 193617 0-36 COUNTY CLOTHES WASHER DISTRICTNO. GROUP I 715NE /P^R�OCESSED BY WATER HEATER LIiN.�✓�"�� CAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD A H 44/.7s P, �La No �a.- .�f , D 0 0 H V w a H 7 O 51.00 PER ITEM — OR FIXTURE $ APPROVALS DATE, INJSPqECfOR'S SIGNATURE PERMIT $' 2 00 UNDER SLAB WORK aJ' d �t 111711 TOTAL FEE ROUGH PLUMBING C 6h GAS PIPING l' R 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A PLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY OS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I A THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL P ERT UTILITY CO. NOTIFIED SIGNATURE OF PERMITI'Ev _ FINAL ®F VALIDATION ROBERT A. WOOD, S.Q wB SUPERVISING MECHANICAL ENG'R LJi'oX 2 7 1 4 :d FEB 1 7 5 D 9.0 u M ;6"ljl� 76AS67-CE617 12/59 TEMPLE CHR Y APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND FETY {}��IVISION BOILDING JOHN A. LAMBIEPS, OU NT/ CNGINEER ADDRESS 'rj 70 L •'��°e i✓(�!'J WILLIAM A. JENSEN, SUPT OF BUILDING PL ,. • .. _ LDCALITS" I" Lr iO9 A /Gr 0) FOR APICANT TO FILL IN NEAAES.T�— 017/7 CROSS ST. !.7 NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAILJJ ADDRESS Z 7/ F �Y>�✓ S BATH TUB (' SHOWER CITY-1 A• - ddb f'LLT TEL. NO. Ar- -I�� 7 LAVATORY CONTRACTOR - K7 ADDRESS SINK DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE LAUNDRY TUB REGISTRATION NO. COUNTY CLOTHES WASHER ' DISTRICT NO. GROUP I ZONE I PROCESSED WATER HEATER GAS SYSTEM INDUSTRIALWASTE APPROVAL y �� INSPECTION RECORD 2, / P O U a O U U a w Z r I 0 $1.00 PER ITEM `�� rD,SCR,,,D OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTALFEE :;fjROUGH PLUMBING GAS PIPING BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONGAS VENT TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYLL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER G.EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES D AS REpVIRED eY LOS ANGELES COUNTY AND STATE OFGAS TEST NIA OR THAT I AM THE LEGAL OWNER OF THE ABOVEED RESIDENTIAL PROPERTY UTILITY CO.NOTIFIED URE ..... � CRMITTE _ FINAL ®r VALIDATIOI`�.� ROBERT A. WOOD, CK. 8.0. CasR SUPERVISING MECHANICAL ENG'R ,07272 a iIiY18 5 0 3 .00 n 1 WORKERS' COMPENSATION DECLARATION -APPLICATION FOR PLUMBING PERMIT MIT I hereTlqa;iwinNhot !;have a certificate of consent to self 76A667A ILJI 'insure, ar a certificafe of Workers' Compensation Insurance, CE 817(REV. 10/81) or o certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGr`,t7/s x R!/7"' Certified copy is filed with the county building inspec- ADDRESS J /O✓ G„s�sr,! tion department. NUMBER FIXTURE OR ITEM r@ FEE LOCALITY /G / 7— G!/ ZX Date Applicant WATER CLOSET Q� NEAREST / 4'� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ©p CROSS ST. COMPENSATION INSURANCE �y SHOWER OWNERG /Z_'OV %! (Thio section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY Q ADDRESS J 7 K�I 1/ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TZIC TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER s CONTRACTOR Da3L�J' te _jApplicant� c�• CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of It Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM With,comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATERLICENSE NO, CLASS LICENSED CONTRACTORS'DECLARATION DISTRICT ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 / GAS SYSTEM OUTLETS (� D (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER u and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL - VALIDATIO DATE License Number Lic. Class Q FINAL U. Contractor Date BY d' ❑ I am exempt under Sec. T F- pvl/ U • B.SP.C. for this reason UJI Plan check fee D nn Date: NPLUMBING PERMIT ISSUING FEE$ Q 5 2 4 8 A ? Signature TOTAL FEE # eee e e 5 Plan check applicant 1-004050 ' SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Nameee 040506 1 hereby affirm that I am exempt from the Contractor's License ddress Law for the following reason (Section 7031.5, Business and A Professions Code): City Tel. No. a 14 7 8 6 1, as owner of the property, will do the work and the structure is not intended ar offered for sale (Section - D -7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 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 D above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize' repres�e 1Lolives-af'Ih3'Cbmuy�to enter upon the o!L t nod rty for inspeUion urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE / Signature of Permittee Date