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HomeMy Public PortalAbout5920-5922 GOLDEN WEST AVE_Plumbing__ C 7 CEE 817817(REV 11/78) APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRES (� , NUMBER FIXTURE OR ITEM@ FEE A LOCALITY 4//T WATER CLOSET 1 NEAREST BATH TUB CROSS ST SHOWER OWNER 49A1,5-- i�T MAIL LAVATORY ADDRE SINK CITY DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS G i SWIMMING POOL RECEPTOR CITY 1 L LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER V LICENSE NO CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING 916 GAS PIPING V GAS VENT as HOT WATER HEATER W PLUMBING FIXTURES GAS TEST g Plan check fee UTILITY CO NOTIFIED PLUMBING PER G FEE$ ®O TOTAL FEE FINAL z Plan check ap PLAN CHECK VALIDATION J Name Adv � 1, 000A Tel No # o o"0 0 0 5 LSTATE REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE , BOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES LAWS REGULATING PLUMBING PERMIT VALIDATION Zo 0 1 (0,00 REBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 'OO O1'Q O O UBY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THEER OF AND INTEND TO OVE DESCRIBED RESIDENTIALL 0L2'/ —80 BE DISTRICT NOl' PRQCESSED BY INDUSTRIAL WASTE APPROVAL /► ���pg O IgI ���yl I}�•�7� � • D:S.17 APPLICATION FOR Pl�l�tl7YOd•ING PERMIT •1 DBS-17 10.85 9 Y !/ DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST 9--" //�� / CROSS ST. r OWNER Q?A�Vle _T,05 A DISTRICT_N Or OUP �UP MAIL ZONE READY FOR INSPECTION ADDRESS 4016 O,FR.K SI" /� /• ,G INDUSTRIAL CITY �',,/'a t 'T� TEL NO T(n Id WASTE APPROVAL PLUMBER 'ITA 1 ,R// O '-'4szq C. c./' INSPECTION RECORD ADDRESS / /S ,4 ov A aa/ia� Tj'g': CITY IJ . C 0 '#"o-ot TEL. NO. 50 o;P Z LICENSE NO -0 7yl NUMBER TYPE OF FIXTURE OR ITEM FEE 13 ' �r-r Ia• WATER CLOSET (TOILET) @ $100slo A ej e- F� BATH TUB @ $1.00 e) c SHOWER @ $1.00 �y3 LAVATORY (WASH BASIN) @ $1.00 �fa0 Q,) OR P. KITCHEN SINK @ $1 00 Q1 DISHWASHER @ $1 00 ��_.�'Aoe v' LAUNDRY TUB OR TRAY @ $1 00 O' ad ` r CLOTHES WASHER @ $100 ©�,/• A WATER HEATER @ $1 00 fJ�-� p GAS SYSTEM @ $1 00 e� -J '� r APPROVALS /UNDER Lbop, DATE INSPECTORS SIGNATURE lUNDERS BWORK L PERMIT $ 00 ROUGH PLUMBING472-9§ q Q GAS PIPING TOTAL FEE GAS VENT ! /-Wl IJI) I HEREBY ACKNOWLEDGE THAT 1 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 FIXTURES PLUMBING. I 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 OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL OPERTY SIGNATURE 01 OF PERMITTEE "•J�` '�-'•�•n FINAL •TZ'J JOHN A. LAMBIE, COUNTY ENGINEER I ALIDATION ROBERT A.WOOD, CHIEF PLBG INSPECTOR VCK G1 0. CASH Lib 3 4 2 2 d; FAR 13 5 A 6 5.0 0 � WORKERS'COMPENSATION DECLARATION 76AG67A I hereby affirm that I have a certificate of consent to self CE ei 7 (2-60) APPLICATION FOR PLUMBING PERMIT, insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800, ab C COUNTY OF LOS ANGELE$� BUILDING AND SAFETY Policy No Company r CATU 01�__ Certified copy is hereby furnished FOR APPLICANT TO FILL-IN (PRINT OR TYPE) BUILDING 7 ',� ^ Certified copy Bled with t Aunty b ildmg inspection NUMBER FIXTURE OR ITEM FEE ADDRESS Q r ie ar m nt f LOCALITY WATER'CLOSET Date Applicant NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL } (This section need not be completed.if the work involved ADDRESS WJL&Q#9CL by the permit is for one hundred dollars ($100) or less.) SINKCITY TQ 0 TEL No. SU I certify that in the performance of the work for which this DISHWASHER permit u issued, I shall not employ any person in any manner CONTRACTOR C�L - 0 soas/to b o e subject to the rker ensation Laws CLOTHES WASHER ADDRESSKmQo de- U Date�a Applicant SWIMMING POOL RECEPTOR CL CITY TEL NO. o y NOTICE TO APPLICANT. If, after along this Certificate'of �2l7 z Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM �r� STATE c p LIC Q/� Compensation provisions of the Labor Code, you must forth- LICENSE,NO I IQ Q CLASS oQ l0 with comply with such provisions or'this permit shall be WATER HEATER • deemed revoked. GAS SYSTEM OUTLETS DI RICT NO� P ESSED LICENSED CONTRACTORS DECLARATION OUTLETS OVER �® I hereby affirm that I am licensed under provisions'of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi_ FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE r�—�6 ��� effect. n FINAL License Number OE Lie Class �- BY Contractor Date/ra�."Z e !yam I am exempt from the licensing requirements as I am a Plan check fee ••- licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code) TOTAL FEE Lie,or Reg No Date Plan check applicant ,-TOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031 5, Busi- City Tel No ness and Professions Code) I, as owner of the property, am exclusively contracting 2 3 0,8 A with licensed contractors to construct the project (Section 7044, Business and Professions Code) # 0 0 0 0 0 5 2o • CONSTRUCTION LENDING AGENCY - - 1 .250 I hereby affirm that there is a construction lending agency o'0 012506 for the performance of the work for which this permit is c� � issued(Sec 3097,Civ.C.). ' 0 � F �� � �� ��� I 1 5-81 INSPECTION"' Lender's Name �a 8 .Ley $ Pull I 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 authorize representatives of this County to enter upon the abovioned property for inspection purposes , 2 Signatur ermittee Date WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I'have a certificate of consent to self CE e17 (2-60) APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,,La ) �� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company �i \ C37— �rn� CiT11 C �fied opy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) rAD DINGS RESS J 2O if op e ounty buildin nspectio MBER FIXTURE OR ITEM • FEE /� dep en WATER CLOSET LITY l� Applicant ESTBATH TUB S ST Ul/r�L7o �J1. