The URL can be used to link to this page

Home My Public Portal About6102 ENCINITA AVE_Plumbing__ 96A669 - CE819 5/90 • APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY 0 'RUING L, JOHN A. AMBIE. COUNTY ENGINEER ADDRESS /1'= COLEMAN W. JENKINS. SUPT. OF BUILDING ,' LOCALITY /J--)77 P4,-NEAREST FOR APPLICANT TO FILL IN(PR NT OR TYPE) ROSS ST, 'IL I7_7 NUMBER FIXTURE OR ITEM EACH FEE OWNER F WATER CLOSET 1.50MAIL �1 nn ,�✓✓ //AA HATH TUB 1.50 ADDRESS �� OQ G L'%Ni�T,+S'r [fir SHOWER 1.50 CITY EL.•NO.. EpG(J�,J�TJ LAVATORY 1.50 CONACSOR' FT1/ /C TAI,/v SINK 1.50 ADDRESS / O_ a Li DISHWASHER 1.50 CITY YnP,CF ,; TEL. NO, 9417 d CLOTHES WASHER I.50 STATE LIC LICENSE NO. c>.//00'9e CLASS SWIMMING POOL RECEPTOR 1.50 - - '- DISTRICT NPS GROU Z PR ESS Y LAWN SPRINKLER SYSTEM 2.00 WATER HEATER 1. _ WINDUSTR IAL A3 E APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD OUTLETS OVER �/ , /I -� 0 5 PER SYSTEM .30 /V �t 0 r W a N Z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE .S 00 TOTAL FEE APPROVALS DATE INSPECTORs SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address i GAS PIPING GAS VENT City, Tel. NO. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - ANO STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 1 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 RE51DE IN. THE ABOVE QE9CRIBEO BIDENTIAL PROPERTY. FINAL SIGNATURE �Q�__ JACK R. ALLEN, BUFERVISING CH ANICAL EN G'R. OF PERMITTEE _ PERMIT VALIDATION CK. m,O. CASH PLAN CHECK VALIDATION CK. M o CAEH L o2 5 b 1 27 5 D 4.75" IN WORKERS'COMPENSATION-DECLARATION v _ f APPLI`L.{s TMN FOR Ir ILrLYtltl91♦DV0C1G, Ir IGNLMT I hereby affirm that I have a certificate of consent to self. 76gyy7A insure, or a certificate of Workers Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lob. G) COUNTY,OF LOS ANGELES , T 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 Q FEE LOCALITY WATER CLOSET Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. fit ii COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS I certify that in the performance of the work for which This permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers Compensation Lows. DISHWASHER CONTRACTOR Do'eNOTC APPLICANT If. of" CLOTHES WASHER ADDRESS Exemption, n, yo _shoul If, after mak' this Certificate of Exemption, you should become sublect to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR CESSED.BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 70D0) of Division 3 of the Business OUTLETS OVER J I and Professions Code,and m license is in full force and effect. 5 PER SYSTEM y FI L - —� VALIDATION 60 License Number Lia Class EU FINAL 19 Contractor Date BY QU 0 ❑ I am exempt under Sec. A W N B.BP.C. for this reason Plan check fee z Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 2.;11. Plan check applicant SINGLE FAMILY 1 8'1 4 A HOME OWNER-BUILDER DECLARATION Name I I hereby affirm that I am exempt from the Contractors License Address u o 0 0 0 0 5 Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. 2 0'0 2250 ❑ 1, as owner of the property, will do the work and the 'e oo Q Q. rJ Q structure is not intended or offered for sale (Section s� 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY x.6,0 7 Pi 4 = 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.). Lenders Nome 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 t Signor a of Permittee vote WORKERS''///COMPENSATION DECLARATION re Nee>p I hereby affirm tl5at I heye a' certificate of'consentto Self CEai) (y-eel " APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or a certified copy thgi*of(.Sec,3800, Lab. C. .15. ^I' 0 COUNTY OF LOS ANGELES. BUILDING AND SAFETY Policy NO. company `s(.q.-/y Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the count building NUMBER FIXTURE OR ITEM O FEE ADDRESS (./IO� // ✓ y g inspecti0 Pa n p WATER CLOSET LOCALITY Dnt — pplicant NEAREST JJJJ BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER MAIL (This section need not be. completed if the work .involved LAVATORY ADDRESS by the permit is for one hundred dollars ($100) Or less.) SINK d CITY TEL.NO� o, O I certify that in the performance of the work for which this DISHWASHER 8 permit is issued, 1 shall not employ any person in any manner CONT RACTO so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER cc ADDRESS O Date Applicant U SWIMMING POOL RECEPTOR .n � NOTICE TO APPLICANT: If, after making thisCertificateof CITY d TEL I Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE q LIC. N Compensation provisions of the Labor Code, you must forth- LICENSE NO.dry S�.2SCLASS a ,S3 U) with comply with such provisions or this permit shall be WATER HEATER Z deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER V 9 I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM - 9 (commencing with Section 7000) of Division 3 of the Busi- - FINAL yL VALIDATION ness and Professions Code, and my license is in full force and - fr✓r'!' — DATE f � �� effect. License N�umbf�/(3S'V15y AL Lic. Class C 5 J BY �G> 0•-a-C.,•a Contractdifz"F�•/1'V Y� Date l� I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my_ professional capacity (Section 7051, Bus- 01 iness and Professions Code). TOTAL FEE Lic.or Reg,No. Date Plan check.applicant - HOME OWNER-BUILDER DECLARATION Name 9 2 8 9,8 A I hereby affirm that I am exempt from the Contractor's Address-525;-V a # e e o,o a 55 License Law for the following reason (Section 7031.5, Busi- City el. No.�!'� �3 2 • ° 2 2.5 0 ness and Professions Code): 0 1, as owner of the property, am exclusively contracting - ,e • • 2 2 5 0 v with licensed contractors to construct the project (Section 7044, Business and Professions Code). ()tfi 1 tJ-8 3 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 Ihave read this application and state that the above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-me Oned pr ope y ecti urposes. Signature of Per it a Date