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Home My Public Portal About4851 GOLDEN WEST AVE_Plumbing__ 7we7A(CM ei79)-11/76 a( Tq D"� J �I ► �f' 1� � APPLICATION FOR PLUMBING ERMIT c BUILDINQ AND SAFETY DIVISION FOR APKK-W TO FILL IN(PRINT OR TYPEJ BUILDING NUMBER FiXFUREOR ITEM a FEE ADDRESS WATER CLOSET LOCALITY 7Z/! N EAR EST BATH TUB CROSS ST. $I pWElt OWNER LAVATORY MAJ L A D DRESS SINK CITY TEL. DLc4iWASHER mwR.A(:T(RAClFSC INSTALLERS CLOTHES WASHER ADDRFss SWIMMING POOL R=N OTY LAWN SPRINKLER SYSTEM SPATE ° WATER HEATER LICENSE NO. �/ CLASS GGASS SYSTEMS OU LETS D + v � 4GRO 671 BY 5 PEREMR INDUSTRIAL WASTE APPROVAL I KEN RECORD V Plan check fee PLUMBING PERMIT[$SUING FEE$ TOTAL FEE Plan check applicant APPkDVALS DATE (14SPECT01t S SIGNATURE Name lJND6RSU,B WORK Addreu ROUGH PLUMBING City TAI.No. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ TH[f APPLICATTON AND STAN GAS VENT THAT THR ASoVE t5 goRRECT IVO)hW To COY1•LY WITH ALJ,COUNTY ORDINANCES AND STATE LAWS REGULATING PLUYSING. HOT WATER HEATER I HERESY CESTrY THAT I AY PROPMY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REOUDtED BY LOS AHQIUZS COUNTY AND STATE OF OALrORMN OR THAT I AY THE GAS TEST LEGE OWNER Or,AHD INTEND TO W IN THE ABOVE C'.}CRIOLD RESDEHTVIL MOP ERTY. 111,NOTIFIED GIGNATURe Of PeRM FINAL PLAN CHECK VALIDATION cx. Wo. CASH PERMIT VALIDATION <_7 Y.O. CASH RHO FOR RmAl SpEf7 �mY 1.2 .5 1) 7.s0 -� a COUNTY OF LOS ANGELES APPLICATION FOR PERMIT ]Department of County Engineer DIVISION OF BUILDING & SAFETY PLUMBING WILLIAM J. FOX, County Engineer ISTR1:IfT NO. ROUP O . FOR APPLICANT TO FILL IN PLUMBER VALLEY G IV D BY READY FOR DATE ISSUED GO. FIRST INSPECTION ADDRESS 8300 (� S BUILDING CITY ROSE?VlEAD TEL No. AT 2 ADDRESS r COUNTY (� t LICENSE NO. 93M EXPIRES Y LOCALITY t NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) 0.50 8 vo ADDRESS _ BATH TUB 0.50 CITY TEL, No. 91 SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @0.50 O E ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL APPLICATION AND STATE THAT HC COUNTY ORDINANCES KITCHEN SINK @ 0.50 Q AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 8 0.50 J� ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER GAS SYSTEM OUTLETS 0 0,50 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. SIGNATURE EE WATER HEATER O.SO ,O PERMITT SLOP SINK 0.50 INSPECTION RECORD FLOOR SINK 0.50 FLOOR DRAIN Q 0.50 ' DISHWASHER 0.50 - DRINKING FOUNTAIN 0.50 URINAL 0.50 —1 a HOUSE SEWER Q 0.50 Z MISCELLANEOUS E3 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT ' CESSPOOL Q 1,00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) 1.00 SEWER PERMIT 1.00 GAS TEST TOTAL FEE UTILITY CO.NOTIFIED � FINAL 76A667 DBS#17 6-52 WORI<i'8 COMPENSATION DECLAMATION 20-OO DPWO/BD I hereby eMrm that I heVe ■.oertlTloate of consent to sell Insure, 7&&ArA APPLICATION FOR PLUMBING PERMIT , or,a of Mcate[,L ra Worker's Compensation Insurae, or a oertifled � �� ( Q 9) ! COUNTY OF LAS-ANaF�ES DEPT,OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DN. PC"No.