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Home My Public Portal About4919 GOLDEN WEST AVE_Plumbing__ 76A667.CE#817 5/63 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS IQl O (' Tcst WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY P City FOR APPLICANT TO FILL IN NEAREST - CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER . Conte WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS Samf? CITY TEL. NO. SHOWER 1.25 P t 6� �6 LAVATORY 1.25 CONTRACTOR SINK 1.25 ADDRESS 92 E . Grand DISHWASHER 1.25 CITY `T'Pm le Cit TEL. NO. 12- _2 CONTRACTOR'S STATE LAUNDRY TUB 1.25 REGISTRATION NO. 71,1, 9 COUNTY Q CLOTHES WASHER 1.25 DIST ICT N GRO ZONE P ESSE'DABY/ WATER HEATER 1.50 1.50 � BY } 50 INDUSTRIAL 1. a' GAS SYSTEM OUTLETS WASTE APPROVAL 0 OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD a O H replacement N Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK �� r0 ROUGH PLUMBING TOTAL FEE 35GAS PIPING I 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 TME LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABO DESC IBED REBID ENTIA ROPE Y. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE �jALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R L tLo 6 4 9 2%-o' HAR 11 5 U . f D.B.H.17 25M HETH 1-48 APPLICATION FOR PERMIT DErARTMENT OF BUILDING AND SAFETY ' COUNTY OF LOS ANGELES PLUMBING; WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DlSTRiCT NO. d OUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE _ RECEIVED BY READY FOR DATE ISSUED HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY NAME JOB - 0.' ADDRFa3S W -- m ADDRESS _G _LOCALITY •� _ _ NEAREST "'1 CITY TEL.No. CROSS RSI'. COUNTY CERT.NO. EXPIRESNAME ld LOCATION OF SEPTIC TANK, OR CESSPGOL z MAIL ADDRESS NORTH O CITY TEL.NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. D 3 1 OWNER CORRECTIONS SOUTH DESCRIPTION OF WORK z_ BATH TUB FURNACE a ROWER DISHWASHER 0 AVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SANDTRAP SL W OP SINK FLOOR DRAIN ASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPUCTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER GAS SODA FOUNTAIN OUTL GAS PIPING GAS VENT CESSPOOL i TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOL_ SEPTIC TANK � ' SEWER Is I UTILITY CO.NOTIFIED TOTAL FEE FINAL 743A6 -CEi.LZ 40-437 '4 w APPLICATION FOR PLUMBING PERMIT C DNTY OF LOS ANGELES` DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION �MD JOHN A. LAMBIE, COUNTY EN41N[[R COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALrr FOR APPLICANT TQ FILL IN R NT O TYP �.. MUMB(R j FIXTURE OR ITEM EACHE¢ + O WIm WATER-CLOSET 1.50 HAIL BATH TUB 1.50 Q 1GDDEEEB r SHOWER 1.50 TEL NO. LAVATORY 1.50 O CO*TXAGTOS I SINK 1.50 a ADDEM o DISHWASHER 1.50 CITY m xO• CLOTHES WASHER 1.50 STATE - � LIC �n LICENSE 140. CLksa `—- 9WIlO�Q6 POOL RECEPTOR 1.50 DISTRidT'NO. ¢ROUP ZOfi[ PItOQ[p[D BY. LAIN SPRRU LER SYSTEM 2.00 d WATER HEATER 1.50 b DmTJ�L WAffm APPROVAL OAS SYSTEM OUTLETS 1.50 1 5,O omarCCAD •- OLJTLL,,ETI3 OVER 5 Pk1 HYSTEM .90 Plan chock fee 25% of above- See reverse. PLUMBING PERMIT ISSUING FEE S 2 00 TOTAL FEE APPki WALE PATE ItLamcTOV■IakA uJ Plan check llcant UNDER ALAE WORK 11 Nam4 ROUGH PLtYMBlN6 Address OAS PIPING SAS VENT City. Tel. No. HOT WATER HEATER Ll m1IACILTIOWI..