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HomeMy Public PortalAbout5949 ENCINITA AVE_Plumbing__ 76A667 17 9-49 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ' L U M B 0 H U WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE_ PERMIT NO. S Z /4r-i �799R7 PLUMBER RECEIVED BY HEADY FOR DATE ISSUED FIRST INSPECTION �/ S-0 I // i G ADDRESS 7 BUILDING CITY of TEL. NOLL .. ADDRESS COUNTY J' JJ�j p/� y LOCALITY LICENSE NO. L7(/ /Q 1 EXPIRES di J NEAREST ( [I� PERMIT FEES caoss ST. / �v NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOS ET (TOILET) O 0.50-Is J ADDRESS BATHTUB © O.SOI I CITY TEL. NO. SHOWER () 0.501 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AV LATORY (WASH BASIN) ({D 0.501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK 0 0.50 STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY (tai 0.501_ ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER OF THE RESIDENTIAL P ERTY DEBC RIBED ROVE. AS SYSTEM OUTLETS 0O.SO �� WATER HEATER Q 0.50 61GNATU RE OF PERMITTEE SLOPSINK 0.501_1_ INSPECTION RECORD FLOOR SINK (� 0.501 I FLOOR DRAIN (] 0.501 IDISHWASHER (R) 0.501 �_�� 'f�l�'1 "' � '✓� �t1A DRINKING FOUNTAIN 0 0.50 /�.r '•-7 /I r6 et/I f I.nl"e) URINAL (@ 0.5011 Mat r' R'c ;VA7' 1?'?+ne7F.^ 1 .j I, HOUSESEWER @ 0.50 Q Z �• MISCELLANEOUS U' K O I� f APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL OF 1.001 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN I I PIT ( ) Q 1.001 I SEWER PERMIT . I I.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE I S (�O FINAL 173 •76A667-CE817 12/59 TEMPLE CITY APPLICATION FOR PLUMBING PERMIT. ] COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY RIVISION BUILDING JOHN A. LAMBIE, COUNTY NGINEER ADDRESS V� WILLIAM A JENSEN, SUP'T OF BUILDING LOCALITY c . . .r.�.. __..... _ FOR APPLICANT TO FILL IN NEARESST. f NUMBER FIXTURE OR ITEM OWN f / / WATER CLOSET MAIL L �^ BATH TUB ADDRESS y SHOWER CITY TEL. �- .7 H / LAVATORY CONTRALTO C SINE ADDRESS i A DISHWASHER CITY IEL. NO �� � IV�� CONTRA R'S •n ^ STATE 19, LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER OhlycTRInCT N,/�// GEDB WATER HEATER A Q /r �•' I/ I GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD a I O U 0 O ' -- F U W a N z Q $1.00 PER ITEM OR FIXTURE $ / •� APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTALFEE .5y )�[/( ROUGH PLUMBING _ GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES / ` LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAI/IPR ERTY. UTILITY CO.NOTIFIED SIGNATURE �'� �' - /✓ OF PERMITTE FINAL I .J h ✓ /r ®r ... . .. .. VALIDATION--, ROBERT A. WOOD Cs. Id.0. L/tCe/R } SUPERVISING MECHANICAL ENG'R LA ,�1182 � APR 6 5 D 3 .50 �' WORKERS'COMPENSATION cafe of conN elf ;•' APPLICATION FOR PLUMBING PERMIT '41 hereby affirm that 1-have a certificate of consent to self - 76Aby7A ' , insure, or a certificate of Worlters 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) BUILDING �/++ Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM C FEE LOCALITY Date AppIccim WATER CLOSET NEAREST /L CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB- [J V CROSS ST. 4 COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved'by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY UO MAIL G .ADDRESS y y✓✓✓�J�✓.'�1�T • I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK �� CITY "fL" i^r� TEL NO, � �- so as to become subject to the Workers Compensafio Laws. DISHWASHER Q CONTRACTOR -ly �_Exernption, Date� if to CLOTHES WASHER ADDRESSNOTICE APPLICANT:T: If, making Certificate of you should b A me subject o the Workers' SWIMMING FOOL RECEPTOR Compensation provisions of the Labor.Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER into LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCES D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM S OUTLETS ell (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER d and Professions Code,and my license is in full force and effect. 5 FER SYSTEM FINAL _ VALIDATION O DATE U License Number Lic. Class Ly FIN j O Contractor Date B 7 U F-17 W I am exempt under Sec H e.&P.C. for this reason Z Date: Plan check fee D PLUMBING PERMIT ISSUING FEE$ lJ. Signature TOTAL FEE Plan check applicant SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Name 2091,9A . • I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and # ea'e ° e Jr Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the 2 ° - 78.00 structure is not intended or offered for sale (Section _ 7044, Business and Professions Code). 'O ° ° 7 a 0 o us CONSTRUCTION LENDING AGENCY e,Q.01 -'83 1 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 Nome Lender's Address I certify that I have read this application and slate that the D above information is correct. I agree to comply with all County ordinances and State laws+egulciting Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned properly for 'msp tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 'Ignature of Permittee Date