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER MAIL (This section need not be completed if the work involved LAVATORY ADDRESS S 20 T by, the permit is for one hundred dollars ($100) or less.) SINK CIT TEL N O. _5 f.certify that in the performance of•the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTORaixi:_cO so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER U ADDRESS Date Applicant SWIMMING POOL RECEPTOR 0,_Te_ LU NOTICE TO APPLICANT If, after making this Certificate of CIT TEL.NO. t/&-)Cno N Exemption, you should, become subject to the Workers' LAWN SPRINKLER SYSTEM STATE I`q Q LIC. z Compensation provisions of the Labor Code, you must forth- LICENSE NO 1 I Q /{� CLASS with comply with such provisions for this permit shall be WATER HEATER Q deemed revoked GAS SYSTEM OUTLETS DISTRICT NO. P OCESSED B LICENSED CONTRACTORS DECLARATION OUTLETS OVER 1 hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL IlQ VALIDATION ness and Professions Code, and my.license is m�lfora and DATE effect. /111�9e FINAL License Number-` Lic BY Contractor liT Date V_ ElI am exemptPlan check fee from the licensing requirements as I am a / licensed architect or a registered professional engineer .PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- (((IGGJll iness and Professions Code). . TOTAL FEE' l� Lie.or Reg No Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031 5, Busi- City Tel No. ness and Professions Code) �9-4Z2 3 A I, as owner of the property, am exclusively contracting with licensed contractors to construct the project #'0 0 0 0 0 5 (Sectwn'7044,Business,and Professions Code) 2 0 0 1 0,00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 0 0 0 1,0,Q 0 X for the performance of the work for which this,permit, is Ott P¢♦ Q issued(Sec 3097,Civ C.) � 3_ 0� 7a. � 0 3 0 9—8 Lender's Name ��a6u8"(�� � a S e 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 ordinan and Sta regulatmg Plumbi and hereb resentatives o is Coun to ter upon e aI Z bove mentione pi nspe ur se. Signature of Permittee Date I WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I have a certificate of consent to self cE 8t7 (2-80) 'APPLICATION F O R- P L U M B I IV G PERMIT . insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec 3800, Lab C.) LLLIII ' - - COUNTY OF LOS ANGELES BUILDING AND SAFETY , Policy No Company �' '� D'r �L F1 Certified copy is hereby furnishe FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /�7� ADDRESS �9o(C) o Ir (A), y� Cert ied opy is filed with th c nt bu n in e t n NUMBER FIXTURE OR ITEM • FEE n d e WATER CLOSET- LOCALIT • �,y� = l Date Applicant NEAREST ` BATH TUB CROSS ST 1 �W CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL (This section need not be completed if the work involved ADDRESS _n- PJS'�II'±� - 0- by the permit is for one hundred dollars ($100) or less.) SINK Qrn �y+� /� 0 CITY TEL NO /IIXJ�3L�7 U I certify that in the performance of the-work for which this DISHWASHER CONTRACTOR i permit is issued„I shall not employ any-person in any manner so as to become subject'to the Workers' Compensation Laws CLOTHES WASHER pn Date Applicant ADDRESS SWIMMING POOL RECEPTOR OW. NOTICE TO APPLICANT: If,•after making this Certificate of CITY ck TEL 'NO �� Z Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC Compensation provisions of the Labor Code, you must forth- Q / n n with comply with such provisions or this permit shall be WATER HEATER i^rD LICENSE NO 0_I IG 4� CLAS (ppC90� deemed revoked GAS SYSTEM OUTLETS lJ�� DISTRICT NO PR ESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER %e I hereby affirm that I am licensed under provisions of,Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL q VALIDATION ness and Professions Code, and my license is in full force and DATE ACl effect FINAL License Number ` � � Lic Class pp � � BY rVt--�–•� ••+ - ,Contractor Date El I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING,PERMIT ISSUING FEE$ acting in my professional capacity (Sectioii 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No Date Plan check applicant ;-IOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 70315, Busi- City Tel No. �2 1 517 A , nessand Professions Code) p I, as owner of the property, am exclusively contracting ' with licensed contractors to construct the project s 2 0-�o O' -(Section 7044,Business and Professions Code) CONSTRUCTION LENDING AGENCY u `° °I'O U,Q 0:= I hereby affirm, that there is a construction lending agency �” 2 2—8 for the, performance of the'work for which this permit is �� �� �° issued(Sec: 3097,Civ.C.) - - - �"! � -�� ""666�� � ���enoiv • , Lender's Name Lender's Address I certify`that I ve read this ap i tion and,state that the above porms correctI e comply with allCountySEE REVERSE FOR EXPLANATORY LANGUAGE ordinaate aws gi Plumbing, and rebyauthorat s o t s my to ente up theabove- o rty r s on purposse�s. Signatur of Permittee Date