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Home My Public Portal About5313 GOLDEN WEST AVE_Plumbing__ 78A667-CE#817 9/63 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BmiDlxc BUILDING AND SAFETY DMSION ADDRESS 1 Golden W JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY Calif. FOR APPLICANT TO FILL IN ''CROSS ST. Tem le Cit Blvd NUMBER FIXTURE OR ITEM EACH FEE OWNER Ed Anderson WATER CLOSET $1.25 BATH TIB 1,25 MAIL Ess 1 Golden West Ave. SHOWER 1.25 2 CITY Temple C't Ca1TjL• NO. 287-9112 LAVATORY 1.25 )_5 _CONTRACTOR E stside Plumbin Co. SINK 1.25 ADDRESS 2128 So. Atlantic Blvd. DISHWASHER 1.25 Los Angeles 22 TEL. NO. AN�.2-0926 CONTRACTOR'S STATE LAUNDRY TUB 1.25 REGISTRATION NO. 193329 TE COUNTY CLOTHES WASHER 1.25 DISTRICT NO. GROUP ONE PROCESSED BY WATER HEATER 1.50 1.50 D INDUSTRIAL CL GAS SYSTEM 3 OUTLETS O_ WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 f INSPECTION RECORD Lu➢ ( D Z nR AMQVgilS PATE INSPECTOF3.SSIG NA7 PERMIT $ 2 QQ UNDER`St3A8 WORK / ROUGH PLUMBING - •,�// TOTAL FEE GAS PIPING 1 I r°ul 1 HEREBY ACKNOWLEDGE THAT I HAVE RE THIS AP ICAT10N 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 ID CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY L09 ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE A opm,14 FINAL ALIDATION ROBERT A WOOD CM O CASH SUPERVISING MECHANICAL ENG'R LAGO 2<O' O 3%lD &L3O 5 A 9.75 76A667•-CE0;17 4-64' APPLICATION FOR PLUMB G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING n BUILDING AND SAFETY DIVISION CT JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS r O tal-en kde S WILLIAM A JENSEN, SUPT OF BUILDING LOCALITY —Q r G I FOR APPLICANT TO FILL IN NEARCROSS ST. it NUMBER FIXTURE OR ITEM EACH FEE OWNER �d r k h S� WATER CLOSET $1.25 BATH TUB 1.25 ADDRESS O l cle GJe s fi SHOWER 1.25 CITY c"vie TEL. NO. 41- LAVATORY 1.25 CONTRACT R SINK 1.25 ADDRESS 5 3 DISHWASHER 1.25 CITY TEL. NO. LAUNDRY TUB 1.25 CONTRACTOR'S STATE 11 REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 DISNO. GRO O TRICNE P OCE QED BY WATER HEATER 1.50 I GAS SYSTEM OUTLETS 1'50 C/ INDUSTRIAL a WASTE APPROVAL Q OU ETS OVER 5 PER SYSTEM .30 E L7QINSPECTION RECORD (J t u uJ ti Q r a to Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE p GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES F LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CA CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO GAS TEST RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE i FINAL VALIDATT�ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENG'R LA1;06 0 9 3 NOv23 5 D ' 3.50— _ __ C4,1✓dORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT �. I hereby affirm that I have a certificate of consent to self 76A667A ir!ure,'or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or p certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY li 2DALLCompanyP'RGIV-0641611 ❑ Certrfi d copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion departmeent NUMBER FIXTURE OR ITEM- @ FEE LOCALITY Date �u �Apphcant S jr-� WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER � (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CIT TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY rI 1 r/. TEL NOZ�'7 05 1 with comply with such provisions or this permit shall be STATE VK Vl/l. !!ll LIC t deemed revoked WATER HEATER LICENSE NO 7 V CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO��/ ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER V 0 Z. and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL A? DATE V (DATION 0 T License Number• 5/ k/6 Lic Class/ p_ d 09 FI Af n o Date ❑ 0. I am exempt under Sec 0. B&P C for this reason Plan check fee Date Poo PLUMBING PERMIT ISSUING FEE$ Q d 2 2 4 U,0 A Signature , TOTAL FEE 3lJ S Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Na I o.- 30,50 I hereby affirm that I am exempt from the Contractor's License Address 2� Y Law for the following reason (Section 7031 5, Business and �o 0,0 3 a 5 0 v Professions Code) City CZETel No Z(p� ❑ I, as owner of the property, will do the work and the o7. 1 2-85 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 1 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 I regulating Plumbing, and hereby authorize representatie of this County to,enter upon the ve-�ti pr e r inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur p Permi tee Date