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Home My Public Portal About5842 GOLDEN WEST AVE_Plumbing__ 7B -17 oBS-I"DIVAPPLICATION FOR PLUMBING PERMIT 1 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING Ll' JOHN A LAMBIE, COUNTY ENGINEER ADDRESS, CASSATT D GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICAN O FILL IN NEAREST CROSS ST. OWNER /{� _� �? DISTRICT NO. GROUPI ,�N� I READY FOR INSPECTION MAIL � �1� ` �� 1 ADDRESS �J,r CITY TEL. NO INDUSTRIAL WASTE APPROVAL PLUMBER _ ,, z INSPECTION RECORD ADDRESS > G 90 . c CITY TEL. NO d/ LICENSE N0��5��. NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ BATH TUB @ $1.00 SHOWER @ $100 LAVATORY (WASH BASIN) @ $1 00 KITCHEN SINK @ $1 00 DISHWASHER @ $100 LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $100 ` - WATER HEATER @ S100 GAS SYSTEM @ 00 ? APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE U� GAS VENT 1 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 I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNEROF THEAAPOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL PROPERTY,SIGNATURE � �� , ,.� - ' OF PERMITTEE — �2`- FINAL &A i i JOHN A. LAMBIE, COUNTY ENGINEERALIDATIO ROBERT A WOOD, CHIEF PLBG. INSPECTOR CK , 4N 8 2 &FEB 53 2.0 0 r -76 76AS67 17 25M SETS 7-46 APPLICATION FOR PERMIT �- DEPARTMENT OF BUILDING AND SAFETY, COUNTY OF LOS ANGELES Wm.J. FOX.CHIEF ENGINEER PLUMBING NATURE 0 ►.STA ATI® DISTRICTNO. GRFUPI ZONE PERMIT O. If P t,/O ROUGH FIXTURES COMPLETE / ! �r HEATER CESSPOOL 'I-I BEPTICTANK RECEI �Y READY FOR DATE 1 UBD FIRST INSPECTION \� MISCELLANEOUS / J APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY, J°mD NAME P g ADDRESS (d - m ADDRESS J- LOCALITY n NEAREST OU CITY TEL.No. CROSS ST. COUNTY LICENSE NO. EXPIRES m NAME LOCATION OF SEPTIC TANS, OR CESSPOOL z MAIL ADDRE NORTH O CITY TEL.NO. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFI)n OF QUALWI ATIO 46 ) PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK z BATH TUB FURNACE O EK ROWER DISHWASHER D _LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP BINK FLOOR DRAIN ? WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I METER GAB SODA FOUNTAIN GAS PIPING I OUTL AAS VENT I CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I I CESSPOOL SEPTIC TANK SEWER .I 8 1 UTILITY CO.NOTIFIED TOTAL FEE t� y� FINAL WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that, I'have a certificate of consent to self 76A667A /r insure, or a certificate of Workers' Compensation Insurance, " CE 817(REV 10/81) ' or o 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 ElCertified copy is filed with the county building inspec- ADDRES r tion department NUMBER FIXTURCOR ITEM @ FEE LOCALITY Date 'Applicant WATER CLOSET,, NEAREST 'CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS COMPENSATION INSURANCE OWNER r (This section need not be completed if the work'involved by SHOWER the permit is for one hundred dollars $100 or less. MAIL P ( ) I LAVATORY ADDRESS . I certify that in the performance of the work for which this permit•,is issued, I shall not employ any person in any manner SINK CITY TEL so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR G Date _Applicant�� CLOTHES WASHER J !!! NOTICE TO APPLICANT If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY — TEL 1 0 Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM - �/ ,with comply with such provisions or this permit shall be STATE 21 LIC �7 deemed revoked WATER HEATER LICENSE NO CLASS C ZO LICENSED CONTRACTORS DECLARATIONDISTRICT NO �y PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (� (commencing with Section 7000) of Division,3 of the.Business OUTLETS OVER D and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAA'LIDATION' 0 DATEL License Number'/ r 2 Lic Classes � `'� r !� FINAL �, O Co ! mate /`ZZ'd T BY ❑ I am exempt under Sec w A. YS Ste— in B 8P C for this reason Z Date Plan,check fee ► �L Ce PLUMBING PERMIT ISSUING FEE$ Signature ' TOTAL FEE SINGLE FAMILY Plan check applicant � • HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License :• Ji �- Law for the following,reason (Section 7031 5, Business and Ad&ess Professions Code) City Tel No I, as owner of the property, will do the work and the ( r, n f. E 0 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 I certify that I have read this application and state that the ► above information is correct I,ogree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above_m ntoned property r in�s coon purposes SEE.REVERSE FOR EXPLANATORY LANGUAGE Signature of ermittee Date