HomeMy Public PortalAbout5021 GLICKMAN AVE_Plumbing__ 76A667 D6517 7-51 APPLICATION FOR PERMIT
DEPAATOF BUILDING AND SAFETY
COUNTY
PLUMBING
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENWNEER
FOR APPLICANT TO/ FILL IN DISTRICT GROU ZONE .•
PLUMBER !r. 1 ` v READY FOR J J 6
RECEIVED BY DATE ISSUED
FIRST INSPECTION
i
ADDRESS 0 i
C
BUILDING
CITY TEL N.-Lo / ADDRESS
COUNTYI,i�_ LOCALITY E
t4C'N.E NO. EXPIRES �^'�
NEAREST
PERMIT FEES CROSS ST. /47[J �
NUMBER TYPE OF FIXTURE DR ITC. FEE OWNER
MAIL
WATER CLOSET(TOILET) 0.50 >S ADDRESS
BATH TUB o.bC CITY �•-f TEL No.
SHOWER 0.50 I HEREBY ArKNOWLED16E THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) qjd APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK ff 0 AND STATE LAWi REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY O.6Q' 0 ANGELES COUNTY LIC BE, OR i AM THE L,LQAL OWNER
OF THE RESIDENTIA ERTY DE RIB ABOV t
BAB SYSTEM -^ OUTLETS -0.58 b SIGNATURE OF
WATER HEATER Q 0.30 OQ PERMITT€Y-
SLOP SINK 0.513 INSPECTION RECORD
FLOOR SINK O.So
FLDOR DRAIN ❑.50
DISHWASHER 0.50 S
DRINKING FOUNTAIN 0.50
URINAL Q 0.50 ��OiD / �G1L- J
Q
HOUSE SEWER 0.60 Z
MISCELLANEOUS
O
APPROVALS
DATE INBPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAB VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER L're
PERMIT1.00 GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE �
0 FINAL
Y
i _
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby, affirm that I have a certificate of consent to self in- 7 0-0026 PW 4/90 6A667A
sure,or a certificapte of Workers'Compensation Insurance,or a
certified copy thereof (Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company
Certified copy is hereby furnished. BUILDING {
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS J u'Z-'I 1.
Certified copy is filed with the county building inspection
depa 1 ent' NUMBER FIXTURE OR ITEM @ FEE LOCALITY ~
` �G ` WATER CLOSET,(TOILET)
Date 7, Applicant NEAREST
ERTIFICATE OF EXEMPTION ROM WORKERS' BATH TUB . CROSS ST.
COMPENSATION INSURANCE SHOWER "OWNER ,
This section need not be completed if the work involved by MAIL - I
the permit is for one hundred dollars (;100)or less.) LAVATORY ADDRESS sl L4C>k_411t IXI
I certify that in the performance of the work for which this per-
SINK CITY-1f;,-r TEL. NO. ,a�
mit is issued, I shall not employ any person in any manner so ri U-3&L
as to become subject to the Workers'Compensation Laws. DISHWASHER
ONTRACTOR C—OZI^ro
Date. Applicant CLOTHES WASHER �r� 4
ADDRESS �(1' a,W�lvvd)
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR .�
em tion,you should become subject to the Workers'Com en- CITY , TEL. NO
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS C
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION 1 DISTRICT NO; PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter t GAS SYSTEM OUTLETS �/�
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL ,/`�l`�� _ VALIDATION }
fect. U rZ HOSE BIB DATE (�G ! a
License Number Z� Lic. Class°�
O
FINAL
Contractor L.-:& o > L Date BY
I am exempt under Sec. ;-• U
W
B.&P.C. for this reason Plan check feePoo. y
Date: PLUMBING PERMIT ISSUING FEE$
Signature TOTAL FEE1
_j ,. . a
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and
Professions Code): Address
E1, 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).
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 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
ab -menntioproperty for inspection pur
ovee es.
/ SEE REVERSE FOR EXPLANATORY LANGUAGE f
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S 6gnat re Permittee Date f
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