[DSi T}1AT I Hwv. IrY.AD THI. APPLICATIONATC THAT THY ASOV[ I• CDI�CT AND ASS TO COMPLY PLUM'DINO FIXTL FZEB - - 1-2ALL, COUNTY ORDINA"CLS AND STAT[ LAWS IWOULATIN• GAS TESTrya. AIIY CLRTIPY THAT I AM FROMLALY RSSISf41RD AHD/Ow UTILITY CO-NOTIFJED m AS RICQUIIM NY LOG ANCOLKS COUNTY AND STAT[ OF RNIA ON THAT I AM THR L[aAL OWN" OF,AND INTIND TOOle IN.TFI[ RS11D[NTtw4 P�P[�Ti'• FINALTURE JACK R. ALLEN, IIUPI:RVIDINO CH ANICAL_EN�'R•ERMITT[[ - PERMI'I'VALIDA'T'ION K. M.0. CASK PLAN CHECK VALEDAtION cLc. a+.o, cAaH JAP,5 4 2 5�g. 4iL 1 �. 5 $ ;a O• . �L WOE"COMPENWON DEQ-"RAT'4N APPLICATION FOR PLUMBING PERMIT t heLpby llcrfflrm thgt I hove a certificate of consent fo self 76AWA *cure, or a certificate of Wor}cere Compensation Insurance, CE 817(REV. 10/81) 'J' ora ceriffled,copy thereof (Sec. 3800, b. C-) COUNTY'OF LOS ANGELES / , BUILbING AND SAFETY Policy L� NF----2;[6rrrlpony Certified copy Is hereby furnIs ed, BURRING Certified copy Is filed wlth the 4ounty building Inspec- FOR TO RL{JN(PRINT OR TYPE) flora department, NUMBER FIXTURE OP ITEM O FIS LbCALiiY Data Appllgoni WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FRAM WORKERS' BAT}f TUB COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If therwork Inwhred by t ie permM Is for one hundred dollari{#I-Op)or$"s.) LAVATORY MAIL AD{)RESS I certify that In the performance of the work for which this perm It Is Issued, I shall not employ arty Berson IR any rriannor S4NkTEL 16 io as to become subject to the Workers Compensation Laws, D15J IYJAS�ER CONTRACTOR pate Applicant— CLOTHES WASJ ADDIE15 3 .� NOTICE TO"APPLICANT: If, -after making, this Certiflcatb of POOL �� Exemption, you should become subjecf� to the Warkors' Compensation provision;of the Labor Cade, you most forth- SAWN SPRINKO SYSTEM I-ITY Q TELNO with comply-with such provisions or thls permit shall be STATE uC deemed revoked. WATtR HEAR -NO. CLASS LICENSED CONTRACTORS DECLARATION DMWICT NO. �OMIMBY ` ey ' I hereby affirm that I pm Ikerued Under provhlona of Chapter 9 GAS SYSTEM OJTLEFS J F (commencing wrrh Section 700b) of Division 3 of the Business O OVER and h6fq*pns Code,gnd my license Is In full force effect, 5 PER SYSTEM FINAL - VkUDAnON 1')ATl V License NumbermZq Ic. Clain 7 1 FI O i�l YI�� GIYDate BY ` Contractor (, t am exempt under Sec. IL SQ su B"&P.C. for this reason Plan check fee _ Date: PLUMBING PERMIT ISSUINGFU;, �'� Slgnature� TOTAL F;i Q Q SINGLE FAMILY Plan check Qppllmnt 1 f' 4 7 8 A HOMEbWNER$UILDER DECLARATION Name f, a o 0 0 0 5 J hereby affirm that 1 arh exempt from the Contractors License taw fpr ihd following reason (Section 703T.5, Bullneis and Address 2 Prroofe"lons Code): City Tel. No. 0 0 0 3 a E G Q1, as owner of the property, will da the work ano thq structure It not Intended or offered for sale (Section , 1.25- 84 nU, Business and ProfemlorisCode), CONSTRUCTION LENDING AGENCY J hereby affirm that there Is a construction lending agency fof the performance of the work for which this permit fs Issued (Sec. 