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HomeMy Public PortalAbout9015 GARIBALDI AVE_Plumbing__ B17 DBS- APPLICATION FOR PLUMBING PERMIT 11-54APPLICATION OF BUILDING AND SAFETY Depcz, ent of County Engineer County of Los Angeles WM.J. FOX, COUNTY ENGINEER BUILDING ADDRESS O 1 � CASSATT D. GRIFFIN, SUPT OF BUILDING ....r.�yJj LOCALITY (� FOR APPLICANT TO FILL IN NEAREST CROSS ST. OWNER -" � i'2 DISTRICT NO. GFO 1�iOyE READY PDR INSPECTION MAIL ADDRESS INDUSTRIAL CITY TEL. WASTE APPROVAL PLUMBER - t� - - ' - INSPECTION RECORD +>p v ADDRESS CITY TEL. N . G LICENSE NO. ' NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) $ BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK - DISHWASHER i LAUNDRY TUB OR TRAY 1 CLOTHES WASHER I TOTAL NO. @ 0.80 APPROVALS DATE INSPESTOR'S SIGNATURE GAS SYSTEM.'-* TS @ 1.00 UNDER SLAB WORK WATER HEATER @ 1.00 ROUGH PLUMBING PERMIT S I 1 00 GAS PIPING TOTAL FEE GAS VENT r� 1 HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ PLUMBING FIXTURES PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED CALIFORNIA OR THAT I AM THE LEGAL OWN R OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. l tt }} SIGNATURE OF PERMITTEEa=m-� ` FINAL 5 � ( ��5 WILLIAM J. FOX, COUNTY ENGINEER VALIDATION t02022 MAR 29 3 2.00 BY ` DEPUTY 76A667A(CE817A) - 8/75 APPLICATION WR PLU ING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS j lIrA HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY ► FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST eor CROSS ST. 21 R 1V1 C.e,� NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET OWNER MAIL (� i BATH TUB ADDRESS -/ J 0.,..e►i SHOWER v CITY ew ^ r TEL. NO. LAVATORY CONTRACTOR SINK ADDRESS " _q �� G DISHWASHER CITY oh IBV A TEL. NO. S 317�� / CLOTHES WASHER 0 STATE LICV LICENSE NO. CLASS SWIMMING POOL RECEPTOR DISTRICT NO. GROUP NE ROCESSED BY LAWN SPRINKLER SYSTEM UL •j A-c-, WATER HEATER 0 0 INDUSTRIAL' WASTE APPROVAL GAS SYSTEM OUTLETS 0 INSPECTION RECORD d OUTLETS OVER O 5 PER SYSTEM U ix 0 F.- Lu - W CL Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Z z, 5—' APPROVALS DATE INSPECTOR 5 SIGNATJ RE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING r City Tel. No. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXT ES WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TESTI'!+ �f:;•- / =i�_�+ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. OTIFIED LICENSED AS REOU IRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER AND INTEND TO RESIDE IN THE ABOVE DESCRIBED R,ESS'IIDENTIA L PERTY. FINAL SIGNATURE .4 j` OF PERMITTEE n� =f PERMIT VALIDATION CK. M.O. LASH PLAN CHECK VALIDATION CK. M•O. CASH 895'0.ftA 9 5 0 22.50A!�} J'-) V6> hereby WOR affirm that I e a�t�� oON to self 76,,�„A APPLICATION FOR PLUMBING PERMIT Insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10181) qr,p certjfied� thereof (sec. 3800, b. c.) n COUNTY OF LOS ANGELES i BUILDMNG AND SAFETY a�y(bpf Certified copy Is hereby fumished. ' BU FOR APPLICANT TO FILL IN(PRINT OR TYPE) Al�S NG Certified copy u filed with the county building Irupec- tion department. NUMBER FIXTURE OR rrEM O FEE LOCALITY s Date�"z� Appll,;.to. Q► WATER CLOSET NEAREST CERTIFICATE OF L}(EMPTION FROM WORKERS' BATH TU9 o4osS ST' COMPENSATION INSURANU SFKYA1Et OWNER t (This section Med not be completed If the work Invah, d by MAIL r 1 the pwmtt Is for one hundred dollars($100)or fess.) LAVATORY ADDRESS I certify that in The performance of the work for which this permit Is Issued, I shall not employ anyperson In any manner SINK CIT lS NO, so as to become subleci to the Workers Compensation Laws. DISHWASHERt CONTRACTOR Date Applicant CLOTHES WASHER V1 NOTJCE TO APPLICANT: If,•after making this Certificate of ADDRt Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth LAWN SYSTEM CITY with comply with such provisions or this permit shall be STATE �y LIC deemed revoked. WATER HEATER UCENSE NO. ? Cly LICENSED CONTRACTORS DECLARATION DISTRICT NO. BY I hereby affirm that I am licensed under provision of Chapter 9 GAS SYSTEM r (commencing•wtth $ection 7000) of Division 3 of the Buslr»a OUTLETS OVER d and l•rofentons Code,and my Ilcense Is In full force and effect. 