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HomeMy Public PortalAbout6019 GOLDEN WEST AVE_Plumbing__ `76A667 - CE817 5/70 APPLICATION FOR PLUMBING PER COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST - CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1 SO J� G,! -BATH TUB 1 50 MAIL SHOWER 1.50 la CITY /- TEL. NO.,,?C75-,jam f LAVATORY 1.50 CONTRACTOR SINK 1.50 ADDRESS DISHWASHER 1.50 CITY TEL. NO. CLOTHES WASHER 1 50 STATE _ LIC LICENSE NO CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO A GROUP ZONE PR D BY LAWN SPRINKLER SYSTEM 2.00 - WATER HEATER 1.50 TRIAL WASTE APPROVAL (1 GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD6�L OUTLETS OVER 5 PER SYSTEM .30 O VD Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 2 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING GJ1� Address GAS PIPING GAS VENT City Tel. No HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY FINAL SIGNATURE � ,I1�Ll� CLr✓J' JACK R. ALLEN, SUPERVISING HANICAL EN G'R OF PERMITTEE ��` PERMIT VALIDATIO CK M o CASH PLAN CHECK VALIDATIONZ CK M O CASH 0 9 2 9C--I JUN 17 5 0 6.5 0, DBS-17 10.45 APPLICATION I°OR �PLUMBINC PERMIT 1 DBS-17 DIVISION OF BUILDING AND'SAFETY Department of County Engineer County of Los Angeles BUILDING � f p JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS Ld' 0 T CASSATT D. GRIFFIN,SUPT OF BUILDING .t LOCALITY /j !i/_ l� 0 FO_R APPLICANT TO FILL IN NEAREST �7- r CROSS ST 15Le OWNER n �F.�1.7") t? DISTRICT NO GROUP ZONEREADY FOR INSPECTION MAIL ADDRES � � � //y �V INDUSTRIAL CITY ..�., >¢! EL� NO. WASTE APPROVAL Lill-` I d„ PLUMBER INSPECTION RECORD ADDRESS CITY TEL. NO LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @• $1.00 �/ /-j t qL� BATH TUB @ $1 00 u a�• / sy ,�^.��? �,nt�1)���` SHOWER @ $1.00 -'LAVATORY (WASH BASIN) @ $100 ' KITCHEN SINK @ $100 DISHWASHER @ $1.00 LAUNDRYTUBORTRAY @ S100 CLOTHES WASHER @ $100 WATER HEATER @ $1 00 GAS SYSTEM @ v-00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 00 ROUGH PLUMBING (� I, GAS PIPING _ TOTAL FEE 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 OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL PRO RTY. I _ SIGNATURE - V d OF PERMITTEE �'+� '(" /�'it � �FI2AL 3 2.TiZ�6 4 JOHN A. LAMBIE, COUNTY ENGINEER 0VALIDATION ROBERT A.WOOD, CHIEF PLBG INSPECTOR EL ` CB. . CASH 1 X65 7 � ; 6 3 3.0 0 in APPLICATION p��gy pry.( i DBS-17 APPLICATION FO • PLUMBING PE6Y.V It 4 DBS-17 10-55 DMSION OF BUILDING AND SAFETY Department 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 i CROSS ST OWNER � DISTRICT NO-. GROU (ZONE READY FOR INSPECTION J_rr s MAIL J,r' r •�"" �'-%:L.'''�.`'(, ADDRES �� I INDUSTRIAL _ CIT TEL. NO WASTE APPROVAL - INSPECTION RECORD PLUM ADDRESS CITY;��� rTEL. O -4 l�/��j� LtC NSE N /( / + NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) _,@ $1.00 BATH TUB @ $1 00 / SHOWER @ $1 00 J LI T LAVATORY (WASH BASIN) @ $1 00 / D KITCHEN SINK @ $1 00 DISHWASHER f @ $1 00 - LAUNDRY TUB OR TRAY @ $100 ly ' CLOTHES WASHER @ $1 00 - WATER HEATER @ $1 00 GAS SYSTEM ' @ $1 00 -' APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK -s ^ PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE OU ' GAS VENT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST I LICENSED AS REQUIRED BYf LOS ANGELES COUNTY AND STATE OF „CALIFORNIA OR THAT II M LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL. PR P�ER7 Y, ' SIGNATURE r/r 1Ny OF PERMITTE a, ��r FINAL JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD,�CHIEF PLBG INSPECTOR CK. M.G. CASH _ ;� 7 ma n 78A887 -CE4817 10-82 APPLICATION FOR PLUMBING, PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 1p© WILLIAM A JENSEN, SUP T OF BUILDING ' LOCALITY .. FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE O WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CI TEL:NElk LAVATORY 1.25 CONTRACTO SINS 1.25 ADDRESS DISHWASHER 1.25 CI SEL.,N LAUNDRY TUB 1.25 CONTRACTOR'S STATE ❑ REGISTRATION NO. COUNTY ❑ CLOTHES WASHER - 1.25 DISTRICT NO 'GR UP ZONE ,P C BE BY WATER HEATER 1.50 (�$ 00I GAS SYSTEM OUTLETS 1.50 INDUSTRIAL d WASTE APPROVAL 0 OUTLETS OVER 5 PER SYSTEM .30 INSPECTI N IWPJDRD V APPROVALS DATE ' INSP_E Oft SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH,ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER ' PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES �• •/ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA R AT tDESED LEGAL OWNER OF,AND INTEND TO RESIDE IN, THE A V TI ROPERTY UTILITY CO NOTIFIED r SIGNATURE OF PERM FINAL ' 7- M LID'ATION ROBERT A WOOD• o CASH SUPERVISING MECHAjNICAt ENG R Q .als 203 s. a 32 5- 76A667 -CE ]-`817 2-82 TEMPLE C,UTY' APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS tje WILLIAM A JENSEN, SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1•25 MAIL BATH TUB 1.25 ADDRESS Q INTYO CITY TEL. NO.SHOWER 1.25LAVATORY 1.25 CONTRACTORSINK 1,25 ADDRESSDISHWASHER 1.25 CITY C TEL. NO.LAUNDRY TUB 125 CONTRACTOR'REGISTRATIO NO. CO CLOTHES WASHER 1.25 DISTRICT NO UP ZONE PRESSED BY WATER HEATER 1.50L" 6 J GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD 9L U m O . a U W d z - APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE ,//i/ <VPA yy z /►�,h/y./�y A .�e OF PERMITTEE FINAL J� t fr l ,—Y I VALIDATION ROBERT A WOOD CK M o cnsH� SUPERVISING MECHANICAL ENG'R LACoO 6 7 .5tZ s&25 5, D 3.25& .q i ;r`WORKE S'COMPENSATION DECLARATION APPLICATION,FOR, PLUMBING,PERMIT ' •+1'LN1he eby,affirm that I'Have a certificate of consent to self 76A667A , insure, or a certificate of Workers' Compensahon'Insurance, CE 817(REV 8/86)' e,y S c• or a cert fled copy thereof (Sec 3800, Lob C) - - _ � X� ,I_ COUNTY OF "LOS ANGELES', DEPT.- OF.'PUBLIC'WORKS t Policy No'CerJ�pciny furnished 'BUILDING. ❑ FOR TO FILL IN(PRINT OR TYPE) ADDRESS d Certifiecopy is filed,with the county building•inspec- ' hon department NUMBER FIXTURE OR ITEM @ FEE LOCALITY t. WATER CLOSET Dote f�QV_is 4)-Appli4arit �'• NEAREST = CERTIFICATE OF EXEMPTION FROM WORK S' BATH TUB -' - CROSS ST, (,( COMPENSATION INSURANCE SHOWER OWNER �� +. - (This section need not be completed-if the work involved by MAIL: f.� Ate' ,g the-permit is for one hundred dollars($100)or leas) , LAVATORY, ADDRESS r 1 S- W rsV� } J'certify that in the performance of the work for which,this c , permit is issued, I shall not employ any person in any manner r SINK r+ CITY "' �, TEL NO` so as to become-subject to the Workers'Compensation Laws , 6 DISHWASHER + ' CONTRACTOR Date- -'A"p (scant i CLOTHES WASHER, y ^ NOTICE TO APPLICANT f, after making this Certificate of ADDRESS ' '•� Exemption,- you should m becoe subiecf SWIMMING POOL RECEPTOR to the Workers' - CITY TEL NO 'Compensation;provisions of ihefLabor Code, you must forth- LAWN SPRINKLER SYSTEM 4f/ �wrth-comply with such'provisions or this,permit'sholl be STATEUC , 4 1 deemed revoked WATER HEATER LICENSE NO GLASS - ' LICENSED CONTRACTORS DECLARATION DISTR�NO, 41? SSED BY t I Hereby affirm that I am licensed under provisions of'Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of'.•Division 3 of-the Business OUTLETS OVER and Professions Code;and my,licenseiis in full force and-effect 5 PER SYSTEM FINAL ` V IDATION DATE, License Number' �i�3•Z� Lic Class g t V ` - - - t ., • � FIN f'/' , -:® Contractor c ' ate�� �1• B ❑ ,I am exempt under Sec LU IL B BP.0 for this reason 47 9 2-DA W Plan check fee'. Z Date # o 0 0 0 0 5 PLUMBING PERMIT ISSUING FEE$ • Signature n r TOTAL FEE. o 3 4.5',0 Plan check applicant ° 3 4,5 0�r SINGLE FAMILY - �/� � o ' HOME OWNER-BUILDER DECLARATION Name ( s, Q 9,11 5'-8`] I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Sechon`•7031 5,-Business and Address 14;w 1, MY41 , 4 0, i Professions Code). City el No. y a • - h - ❑'' I, as owner of the property,'will do the work and the structure•is not intended or offered for sale (Section 7044, Business and Profess ions'Code)_ Y' CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructiori lending agency for the'performance of the work,for which this permit,is,issued Vi f (Sec 3097, Civ'C,) Lender's Name Lender's Address " I,certify that,I'have read this application and state-that the _ - above informahon,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 property for inspection purposes SEEMEVERSE FOR EXPLANATORY LANGUAGE Signature of Fierinitte ate "