HomeMy Public PortalAbout6023 GOLDEN WEST AVE_Plumbing__ APPLICATION FOR PLUMBINP PERMIT
DBS-17 12_.^4 '
4*kzSION OF BUILDING AND SAFETY
Department of County Engineer
County of-Los Angeles BUILDIN
WM.J. FOX, COUNTY ENGINEER ADDRESS 1
CASSATT D.GRIFFIN, SUPT OF BUILDING
LOCALITY
FOR APPLICAN TO FILL IN NEAREST
1� CROSS ST '
OWNER -�- (T• �I (,..L� 1 c E T DISTRICT NO GROUP- ,.(Z��ryONE READY FOR INSPECTION
MAIL ADDRESS ^ Q .'/� V O 1 �,l -�S/ I . L/�_ I J 'I /�
INDUSTRIAL
_CITY f=Al PLS C17- TEL NO WASTE APPROVAL
PLUMBER fJK r�'I'✓F N INSPECTION RECORD
,l
ADDRESS //�� / W 6 Iz , --0 R` iVC� �( `
CITY 5A TEL. NO. V 16
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET•(TOILET)
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
,SPPO IV KLc t y S FAIN ��r
TOTAL NO @ 080 APPROVALS
DATE INSPE(i-TOR'S SIGNATURE
GAS SYSTEM L OUTLETS @ 100
UNDER SLAB WORK
WATER HEATER @ 1 00
,��QQI1 ROUGH PLUMBING
PERMIT S (�l/ 00 GAS PIPING
TOTAL FEE GAS VENT
1 HEREBY ACKNOWLEDGE'THAT1 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 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LO ANG L'ES COUNTY AND STATE OF UTILITY CO NOTIFIED
CALIFORNIA OR THAT AM C E L�AL OWNER OF THE ABOVE -
DESCRIBED RESIDENTI O TY. "
SIGNATURE ?
OF PERMITTEE FINAL ?� O
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION ,
�LK02B� �. 0 JUS! �. 5 D. 3 .0 0 � s
D UTY
76A667-CE817 12/59 r
APPLICATION* FOR _Pg..UMBI C PERMIT �
" COUNTY OF LOS ANGELES
t DEPARTMENT OF COUNTY -ENGINEER
BUILDING ' SAFETY RMSION BUILDING b D 3 �rIP» L �()��
JOHN A. L M 1 COUNTY NGINEER ADDRESS
- WILLIAM A. JENSEN, SUPT OF BUILDING,
LOCALITY
FOR APPLICANT TO FILL IN NEAREST d
CROSS ST.
NUMBER FIXTURE OR ITEM
/ OWNER -
WATER CLOSET
MAIL —o _ ,-$r—
ADDRESS n� �
BATH TUB
-
CITY TEL. NO. f 3 „•j,
sxowER
LAVATORY
CONTRACTOR /�I7 et-
- '
SINE ADDRESS
DISHWASHER CITY TEL. NO.
/ CONTRACTOR'S STATE ❑
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOS WASHER , - DDIISSTRIIC�TN G NE P D BY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD y
a
O
- U
a
$1.00 fiXTER MEM URE
$ I �..� �lC� �°°,Vv�;,g �i Rc r
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 : UNDER SLAB WORK _4/ 1_1.& All
ROUGH PLUMBING •� v� r
TOTAL FEE -
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE-READ THIS APPLICATION IGAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
-
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AHD/OR PLUMBING FIXTURES
LICENSED A3 REQUIRED BY LOS ANGELES COUNTY AND I I" OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITT =„� -�'�� 'A.
FINAL U,24
VALIDATIQN—,ROBERT A. WOOD.
CASH SUPERVISING MECHANICAL ENG'R
L ico•5 2 4 �G _ 5 D 7.0 0 ;�
WORKERS' COMPENSATION DECLARATION ,APPLICATION FOR PLUMBING-PERMIT
I hereby affirm that I have a certificate of consent to,self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81)
or o'certified co th reof ec 3800, Lab, C-) COUNTY OF LOS ANGELES 7' BUILDING AND SAFETY
�ji�'!�0—O �a
Policy N Companny! _
❑ Certified copy is hereby furnished BUILDING
FOR APPLICANT TO FILL IN(PRINT'OR TYPE)n ns ec-
ADDRESS
Certified copy is filed with the county buildi
tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY' _
WATER CLOSET
Date __I— iiijiApplicant NEAREST' -
7-1
CERTIFICATE OF.EXEMPTION OM WORKERS' BATH TUB CROSS ST
COMPENSATION I RANCE. OWNER
(This section need not be comple if the work involved by SHOWER
MAIL L A
the permit is for one hundred dol ars (5100)or less.) 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, Ali c TEL NO
-so as to become subject to the Workers,Compensation Laws, DISHWASHER ,
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESSq o
NOTICE TO APPLICANT If, after making this'Certificate of 0 ! I CO nag,- -
Exemption, you should become subject 'to the Workers' SWIMMING POOL RECEPTOR
AA //
Compensation provisions of-the Labor CodCITY V+e, you must forth- LAWN SPRINKLER SYSTEM �-•� ov� TEL NO."6 ��9"
with comply with such provisions or this permit shall be STATE
deemed revoked DD CLASS G
WATER HEATER LICENSE NO c7
LICENSED CONTRACTORS DECLARATION DISTRICT NO P CESSED•BY
I herebyaffirm 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 license is in full force and effect 5 PER SYSTEM FINAL VALIDATION V
p� �r
License Number V Lic Class Sc-� �� 1 09
L FINAL A O
Contractor Date BY- U;
LU
F-11 a xempt under Sec L/`'
N
CL
B& C for this reasonZ
Plan check fee pop /0/ 01 o
Date PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE �(�
Plan check applicant
SINGLE FAMILY _ 8 81,8A 8A
HOME OWNER-BUILDER DECLARATION Name.
I hereby affirm that 11 am exempt from the Contractor's License Address #j.o 0 0 0 0 ,5
Law for the following reason (Section 7031 5, Business and • t ,
-Professions Code) City Tel No 2,o to ] &.5 0
❑ I;as owner of the property, will do'the work•and the a •
_structure is not intended or offered for sale (Section , C a o 6-
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 laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above- e oned nrispection purposes
L SEE,REVERSE FOR'EXPLANATORY LANGUAGE ,
Sign re of Permittee Date a