15 PER SYSTEM FINAL DATE —?—�� VALIDATION u License Number ? -' Llc:Class J�'- �— OL ? FINAL /` O Contractor nq Date. a BY ❑ I am exempt under Sec. B.BP.C, for this reason Plan check fee Date. PLUMBING PERMIT ISSUING FE Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason {Sectlon 7091.5, Buglness and Address 0 0 2 Q 7 A Professions Code): City Tel. No. ,�f 0 0 0 0 0 5 ❑ i, as owner of the property, will do the work and the structure Is not Intended or-offered for sale (Section , 2+0 0 6 50 7044, Business and Profeasioru Code). 'r CONSTRUCTION LENDING AGENCY o 010 6.5 0� I herej�y affirm that there Is a construction lending agency for 0304-83 the performance of the work for which this permit Is Issued (Sec. 3097, Civ. C). Lenders Name Lenders,6¢dress 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 Slgrwture of Permittee Date RLORlC1::RS'COMi'ENSA'I'IQN DECLARATYON ' y� � iswaran'� /� I hereby afra-m that I have r cetthficate of consent to .elf cle e,17 (s-+a) J!`1PP�I AT[O,iV FOR PLUMBING PERM IT Inure,or a certiflcat0 bf Workers'Compensation Insurance,or a tertifte4 copy thereof(Sec.3800,Lab.C.) na, F�md ��j.��� COUNTY OF LOS ANGELESJ3UILD1Np AND SAFETY ' Policy No.__1 LLPaar �8te ('AI[IpU.I Certified copy Y hereby furnished. BUJLDIN-G FOR APPLICANT TO-FILL IN (PRINT OR TYPE) (Yy © Pertified copy is fired With the,ounty building Inspection FIXTURE OR ITEM Ftp ADDRESS 9015 �l;. Gaxibaldi LIT department. Applicant WATER 4LOSE1 LNEARESTCYTeDate [NLO"AWBER 1 1 BATH TUB 00 CqOq8 ST. CI;RTIFICATF,OP EXEMPTION FROM WQRKERS' COMPENSATION INSURANCE SHOWER OWNER Bruce McCormick (This wolon need not be com.placed if tbQ IIIVOIred 1 LAVATORY A11DFlE Same by the permit Is fOr one hundred doom (t I W).0[ Ilea.) SINKS CITY TEL. NO.78 �8 I certify that in the performance of-4h&Work for which this DISHWASHER � per" is issued, I snail not employ any person In any mann6r CONTRACTOR O to as to become suNact to the Workers'Compensation Laws, CLQ'rHE$WASHER ADDAESS-: 71"'Z5 �+,�-Lag Tuhas Dr. Data Applicant. SWIMfMINO POOL A•ECEPTOR LLI NQTICI?TO.APPLICANT: If,aftet mtldng,tbu Certificate of CITY a Ile Cit TEE L,NO. 8 5-3224 Exemption, y¢u 'should, bepome -+UbJect to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compehaation•provlsions of the Labor Code, you must forth LFCENSE NO. CLA$8 WATER HEATER +cath comply vAth such prodslone or'tlils perm-ft shaD b6 DISTRICT NO.' R dCE$S Y debmedrevoked. OASSYSTEM ' OUTLETS . V LICENSED CONTkACTQRS DW-ARATM?i OUTLETS OVER I hereby ifffrm that 1 am Uc6nscd under provisions of Chapter S PER SY$TEM ' 9 (commencing with Section 7000)of Dtvision 3 of the Bull- FINAL c nes and Profasalons Code, and my license,Is In full force and DATE f S "� VALIDATIO effect. FINAL ,License Number Liq.Class BY Contractor Data 0 1 arh exempt from the tiianrtng requirements as I am a Plan chaed fee iirensed architect or a reg4"red profpsdonal engineer PLUMBING PERMIT 1SSUfNG FLEE$ 7 ,00 acting in my profeaalonai capacity (Suction 7051, Bus- Ines and ProfeWonsCode). [TOTAi. FEE 16 OC) Ur.or Ra(.No. Date Plan chock appl"rt , HOME OWNER-BUILpERDECLARATION Noma. R 4,5.4.5 A I hereby affirm th,t I am exempt from the Contractor's Address # o 0 0 o 05 Licbhae Law for the following reason (Section.7d31,5, Bust- QKy Tal.No. nes and Professions Code): 2 ° - 1 .600 F, as owner of the property, am exclustrely contracting with licensed contractors to construct the project 0 0 0 1 0 (Sect Ion 7044,Buatn'est and Professions Code): 0 2'6=-8 1 CONSTRUCTION LENDING AGENCY ; I hereby affirm that there L a togstructi6n rending akancy fqr the performance of the work for which this permlt is issued(Sec.3097,Civ.C.), Lehd6T'$Name Lender's Addr6a/^ I certify that I htve read this application and state that the above information L correct.l agree to comply with all County ordinanpand State laws regulating Plumping, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE a ■µtharl;e esentat of this my to enter upon the above-Merl pro for on purposes. ! f Perifiittee Date