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HomeMy Public PortalAbout5704 GOLDEN WEST AVE_Plumbing__ 76AG67 8- CE 817 8-8B APPLICATION FOR PLVMBING PERMIT 1 j BUILDING AND SAFETY DIVISION Department of County Engineer County of Los Angeles FA' UILDING JOHN A. L.AMBIE,COUNTY ENGINEER DDRESS �/ N 1 &X-1 CASSATT D.GRIFFIN,SUPT OF BUILDING CALITY FOR APPLICANT TO FILL IN NEAREST L > CROSS ST. OWNER I—`-,- 7-e)A-2 DISTRICT NO. GROUP ZONE READY FOR INSPECTION MAIL ADDRESS INDUSTRIAL CITY ( - L. NO. WASTE APPROVAL QJ-UN,BER_ � I- r - INSPECTION RECORD' ADDRESS CITY TEL. NO. LICENSE NO NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 BATH TUB @ $1.00 SHOWER @ $1 00 LAVATORY (WASH BASIN) @ $100 KITCHEN SINK @ $100 DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ $100 CLOTHES WASHER @ $1.00 WATER HEATER @ $1 00 GAS SYSTEM @ $100 APPROVALS DATE INSPECTORS SIGNATURE UNDER SLAB WORK PERMIT $ 7 00 ROUGH PLUMBING GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM T A /OW THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIALP SIGNATURE OF PERMITTEE FINAL ROBERTA.WOO15, JOHN A. LAMB, UNTY ENGINEER TAUDATION SUPERVISING MECHANICAL F.N CCK./ M O. CASH w I O 3 0 7`7ru'-) OCT 8 3 2.0 0 2 78A68APPLICATION FOR PLUMBING PERMIT CE 8178-56 17 8--BUILDING AND SAFETY DIVISION Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS 0 r CASSATT D GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. OWNER DISTRICT NO. WOO E I READY FOR INSPECTION MAIL ADDRE ,,,Jl/ S INDUSTRIAL CITY TEL. WASTE APPROVAL If PLUMBER C INSPECTION RECORD ADDRESS r ^G CITY TEL. NO. LICENSE NO. u NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1 00 KITCHEN SINK @ $1.00 ) DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ $1.00 s CLOTHES WASHER @ $1.00 WATER HEATER @ $100 GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ I 1 00 ROUGH PLUMBINGU GAS PIPING TOTAL FEE GAs VENT LDESCRIBED BY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY L COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES G. EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF NIA OR THAT I AM THE LEGAL OWN R O THE ABOVE UTILITY CO.NOTIFIED ED RESIDENTI L PROPERTY, URERMITTEE FINAL ROBERT A.W OD, JOHN A LAMBIE. COUNTY ENGINEER VALIDATION SUPERVISING MECFiANICALENG'R CR. H.0. CASH ' OCT 31 3 2-00- 0 76AG67 DBS 17 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER DISTRICT GROUP ZONE PERMIT NU. FOR APPLICANT TO FILL IN �.� . ,/ PLUMBER , ` L,f P ��" RnI�� FIIKR NBPECTION DATE ��ED ADDRESS �LJ� f CITY +�T^6 ,_ .TEL. Now ff ADDRESS ADDRE69 ,,,. COUNTY LICENSE NO. t ®� EXPIRES Re�'� 3A3 =LOCALITY a` A 1 ' NEAREST PERMIT FEES CROSS ST. �gy qj ," NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER 71"e-o 2��4oy id MAIL WATER CLOSET(TOILET) @ 0.50 111 ADDRESS BATH TUB Q 0.50 CITY TEL No. SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASHBASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS Ole GEI LAUNDRY TUB OR TRAY 0 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER � OAS SYSTEM OUTLETS O.SO OF THE RESIDENTIAL PROPERTY E�EPRIBED ABOVE. SIGNATURE OF-A.'� WATER HEATER @ 0.50 PERMITTEE SLOP SINK @ 0.513 INSPECTION RECORD FLOOR SINK @ 0.50 / JJ ,_ A _ FLOOR DRAIN a@ 0.50 L _J iGCsa:fi9 DISHWASHER .;�',�. (�, 0.50 6-4 DRINKING FOUNTAIN 0.50 URINAL ,3s+' C� 0.50 r J a HOUSE SEWER , . (� 0.50 Z_ _ MIBCELLANEDUSVr�-7: •5 0 Y� O O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING #!O GAS VENT CESSPOOL @ 1.00 CESSPOOL V SEPTIC TANK: SEPTIC TANK DRAIN ( ) 131T ( ) @ 1.00 SEWER PERMIT I 1.00 GAB TEST c, 49� UTILITY CO.NOTIFIE TOTAL FEE v v- ®� FINAL �/ P WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I have a certificate of consent to self CE 617 (2-80) APPLICATION C r aJ R PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800, b C) u ��-�SI,�"„B� r��I/�✓I�P�/�lA�'J�S COUNTY OF LOS ANGELES ,BUILDING AND SAFETY . Polic o t5tK.pan} /// Certified copy is hereby furnished ` ��� FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS40 Certified copy u fill ith the cou ty wldmg inspection NUMBER FIXTURE OR ITEM • FEE LOCALITY C � Date de +t en App WATER CLOSET NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS'- ^ COMPENSATION INSURANCE SHOWER OWNER S LAVATORY MAIL 1 IL (This section need not be completed if the work involved- ADDRESS by the permit is for one hundred dollars ($100) or less.) SINK _, D. CITY TEL NO I certify that in the,performance of the work for which this DISHWASHER cc permit is issued, I shall not employ any person in any manner CONTRACTOR O so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ) U ADDRESS Date Applicant SWIMMING POOL RECEPTOR LU NOTICE TO APPLICANT If, after making this Certificate of CITY M,0 tfi�,. TEL.Nt�27� Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM Z p J STATE LIC Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO7� CLAS with comply with such provisions or this permit shall be deemed revoked. GAS SYSTEM d* OUTLETS DISTRICT N d R ESSED Y LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3-of the Busi- FINAL VALIDATI ness and Professions Code, and my license is in full force and DATE l (p � effect / �Q—}� FINAL License Num Lic Class (� �u BY ► `^c Contr ct Date Jr `'r l�77 C..7 ElI am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg No Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name 2 1 81.8 A I hereby affirm that I am exempt from the Contractor's Address # o'o 0 o o 5 License Law for the following reason-(Section 7031.5, Busi- City Tel No Hess and Professions Code): 2 ° ° 10.00 0 I, as owner of the property, am exclusively contracting '0,0"o 1 Q 0 0 2 with licensed contractors to construct the project (Section 7044, Business and Professions Code). 1.0 3-81 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 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 ordinances and State laws regulating Plumbing, and hereby aut a repre entatrves of this County to enter upon the ove-mentione pr perty for inspection purposes igna u of Per a Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I he�e'by affirm that I have a certificate of consent to self 76A667A insure, ct a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) ° or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES, BUILDING AND SAFETY Policy No Company ❑ Certified copy is hereby furnished . _ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � �O � �� Certified copy is filed with �countybuildingtio n department NUMBER FIXTURE OR ITEM @ FEE ADDRESS LOCALITY Dotphi Apcant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTIO FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER evq n oU (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars (:100)or less.) LAVATORY ADDRESS 7 f�77_ `'d &0 ldzwl (N I certify that m the performance of the work for which this SINK .. � �— CITY / e-1 �� TEL NO � Q permit is issued, I shall not employ any person in any manner !!! , _ so as to become subject,to the Workers'Compensation Laws DISHWASHERCONTRACTOR - 1 ! L DateApplicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of-the Labor Code, you must forth- LAWN,SPRINKLERSYSTEM• CITY ^ TEL N0�8 3 with comply with such provisions or this permit shall be STATE LIC .� deemed revoked r WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION / DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /-^© :1- (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER J IL and Professions Code, and my license is in full force and effect 5 PER SYSTEM FINALVALIDATION u DATE License Number Lic Class r� OC FINA 0 Contractor Date BY V I am exempt under Sec d' H B&P C for this reason Plan check fee Dote 5(J :9-0 9•Q 5A• PLUMBING PERMIT ISSUING FEE$ Signature # 0 0 0 0,0 5 ' TOTAL FEE Plan check applicant I.- o 4 Q 5 0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name r� o o o 4 Q 5 0:C7;:1' 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and rAddress Q¢ �. 0 G j ') Q 1 7-8 4 Professions Code) ty"TEy✓l(�Z j Tel No 197 g3 ❑ 1, as owner of the property, will do the work and the structureis 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 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 jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the abov -men,onecl p perty for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE LO 17_8 gnature of Permit a Date