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Home My Public Portal About5819 GOLDEN WEST AVE_Plumbing__ PLUMBING 1 DEPARTMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION -COUNTY_OF EAS ANGELES - BUILDING G / �efJ/ }� WILLIAM J. FOX, COLINTY ENGINEER ADDRESS V �G �� c �aA l��pA1 FOR APP A T O F LL IN LOCALITY - (3. BUILDING NEAREST ADDRESS / CROSS ST. DISTRICTN0. GRpOUP� ZO{{{NE PERMIT NO. LOCALITY .f ___ t /3 6 `7 NEAREST CROSS ST. , RECEIVED B Ready for inspeotion DATE ISSUED OWNER MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY y EL.N . INSPECTION RECORD PLUMBER ADDRESS I Q� CITY TEL.NO. - ATE LICENSE N0. COUNTY J PERMIT FEES a _z NUMBER TYPE OF FIXTURE OR ITEM FEE M WATER CLOSET(TOILET) @ 0.80 $ Ir O BATH TUB @ 0.80 SHOWER @ 0.80 LAVATORY(WASH BASIN) @ 0.80 KITCHEN SINK @ 0.80 LAUNDRY TUB OR TRAY @ 0.80 SLOP SINK @ 0.80 FLOOR SINK @ 0.80 FLOOR DRAIN @ 0.80 DISHWASHER @ 0.80 DRINKING FOUNTAIN @ 0.80 URINAL @ 0.80 GAS SYSTEM..............OUTLETS @ 1.00 WATER HEATER @ 1.00 12WISCELLANEOUS APPROVALS r / DATE INSPECTOR'S SIGNATURE UNDERSLAB WORK PERMIT $ I 00 ROUGH PLUMBING TOTAL FEE 012— GAS PIPING HEREBY ACKNOWLEDGE THAT I HAVE 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 I HEREBY CERTIFY THAT 1 AM PROP RL REGISTERED ANO/OR LICENSED AS REQUIRED BY LO AN ELES COUNTY GAS TEST AND STATE OF IFARNIA O.R T A I M T E LEGAL OWN- ER OF THE AB SCFrg D�E TIAL PROP RTY. UTILITY CO.NOTIFIED SIGNATUE OF PERMR TE .............._.........._......_ - - •........ .. NAL fTt�:;�'` 'f __R r•'f�-^ ._� 76A667 DBS 17 1/53 F 1 rj D.B. 17 25M SETS 12-43 APPLICATION TROTS PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES Wm.J. FOX. CHIEF ENGINEER PLUMBING NATURE OF INSTALLATION DISTRICT NO. GROUP zo E---P RMIT NO. ROUGH FIXTURESCOMPLETE HEATER CESSPOOL 1;�/SEPTIC TANK R CEIVED BY READY FOR DATE ISSUED AS MISCELLANEOUS FIR T NSPFrGT10N APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB Z_ E NA'E ys { -��k f� .�.n,�{�-- ADDRESS 4 LAY " .� ADDRESS11044 .0 LOCALITYNEAREST 'J CITY /�,� a TEL.No. CROSS ST. 6. g _ COUNTY CERT.No. ` EXPIRES d' NAME LOCATION OF SEPTIC TANK OR CESSPOOL z MAIL 3 ADDRESS NORTH O i r� CITY -�=.. ti: ,. TEL.No. I AM THELEGALPOSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION./ 4 PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. m OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORD z z_ BATH TUB FURNACE 5 SHOWER DISHWASHER Q LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAM¢ WATER HEATER DENTAL LAVATORY I ROUGH PLUMBING METER GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT I I _ CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I I OCESSPOOL_ SEPTIC TANK SEWER S UTILITY CO.NOTIFIED TOTAL FEE �o / iG1 FINAL Q 'f WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A 1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thefeof(Sec.3800 Lab. C.) r COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS-DIV-- Policy No. Company ❑ Certified copy is hereby furnished. ADDRESS FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ G Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM Qo FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Tvi�/� COMPENSATION INSURANCE ASSESSOR 1� (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE V PARCEL Q� permit is for one hundred dollars($100)or less.) OWNER- zv 1 certify that in the performance of the work for which this permit LAVATORY (Ji is issued, I shall not employ any person in any manner so as toSINK MAIL become subject to the Workers'Compensation Laws. ADDRESS 0 v V DISWASHER CITY .0 EL.N0. Gil Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER Q. (commencing with Section 7000) of Division 3 of the Business and STATE LIC. 0 Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS V OUTLETS OVER DISTRICT NO. PROCESSED BY I= 5 PER SYSTEM 0 License Number Lic.Class ` V FINAL^� C� �`q/ W DATE X11 ( VALIDATION a Contractor Date ❑ I am exempt under Sec. FINAL4f f� Z B.&P.C.for this reason BY CV�F-. Date: Plan check fee , Signature PLUMBING PERMIT ISSUING FEE$ 00 F-1 TOTAL FEE (� c Plan check applicant SINGLE FAMILY Ai•,:f �g HOME OWNER-BUILDER DECLARATION Name hereby affirm that I am exempt from the Contractor's License La for the following reason (Section 7031.5, Business and Professionsw Address' yp (�O Code): i T tM-3 ❑ CityQ Tel. No. _ I, as owner of the property,will do the work and the structure ,+ i iL ��.' ?=�� is not intended or offered for sale (Section 7044, Business /'��//0V O/ �.�D�� and Professions Code). u/P / `? 5D CONSTRUCTION LENDING AGENCY • 0 1i. I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, Lender's Namg/ C. C it7Y v '` /� (lVN ^{ .: ,3 i ? =€"I3 i e 1 0 Lender's Address I certify that I have r ad this application and state that the above information is correc. I agree to comply with all County ordinances (1 and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20'0026 DPW 4%90 76A667A sure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) • COUNTY OF LOS-ANGELES DEPT. O OF PUBLIC WRKS. Policy No. Company -- Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / Certified copy is filed with the county building inspection ADDRESS O G department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET,(TOILET) 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 'r the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL. NO.t7 mit is issued, I shall not employ any person in any manner so ( /fes as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR 26I VL-A JJ Date. Applicant CLOTHES WASHER ADDRESS J_ NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the.Workets'Compen- CITYTEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMSIM Apa 6�0 ly with such provisions.or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION. DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER. and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB . DATE License Number Lic. Class FINAL Contractor J Contractor1 V1 �" Date �` �� BY O I am exempt under Sec. V B.&P.C.-for this reason Plan check fee W Date: PLUMBING PERMIT ISSUING FEE$ � de' Signature TOTAL FEE 149 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION - Plan check applicant I hereby affirm that 1 am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address " ni,.t.4 a E1, as owner of the property, will do the work and the City Tel. No. Q.-i J structure is not intended or offered for sale(Section 7044, Business and Professions Code). , 1 T,i_I}=r CONSTRUCTION LENDING AGENCYg ; �_ •s 7 7F I hereby affirm that there is a construction lending agency for C the performance of the work for which this permit is issued l"'- K ,•i•»}.•- (Sec. 3097,Civ. C.).- - 6 CHH i_l .00 iii Lender's Name o Lender's Address S�_�a�j8' I certify that I have read this application and state that the , (a 1 $ f-'s� 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 above-mentioned popierty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ttee gnature of rmiDate