�� T Company ❑ CeMltfled cgpy Is hereby hrnWF»d. p f FOR APPLCNNT TO F01 IN(PRINT OR TYPES ❑ Grtttted copy In filed wilth the oou!r"bulkitrp tnapst6on department 14111113EIR FDC11RE Oft MEW f FEE LOCAUm Data, Appk-d WATER CLOSET NEAREST CEFM OF EaAFnQN•FROM WOFI? CF1068 COMPENSATION INSURANCE BATH TU8ASSESSOR (ThIa sWIon need nm riot be ooph tf the worts Invorvo by-the - SHOWER MAP BOOK /va � PACEO PARCEj�13 prat t to for ora hundred dollars(!1100)or low) LAVATORY I aertIfy that In th'a performsnae of the work for which this permtt I! lasued, I shill not employ any person In lny manner_po as to 84wADDRESS beoome subfact to the Workers' Compensation Lars. DISWA9WER CITY TEL.Na. Data Ap4Ilm CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become&&Oct to the Workers'Compenaatkm SWIMMING POOL RECEPTOR provisions of the Labor Chde, you must forthwith domply with such ADDRE prwWlorta orthb permit D shall [ ked. LAWN 8PHlfD(LEA SYSTEM NSI TI(JN '� d I hereby aMrm thli I sin Ilgerised under provisions of Chapter P am MSTEN ATEWATER HEATER (oommencing with 8}atlon 7000) of Dfvlalon 3 of the Business and OUTLETS �L ANO. "1' CMgg ,rte ProfepJons Code,and my floerwa is In full tome and ettpct DISTRICT NO. PAOCEl38ID HY a: 6 PER SYSTEM � a^ lJcenhe Number Iia Claes V RNAL VALIDATION W ' DATE (Lcbntr'Wom D.te AL z � l�� ❑ I am"WO undpr Seo. BY a 7Th) 41.b�I — B.BP.C.kc thW reason I ITEI k7 Data- Plan check fey , TOTAL 4-2 - 60 SrQr>atue PLUMBING PERMIT ISBUINQ FEE i C�ECVI 42.613 ❑ TOTAL FEE C .CTI plk�irt SINGLE FAMILY Plan check ap HOME OWNS BUILDER DECLARATION Name - - I hereby affirm that I am exempt from the Contractor's Lloerlas Law1 �� r•7.1? 2� 95 for the following reason (Segdon 7031.6, Business and Profess4ons Address l C-od*): Ctrr Tel.No. 9b4� - 1 ASS 8:.57 ❑ I,as owner of thePSA � W0 do thq work and the structuro - is not Intended or dtfered foc sale(Section 7044, Buelneas and PrvleseJons Code). CONSTRl/CT"LENDING AGENCY I hereby atfirrn that there Ira conetructlon lending agency for the performance of the work tom whloh this pormtt Is Issued (8eo. 3097, Ch.C.) Lenders Name Lender's Address I certify that I have read this appllcatlon and state that the above , lOxTlation la comeat I agree to oomply MRth all Courrty drdlnanoes and State I s regulating Plumbing, and hereby ■uthoriXe I represent of this enter upon the 4¢ove-mentlonecl prof Y napectlor} SEE REVERSE FOR EXPLANATORY i AWRJAGE 8 of Permttt� Date COUNTY OF LOS ANURLAS 7RKPLE CITY # 0508 PLUMBING PEB.I(IT DYPARTNIM7 OF PUBLIC WORKS 9701 LAB TUNAS PL 0508 0509120011 BUILDING AHD SAF= / LAND DEVELOPMENT TB70LE CITY CA 91780 PBOYR: (616) 285-0488 KIT: L GJLL Ip: FYES PASD BUILDING ADDRESS. ON FILE 4851 GOLDEN WLRT AV YKE DRBCRIPTION. QUANTITY: DOM. AMOUNT TZKP CA 917803936 A38WSOR INYORMATIOI NUMBER, NEAR-UST CROSS STRISP. LOWER AZUSA 8589-019-O23 01 PERMIT IBSUAICE FSE 17.75 THOFXB PAZI. 597 GRID AS LOCALITY. T3CKPLZ CITY, C 07 BATHTUBS/SHOWERB 1.00 FII 16.10 ANT: 15 LAVATORSEB/SINKS 1.00 FII 16.20 ISSUED ON. PROC3B9YD BY: PLAY BY. =IRAs OE: 45 WATER CLOG]rr/URMI[AL 1.00 FIX 16.20 09/72/05 JL. _ _ 03/11/06 TOTAL FEYB 76.35 ' TNI,. XOi VLaL HATE FI$L B7: CODR TSU-I, WING (616) 79�-1997- //!/~'�,�f`�+� 4851 GOLDEN AV TEMP 917800000 DESCRIPTION OF WORK PLUMBING FOR NEN BATHROOM APPLICANT: TSL. NO: SAME AS OWNYR - SPECIAL CONDITIONS: CONTRACTOR: TSL. NO: APPROVALS DATR INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO UNDER SLAB WORK AFTER SERVICE PLASTIC Y/1 METAL Y/1 ARCBITRCT OR ENGIN M: TEL. NO. - ROUGH PLUMBING LIC. 10: GAB PIPING GAB VSHT HOT WATER HYATER PLUMBING FIITURYB LAMI SPR 3n[Id[Ra GA8 TEST UTILITY COMPANY NOTIFIED CFV GRAY WATER SYSTEM REPORT IDA DPR763 ROUTE TOz B80508