HomeMy Public PortalAbout5606 GOLDEN WEST AVE_Plumbing__ Y PLUMBING 1
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,?IVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGiET, S3 BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
FOR APPLICANT TO FILL IN LOCALITY i�w��� d✓/ h9
BUILDING 1 NEAREST/
, � `Imkj CROSS ST
ADDRESS ', s
DISTRICT N0. G7 P I ZO PERMIT N0.
LOCALITY ,y `�2 xjq
CR A S ST. rK 11 (ep SSG'f�A ,d RECEIVED BY Ready for Inspeotion DATE ISSUED
OWNER 1�l� �Lf P.� ��
M At INDUSTRIAL
ADDRESS �g � ���J gin WASTE APPROVA
CITY A (�#,tiTEL.NO. INSPECTION RECORD
PLUMBER
ADDRESS '
CITY TEL.NO.
State Contrac 's
License No. Class
L.A.County Contractor's J
Q
Registration No. Z
PERMIT FEES P
NUMBER TYPE OF FIXTURE OR ITEM FEE m
D
WATER CLOSET(TOILET) @ 0.80 111
BATH TUB @ 0.80
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 080 0
SLOP SINK @ 0.80
FLOOR SINK @ 080
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM..._.._.__OUTLETS @ IAO
WATER HEATER @ i.00
MISCELLANEOUS APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK II A
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLI. GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTF � t;�Y� � 1
FINAL `-
764667 DBS 17 0/54
�y NORKERS' COMPENSATION DECLARATION
Lh =bf�'f m that 1 have a certificate of consent to self in- 20-0026 DPW 4/87 APPLICXT-vii FOR PLUMBING PERMIT
76A667A
sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified cop thereof (Sec. 3800, L )
COUNTY OF LOS ANGELES DEPT. OF"PUBLIC WORKS
Policy No, W� Company
Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
Certified copy is filed with the county building inspection ADDRE S
deYlart ent. NUMBER FIXTURE OR ITEM @ FEE
/// / LOCALITY
Date �y Appicant (' �- ��%?�L���.� WATER CLOSET(TOILET) U NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' ' > • � —'
COMPENSATION INSURANCEOWNER
�. SHOWER
(This section need not be completed if the work involved by MAIL r
the permit is for one hundred dollars ($100)or less.) LAVATORY a O ADDRES [; t
I certify that in the performance of the work for which-this per- SINK D IT•Y
mit is issued, I shall not employ any person in any manner so 1/
as to become subject to the Workers'Compensation Laws_. 1 DISHWASHER
CON f
Date Applicant / CLOTHES WASHER ADDRES��
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption, you should become subject to the Workers'Compen-'
sation provisions of the Labor Code, you must forthwith comp-' LAWN SPRINKLER SYSTEM O
ly with such provisions or this permit sholl.be deemed revok= STATE 9 LIC. �f
ed., ! WATER HEATER SU LICENSE NO. / CLASS y�
LICENSED CONTRACTORS DECLARATION . ' DISTRICT NO. PROCESSED BY
Thereby affirm that I am licensed under provisions oft.hapter GAS SYSTEM OUTLETS O
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER, ;.0
and Professions Code, and mpy license is in fu force an ef- 5 PER SYSTEM FINAL VALIDATION
Lcense Numbes9��a Lic. Clbss�j� �N DATE Q
FINAL f
Contracto,4�leld � Dates�1- 7 BY /rit �0 , O
I,am exempt under Sec. 0
B.&P.C. for this reason g
Plan check fee -
Date: PLUMBING.PERMIT ISSUING FEE$ U
Signature
TOTAL FEE 0,0
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 uE F IE_E
I, as owner of the property; will do the work.and the City Tel. No. art
structure is not intended or offered fof safe(Section 7044,
Business and Professions Code). ®
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for i
the performance of the work for which this permit is issued i• t� �t.Yl� '� _�
(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
%enti�oneroperty for inspection urposes. ,
SEE REVERSE FOR-EXPLANATORY LANGUAGE
Signature of Permittee Date