3097, Qv. C_)* Lender'; Name r T Lenders dress I cert[fy thqt I have read this oppllcgtfprl and state thea the , above Informatl6n Is correct.1 agree to comply with all County crdingnces and State laws regulating Plumbing, and hereby authbrize representoHY&z of this County to enter upon the above nti ed for Inspection purposes. SEE REVER5E FOR.EXPLANATORY LANGUAGE ••- Slg q orrPlefFittee Date WORKERS'COMPENSATION DECLARATION 7GAsa7A I hereby affirm that I have r certificate of consent to self �� .,, ,.�., APPLICATION FOR PLUMBING PERMIT insure, or a certif(cate of Workers'Compensation Insurance,or e certified copy thereof(Sec.3800, b COUNTY OF LOS AN a AND SAFETY Pb1ky No.--Cg111pany U Ce tang V hereby FOF4 APPLICANT 70 FILL IN (PRfNT OR TYP Bl}ILD ADD �I y V Q R FIXTlJFE OFI 1T�t FEE lqJ WAVER CLOSET LOCALITY b ApplicantNEAREST BATH TUB CROSS ST. CERTI' CATI QF EXEMPTION FROM WOR�RS' COMPENSATION INSURANCE SHOWER OWNER MAIL MkMksectLvn aeQd isot l}e compfeted If tie woLk iII�E3Fred LAVATOR ADORESg 19 by the permit Is for one hubdred doRm (311)0) or loss.) SLNKGTl TEL.Nge_ � I tgritfy that in the performance of the.Work for which this DISHW,ASHE L`pNTpACTO p it Is-Issupd, I shall hot employ any persorl in aby manner so as to becorge sub*t to the Workers' Compensation Laws CLOTHES W ADdRLMDate Applicant t SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of CITY TSL.NExemptiorl, you 'nould become subject to the Workers' LAWN,SPRINKLER SYSTEM //� q pCoxpepsatlon proviaiom of the Labor Code, you must forth- �LIC£NSENO. 'd+ JQ CLASSrA r4itb. comply with such provisions or this permit shall be WATER HEATERDIST T NO. O deemed revoked GAS SYSTEM OUTLETS A g LICENSED CONTRACTORS DECLARATION OUTLETS OVER - "V d 3 hereby affirm that I■m Ucenagd under provisions oflC apter lI PER SYSTEM C. 9 (commanctnl wftb Section 7000) of Df-viaion 3 of thq Bull- FINAL near and Professions Code, and my license In and DATE effect. FINAL yi Lite be C. Class BY (� Q I sm exgmpt from Tho-iiceming requ anti as T am a 1811 Check fee Licensed erchltQct or a registered profeaaional eilgin ear PLUMBING PERMIT ISSUING F E£S acting In my professional capactty (Section 7051, Bus- iness and Professions Code}. T1� FIS Ldc.or Rei.No. Date, _ Ian check applicant - .ROME OWNER-BUILDER I)ECLA kTION sins I hereby affirm that L am exempt JYrom the Contractor's Addrs•s License Law for the following reason (Soolon-7031.5. Bust- City Tel.No- ness and Professions Cede): 0.0 1.5 A 1, as owner of the property, am excivatveir contracting # 5 ono 0 0 0• w1th licensed cdntractgrs tg r.QnstruCt the pMjgrpt / 4v� (Sectipn 7044,Business and profbaaious Code). 0!e,;2/ 000 CONSTRUCTION LEADING AGENCY o.o o 1 0 0 0 TLf I hereby affirm ttiat'thgre fit a construction, Iending agency for the performance of the work for which this permit is 0402-81 issued(sec. 3097,c .c.). .. Lender's Name i Leader's Address 1 - ' I certify that I have road this Epplicatio rtFto that above info on correct.I aj a to comply aII o an re"ting Plum g, and y SEE REVERSE FOR EXPLANATORY LANGUApI ■ut representattres thL County to enter the ab m n r imp Signature of Permittee Date