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HomeMy Public PortalAbout5041 GLICKMAN AVE_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer PLUMBING DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer FOR APPLICANT TO FILL IN DI TJ� NO. GROUP Z NE PER �7_ PLUMBER - BY READY FOR DATE ISSUED FIRST INSPECTION _ ADDRESS BUILDING CITY TEL N ADDRESS L [/ COUNTY LICENSE NO. i EXPIRE 4 JO -,S3 LOCALITY NEAREST PERMIT FEES CROSS ST. NUMBER TYPEOF FIXTURE OR ITEM FEE OWNER / MAIL WATER CLOSET(TOILET) @ 0.50 I$ ADDRESS / BATH TUB @ 0.50 CITY TEL. No. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LIC SE, OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL ROPERTY DESCRIBE ABOVE. GAS SYSTEM OUTLETS 0.50 SIGNATURE OF WATER HEATER @ 0.50 PERMITTE - SLOP SINK @ 13.50 nINSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 L DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 'J Q HOUSE SEWER @ 0.50 Z MISCELLANEOUS 9 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING - i GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE $ FINAL �s 76©667 DBS#17 6-52 76A667 •CE#817 5/63 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION fAUDDRENSS'Y;. ILDI JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN. SUPT OF BUILDING OCALITFOR APPLICANT TO FILL IN EAREST ROSS ST NUMBER FIXTURE OR ITEM EACH FEE OWNER jan r,z. WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS N '.jkl SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR SINK 1.25 ADDRESS DISHWASHER 1.25 CITY rn E• TEL. NO. LCONTRACTOR STATE LAUNDRY TUB 1.25 REGISTRATION NO. + COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY WATER HEATER 1.50 >- d GAS SYSTEM OUTLETS 1.50 INDUSTRIAL O WASTE APPROVAL U OUTLETS OVER S PER SYSTEM .30 INSPECTION RECORD w Q O 2 realacerAnt ::E w H APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DDESCRIED RESIDEIy7J ,,.PROPERTY. UTILITY CO. NOTIFIED C w" / SIGNATURE OF PERMITTEE + t / i""^� -�"•^ FINAL VALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R WORKERS'COMPENSATION DECLARATION CE 817( ) APPLICATION FOR PLUMBING PERMIT I herebya affirm that I have certificate of consentce to self a17 z-ao insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab. .) COUNTY OF LOS ANGELES BUILDING AND SAFETY .Policy No. Company ��� Cert ifie cop is hereby furnished, FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Cj rt' i file�withe unty b 'ding inspecti NUMBER FIXTURE OR ITEM • FEE ADDRESS WATER p CLOSET LOCALITY Dat App NEAREST BATH TUB CROSS ST. lxl�T� ER IFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL /� � (This section need not be completed if the work involved ADDRESS Sj 04-rp-. by the permit is for one hundred dollars ($100) or less.) +r �1 SINK CITY TEL.NO. 12,)vN 8 I certify that in the performance of the work for which this DISHWASHER U permit is issued,,I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ' ADDRESS /'� o Date Applicant SWIMMING POOL RECEPTOR mx_ W NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO.(`g2_J0?C> Exemption, you should become, subject to the Workers' LAWN SPRINKLER SYSTEM STATE / d LIC UJ Compensation provisions of the Labor Code, you must forth- LICENSE NO.0 p /rD CLASS 6 e,( ©Q with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER Ihereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM /J 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL J VALiDATI ness and Professions Code, and my license is in full force and DATE I r effect. (x� /^� ' *,, ,n' Lia Cl y FINAL BY eI am he licensing requir ents as I am a Plan check fee1v! licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Busoo - iness and Professions Code). TOTAL FEE ®Q Lie.or Reg.No. Date Plan check applicant 902 1.3 A HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address # o o,o o 'o 5 License Law for the following reason (Section.7031.5, Busi- City Tel.No. 2 ° 0 1 0,0 0 ness and Professions Code): I, as owner of the property, am exclusively contracting ° ° 10,0.0• with licensed contractors to construct the project 0 1 6781 (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY y � i 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.). FINAL 1 S i 10, p !J Lender's Name CT 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 SEE REVERSE FOR EXPLANATORY LANGUAGE i agnatuermittee awsregulating Plumbing, and hereby ofthis County_to enter upon they for inspec pur ose Date