HomeMy Public PortalAbout8721 GARIBALDI AVE_Plumbing__ DEPARTMENT OF COUNTY ENGINEER PLUMBING I
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDINGQ r
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS S.? E j
QrFOR APPLICANT TO FILL IN LOCALITY �h Gam
NEAREST
ADDREISS �J y' f 1 / �_. CROSS ST. Q r
�
DISTRICP.LNO. GROUP ZONE PE"I E N0.
LOCALITY Zn c ( /� /
NEAREST ry7,16
1!
CROSS ST. t A y RECEIVED BY Ready forlospeetio DAT ISSUED
OWNER
MAIL INDUSTRIAL vT-
ADDRESSr? r WASTE APPROVAL
INSPECTION RECORD
CITY a' i lai j TEL.NO. "4 7 St
a .
PLUMBER -J 1 iq •
ADDRESS
CITY TEL.NO.
❑STATE
LICENSE NO. fl COUNTY .J
PERMIT FEES z
J:;hiGER TYPE OF FIXTURE OR ITEM FEE 19
WATER CLOSET(TOILET) @ 0.80 S d'
O
BATH TUB @ 0.80
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK @ 0.80
FLOOR SINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM.....I-------OUTLETS @ 1.00 0
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UkDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE °S 66 GAS PIPING
IHEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED y
ANDiOR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ~
ER OF THE ABOVE DESCRIBED RESIDE NNTTIAL
�PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE ���...�L�-l..e.C..! CL
OF PERMITTEE. - ........... FINAL G _
76A667 DBS 17 1/53
.WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
T heteby affirm that I have a certificate of consent to self 20-0026 DPW 6/87
Insure, or a certificate of Workers'Compensation Insurance, 7GA867A
or 6 c*rttfied copy thereof (Sec. 3800, Lob. C.) Q COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No D7 Company. 7
Certified copy Is hereby furnished.
❑ FOR Al'PEtG4NT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy Is filed with the coun b Ilding Inspec- ADDRESS
tion department. 5 ,�J NUMBER FIXTURE OR ITEM O FEE
Mc41Tfy
Appllr<ant WATER CLOSET NEAREST 457
CERTIFICATE OF EXEMPT FROM WORKEn' BATH TUB CROSS ST.
COMPENSATION INSURANCE s> pyyttgt
(TMs secilon need not be romp{rhd If the work Irnrohred by
the pemitt b for one hundred dollars($100)or less.) LAVATORY OWNERADDRESS
I certlfy that In the performance of the work for which this
penrtilt Is Issued, I shall not employ any person In any manner SINK cn - �/T TEL NO.
to a;to become subject to the Workers Compensation Lows �/�
ea
DISHWASHER TOR T.1T 6a `4
lzkj
Date AT Ilcont CLOTHES WASHER /V,,�¢�/ 'j` Y
NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING ADDRESS 2* J � A(/
Exemption, you should become subject to the Workers' POOL p�(/��,r} �Q
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY �"' -� " TEL NO ' "'
ly
with comply with such provisions or this permit shall be STATE NO 3`4 LIC
deemed reyoked. WATER HEATER
LICENSED CONTRACTORS DECLARATION DISTRtCT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 t GAS SYSTEM OUTLETS t-- p'
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license Is to full force and effect. S PER SYSTEM FINAL
6103(1-117n'� DAZE / VALIDATION
License Number I Ir: Class £ }
S
COntractcr ;2 r2 Data FINAL BY
f I am exempt under Sec. �� .Q�
BAP.C. for this reason Plan check fee
PLUMBING PERMIT ISSUING fes; TOTAL 82 - S
Slgndtu
TOTAL FEEPlan check applicant •I��
SINGLE FAMILY
HOME OWNER BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Llcense Address
Law for the following reason (Section 7031.5, Business and �7�1q i ff111'��
Profwlons Code): city Tel. No.
❑ I, as owner of the property, will do the work and the
structure Is not Intended or offered for sale (Section '
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I affirm hereby arm that there Is a construction lending agency for
the performance of the work for which this permit Is Issued
(Sec. 3047, Civ. C.}.
Lender's Name
i
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
a orlxe reprelentatives of this County to enter upon the
b vo-m o for Inspactlon pu
Z SEE REVERSE FOR EXPLANATORY LANGUAGE
Ignature of Permittee Date