HomeMy Public PortalAbout5835 ENCINITA AVE_Plumbing__ COUNTY OF L08 ANGELES . APPLICATION FOR PERMIT .
DeparMeW*of County Englneer- p
]DIVISION OF BUILDING & SAFETY EMS
L�U M 0 N G
WILLIAM J. FOX. County Enpl-tcr
FOR APPLICANT TO FILL IN DISTRICT O. Iz P lir �/
TE � .
'
PLUMBER /1 T RECEIVED BY READY FORR DATE ISSUED
/ (,L .� .(e1e FIRST INSPECTION fes/
ADDRESS !/� (/._ln/ ' p-
BUI LDINO
CITY �L No. ADOR"S
COUNTY LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES. cROSS By.
NNMBEqTYPE DF FI%TYgC OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) Q 0.50 8 ADDRESS If
G_(��.�^,
BATH TUB Q 0.50 CITY _i +TEL No.
SHOWER O.SO 1 HEREBY ACKNOWLEOOE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY ® 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
GAS SYSTEM OUTLETS 0.50 Q U OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
SIGNATURE
WATER HEATER ® 0.50 PEgMITTEF
SLOP SINK 0.50 INS ECTION RECORD
FLOOR BINK 0.50
FLOOR DRAIN ® 0.50
DISHWASHER ® 0.50
DRINKING FOUNTAIN ® 0.50
URINAL Q 0.50 J
Q
HOUSE SEWER ® 0.50 Z
MISCELLANEOUS E9
0
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
kGAS PIPING
GAB VENT
CESSPOOL ® 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) ® 1.OD SEWER .f
PERMIT 1.00 GAS TEST A / 1.2-
UTILITY CO.NOTIFIED /
TOTAL FEE 5L O
FINAL
76A667 DBS#17 10/52
COUNTY OF LDS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY
i
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRICT O. GROUP I Z N
� Co z y76.
PLUMBER • R�(1 Jt' fyM rt i C. RECEIVED BY READY FOR DATE IBHUED
''// ,(qW__\ FIRST INSPECTION 6_//I��
ADDRESS yG/ E' �AMBn/H
I BUILDING +r�� -t /J
CITY �plif/�tJ rjy/r(( TEL No.. (o ADDRESS J O l:
COUNTY
LICENSE NO. J�Z�SG EXPIRES O•-+�` LOCALITY
PERMIT FEES' c`aoss 6T. CL AS /y A/A 5
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER J'C(7 A/L
MAIL
WATER CLOSET(TOILET) 0.50 S ADDRESS -
(
BATHTUB ® 0.50
CITY TEL No.
SHOWER O.SO 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.50 O APPLICATION AND STATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK Q O.SO [�/ AND STATE LAWS REGULATING PLUMBING.
/ I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY Q 0.50 U ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESgRARC13 AB E.
GAS SY9TEMOUTLETS Q 0.50 Q O
SIGNATURE OF �-
WATER HEATER Q 0.50 O U PERMITTEE
SLOP SINK Q 0.50 INSPECTION RECORD
FLOOR SINK Q 0.50
So S 3
FLOOR DRAIN Q 0.50
DISHWASHER Q 0.50DRINKING FOUNTAIN FOUNTAIN Q 0.50l-
URINAL Q 0.50
MOUSE SEWER Q 0.50
MISCELLANEOUS
0
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
r
GAB VENT
CESSPOOL Q 1.00 CESSPOOL
SEPTIC TANK• SEPTIC TANK
DRAIN ( ) PIT ( ) ® 1.00 SEWER
PERMIT 1.00 GAS TEST
i
UTILITY CO.NOTIFIED
TOTAL FEE
9 - —r
vo FINAL
76A667 DBS#17 10/52
WORKERS'COMPENSATION DECLARATION 70-0076 DPW 4/87 APPLICATION FOR PLUMBING PERMIT
'1-hereby, affirm that•I have'p certificate of consent to self in- 76A667A
sur., or o certificate of Workers'Compensation Insurance,Dr a ,CE 817(REV. 8/86) -
• Ser+"�e�q fo,p' thereof Sec 3800, Lob. C.) '
"�3`So'dampany C—Pio COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS' Z.
4
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Merl stied copy is filed with the C unty building inspection ADDRESS O
t-lF1'department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
WATER CLOSET (TOILET) `!
Applica NEAREST ,
CERTIFICATE OF EXEMPTION FROM WORKERS' O'� BATH TUB 100
CROSS ST. 9 •1.(.L,�.fw/ „` �� `:
- COMPENSATION INSURANCE SHOWER OWNER d! `LO
(This section need not be completed if the work involved by - MAIL / - r'
the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS /!pr-_V -
1 certify that in the performance of the work for which This per- SINK , f��
mit is issued, I shall not employ any person in any manner so CITY fT=7�0 TEL NO.
as become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR //lC /L!�'YLAP P11p . _
Date Applicant CLOTHES WASHER 07
NOTICE TO APPLICANT: If, after making this Certificate of En- ADDRESS 7 G,�y� 19',LQ_ f'
emptlon,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR
cation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM CITY TEL. NO. z�
ly with such provisions or this permit shall be deemed revok- STATE (j.�q• LIC. // -
ed. WATER HEATER LICENSE NO. (� / CLASS (57- [9
LICENSED CONTRACTORS DECLARATION GAS SYSTEM OUTLETS I - DISTRICT N CES BY
I hereby affirm:that Iam licensed under provisions of Chapter S
9(commencing with Section.7000)of Division 3 of the Business OUTLETS OVER
�� VALIDATION
and Professions Code, and my license is in full force and'ef- 5 PER SYSTEM FINAL >.feet. �/t DATE aO
License.Number Lic. Glass o�-l� U
AN FINAL Q
Contractor lK`L lG'-e ate BY O
oam exempt under Sec / W
IL
B.BP.C. for this reason `
- Plan check fee• D _ Z
'Date: PLUMBING PERMIT ISSUING FEE S -
Signature TOTAL FEE
SINGLE FAMILY Plan check applicant .
HOME OWNER-BUILDER DECLARATION 5
I hereby affirm that t am exempt from the Contractor's License 'Name " t
'Law for the following reason (Section 70311':5, Business and - ACCT.T
Professions Code): - Address -
) 3307 94'.50
❑ I, as owner of the property, will do the work and the City - Tel. No. - ,,, 1 ITEMS
structure is not intended or offered for sole(Section 7044, _ _ p
Business and Professions Code). _ D TOTAL T' .50
CONSTRUCTION LENDING AGENCY _ _ CHECK RAF.1O
1 hereby affirm that there is a construction lending agency for 00
the performance of the work for which this permit is issued -
(Sec. 3097, Civ. C.). '
Lender's Name r ) =-cool 9/L14/89
Lender's Address 55702 1 A 110:11
I certify that I have read this application and state that the
above information is correct. I agree to comply wish all County D
ordinances and State laws regulating Plumbing, and hereby -
cut ize representatives of this County to enter upon the
ve" e coned pror�erty for inspection purposes. ,
�J. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date - ,