HomeMy Public PortalAbout6204 ENCINITA AVE_Plumbing__ 76.6.1 ICE-8171 - 1/75
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ` .
MAKE CHECKS PAYABLE TO: ADDRESS 2p4 Encinita Ave
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Tem 1 ' City
FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST
cRoss sT. b d '
NUMBER FIXTURE OR ITEM @ FEE OWNER Wade Redo
WATER CLOSET 2.00 /f(I
MAILL AC1Al a
BATH TUB 2.00 ADD SS p
SHOWER 2.00 CITY TEL. NO.286-5327
LAVATORY 2.00 CONTRACTORgUben F. Robles
SINK 2.00 ADDRESS15722 A E. Gale Ave
DISHWASHER 2.00 CITY H aClen a Helglltk. No.
CLOTHES WASHER 2.00 STATE LIC T�
LICENSE NO. 2$ 1 CLASS B-1
SWIMMING POOL RECEPTOR 2,00 -
DISTFLLCT N,� GR[,11P E PR CES D B.
LAWN SPRINKLER SYSTEM 2,00 I
WATER HEATER 2.00 INDUSTRIAL
WASTE APPROVAL a
GAS SYSTEM OUTLETS 2.00 INSPECTION RECORD U
OUTLETS OVER ,30 ` O
5 PER SYSTEM
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Plan check fee She R.v.,G.
PLUMBING PERMIT ISSUING FEE S l7f
TOTAL FEE ✓' APPROVALS DATE iNSPECTG.•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 IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING _FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
HEREBY CERTIAM PROPERLY REGISTERED ND/OR UTILITY CO. NOTIFIED
LICENSED AS REQU I RED BY LO S ANGELES COUNTY AND STAY THAT I
OF
CALIFORNIA OR THAT AM TME LE L NEI OF, I INTENDT q /J
RESIDE IN THE ABOVE DESCRIB D-R TIAL PRO PERT FINAL
SIGNATURE L��
OF PERMITTEE - PERMIT VALIDATION CK. M,0-. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
79 1fiSEP 13 5 D 1 0.5 0 e�;!
7GA667A ICE`B 1181- 11/76
APPLICATION FOR PLUM 03ING PERMIT
BUILDING AND SAFETY DIVISION
NUMBER FOR AFI%TURF ORIOTEML IN iPRINT OR TYPE F L
PPLICANT BUILDING
EE ADDRESS
WATER CLOSET LOCALITY ' �C�.yR.L 67-1
NEAREST
BATHTUB
�i OQ CROSS ST. /
SHOWER (jQ OWNER
3 UT 'LAVATORY MAILADDRESS
SINK CITY TEL.NO. e6
DISHWASHER CONTRACIA
CLOTHES WASHER 00 ADDRESS -
Li
SWIMMING POOL RECEPTOR �•
CITY
LAWN SPRINKLER SYSTEM
STATE UC.
WATER HEATER 3 ,50
LICENSE NO. °.J CLASS
/ GAS SYSTEM OUTLETS 20
Cj DISTRICTC: OUP /7L77 GRZONE PRO SSED BY �I
S L/
OUTLETS OVER }
5 PER SYSTEM INDUSTRIAL 6
WASTE APPROVAL O
INSPECTION RECORD V
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Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE
Plan check applicant
APPROVALS DATE IN TON'S SIGNATURE
Name
UNDER SLAB WORK -:;-p�77
Address - ROUGH PLUMBING
City Tel, No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUM BING. HOT WA TER HEATER
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REDU IN
ED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO,NOTIFIED -
SIGNATURE
OF PERMITTEE _ FINAL
'1
PLAN CHECK VALIDATION CK. M o. CASH PERMIT VALIDATION cK. M.O. CASH
005i�'AUG 5 5D 34.50 "" a
1- ®5
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WORKERS,-COMPENSATION DECLARATION20 6 DPW 4/B]7,5AMAPPLICATION FOR PLUMBING PERMIT
n
I
hereby, affirm that I have a certificate of consent to self in- ]6g667A
sure,ar a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified copy thereof (Sec 3805, Lab.,C:) '
Policy No,• - Company ` COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS r
Certified copy is hereby furnished. - BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) _
ertified copy is filed with the county building inspection ADDRESS
depart nt. •NUMBER FIXTURE OR ITEM ee ' FEE LOCALITY r
WATER CLOSET(TOILET) —`E
ba;. WATER�� NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
•(This section need not be completed if the work involved by MAR
the permit is for one hundred dollars ($100)or less.)' LAVATORY - ADDRESS (r'�+
I certify that in the performance of the wank for whichthis per- SINK '
mit is issued, I shall not employ any person in any manner so CITY TEL. NO.
os to become subject to the Workers' Compensation Laws. DISHWASHER
CONTRACTOR AIA
Date ' `Applicant tr CLOTHES WASHER O '
NOTICE TO APPLICANT: If, after making this Cerlificate of Ex- ADDRESS/ft-1 T r
emption;you should became subject to the Workers'CompenSWIMMING POOL RECEPTOR- - CITY TEL NO. VY
sation provisions of the Labor Cade, you must forthwith comp- LAWN.SPRINKLER SYSTEM 7—c
ly with such provisions or this permit sholl.be deemed revok- STATE ['' / (� LIC.
ed. WATER HEATER LICENSE NO. J f7 0 l C1ASS
LICENSED CONTRACTORS DECLARATION DI ICT NO. P CESSED BY '
I hereby affirm that I am licensed under provisions o4 Chapter GAS SYSTEM OUTLETS
9;(com mencing with Section 7000)of Division 3 of the Business OUTLETS OVER _
s
d I Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL 3
feV ATION 6
p DATE / Q
License Number 57�8� Lic, Class .4?- O
�/Jp.7 FINAL
Contractor Al /�G�C2 1JDate a BY440,
O
am exempt under Sec.
B.sP.C. for this reason Plan check fee 28'264 A y
z
Date: PLUMBING PERMITEISSUING $ D # e s e so 5j
Signature - - S •) ° : 34,50
SINGLE FAMILY '
HOME OWNER-BUILDER DECLARATION Plancheck applicant a e : 3 4,5 0 5'
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and -
I14. p3=8,7
Professions Code):, - Address -
❑ I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044, -
Business and Professions'Code).
t CONSTRUCTION.LENDING AGENCY t -
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 f
I certify that I have read this application and state that the
above information is correct. I agree to comply with all County D
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this Countyto en upon the
I above-me ioned property for nspection pur ses.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Dote