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Home My Public Portal About6046 GOLDEN WEST AVE_Plumbing__ DEPARTMENT OF COUNTY ENGINEER PLUMBING DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION QOIINTY OF LOS'ANGELES BUILD NO /f / WILLIAM J. FOX, COUNTY ENGINEER ADDRESS ��✓✓ (0 1 7 *1�1aYNb�l/ FOR APPLICANT"�TTO� FILL EST tN LOCALITY BUILDING // / +' ADDRESS CRO S ST. DISTRICT N0. GROUP ZONE PERMIT N0. LOCALITY NEARESTy CROSS ST. �J 2za Ready for Inspection DATE ISSUED OWNER /f� — �CS� �� INDUSTRIAL MAIL WASTE APPROVAL ADDRESS CITYTEL/No. INSPECTION RECORD PLUMBER �� v� , ADDRESS ` CITY TEL.NO `ed 1(3/(S State Contractor's Llcens /, Cla s e,No. q 1.1 L.A.County Contractor's A (� Q Registration No. ) /S PERMIT FEES NUMBER TYPE OF FIXTURE OR ITEM FE[ WATER CLOSET(TOILET) @ 0.80 a BATH TU B @ 0.80 SHOWER @ 0.80 LAVATORY(WASH BASIN) @ 0.80 KITCHEN SINK @ 0.80 p, LAUNDRY TUB OR TRAY @ 0.80 E SLOP SINK @ 0.80 FLOOR SINK @ 0.80 FLOOR DRAIN @ 0.80 DISHWASHER @ 0.80 DRINKING FOUNTAIN @ 080 URINAL @ 080 GAS SYSTEM............OUTLETS @ 1.00 WATER HEATER @ 1 00 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT s I DD ROUGH PLUMBING TOTAL FEE GAS PIPING CATi HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT ION ANO STATE THAT THE ABOVE 18 CORRECT AND AGREE HOTIWATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES = I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS EQU RED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALI NI R THAT I AM TH.F LEGAL N. ER OF THE ABOVE C BED RESI ENTIAIr ROP RTY. UTILITY CO.NOTIFIED SIGNATURE ��J'��' OF PERMIT EE -Xlz ...... 1\ 76A667 DBS 17 6/54 76A667A CE 817,f 114V 6/78) APPLICATION FOR PLUMBING, PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS NUMBER FIXTURE OR ITEM ® FEE LOCALITY - WATER CLOSET NEAREST /7 BATH TUB CROSS ST SHOWER OWNERAu p�Cot LAVATORY MAIL n ADDRESS SINK CITY TEL N 5 D DISHWASHERCONTRACTOR CLOTHES WASHER ADDRESS T SWIMMING POOL RECEPTOR CITY TEL NO LAWN SPRINKLER SYSTEM STATE, LIC WATER HEATER LICENSE NO 3�?50 CLASS x,53 GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK S PER SYSTEM ROUGH PLUMBING T GAS PIPING GAS VENT &! HOT WATER HEATER ¢®9 PLUMBING FIXTURES �( GAS TEST Ui (rj T (� N Plan check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING,FEE$ TOTAL FEE S FINAL ��,�� Cl • Plan check applicant L/ PLAN CHECK VALIDATION Nome Address City Tel No I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ' THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES , AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION, I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS y D 0"4 ,3 R REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCWBED RESIDENTIAL # O O 10 O-0 5 PROPERTY 10 .. SIGNATURE 2'O o 1 0,00 `_ f - OF PERMITTEE - DISTRICT NO P CESSED BY o 0 0 �•Q 0 0 v 0522-80 INDUSTRIAL WASTE APPROVAL WORKERS'COMPENSATION DECLARATION 7aasa7A I herebyaffirm•that I have a certificate of consent to self ce e17"(2-80) A P P L I CAT I O N , FO R PLUMBING PERMIT. * insure, or'a certificate of Workers'Compensation,Insurance,or --�-^ a certified cop thereof(Sec 3800,Lab C) l yT �� r ,.f COUNTY OF LOS ANGELES7_ BUILDING AND SAFETY' Policy No. ,, s Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) 'BUILDING Q �j Certified copy is filed-wit county bu mg i s e, ion NUMBER FIXTURE OR ITEM • FEE ADDRESS 4" lepar nt LOCALITY L;` WATER CLOSET Date. �Apphcant NEAREST :� BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FOM WORKERS' COMPENSATION INSURANCE SHOWER OWNER - kk w MAIL (This section need not be completed if the work involved LAVATORY ADDRESS S by the permit is for one }iundred dollars ($100) or less.) SINK , CITY ' TEL NOS I certify that in the performance of the work for'which,this DISHWASHER CONTRACTOR' _ U t2 permit is issued,'I shall not employ any person in any manner " _ 0 so as to become subject to the'Workers' Compensation Laws CLOTHES WASHER ADDRESS (~) 'Date Applicant ' W SWIMMING POOL RECEPTOR NOTICE TO APPLICANT, If, after making this Certificate of CITY TEL NO. 2 _ Exemptiori, you,should become subject, to the Workers' LAWN SPRINKLER SYSTEM STATELIC z Compensation provisions of the Labor Code, you must forth- LICENSE NO `R � ' 'b CLAS - �- � with comply with such provisions or this ,permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER S ,Cf� I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license`is in full force and DATE -g �� effect. - -- �'^��}f�/�J�(�,�q,r��''�y1�''-��- �/[� .- . e - - - • a License NumberLic Class -�$� f/- 7 / BY AL ContraZ5" ate ` I mpt r lice ns37f`g requirements as Lam a Plan check fee ° licensed architect, or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- 7, iness and Professions Code) TOTAL FEE �CO 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 l " License Law for the following reason,(Section 7031 5, Busi- City ' T,6I No. ness and Professions Code) I, as owner of the property, am exclusively contracting2 7 8 A with licensed contractors to construct the project (Selctioh 7044, Business and Professions Code) o�o o'o 0 '# 5 CONSTRUCTION LENDING AGENCY 2:- 0 1 250 I,hereby affirm that there is a construction lending agency ' ' for the performance of the work for,which,this permit is' a 0'a 0 1 2 5 0 c=i issued(Sec 3097,Civ C.). Lender's Name `1',2 7 -82 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�present�ves of tttusounty to enter upon the above-mebti n &gropertyr1n ctio p poses Signature of Permittee' u� Date WORKERS'COMPENSATION DECLARATION 76A667A I hereby affirm that I have a certificate ofconsent to self ce 817 (z-6o) A P P L I C A T I O N' FOR PLUMBING" PERMIT insure, or a certificate of Workers'Compensation Insurance,or - - I a a certified copy thereof(Sec. 3800,Lab C.) COUNTY OF LOS ANGELE BUILDING JAND SAFETY' Policy,No Company �� , El:Certified copy is hereby furni FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 1 Certified copy is"filed with t e count uhi dm i pe NUMBER FIXTURE OR ITEM • FEE ADDRESS Q LOCALITY Date !r #applicant WATER CLOSET 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 O Ot% C✓ } by the permit is for'one hundred dollars ($100) or less.) _. SINK d CITY TEL NO I certify that in the performance of the work for which thisDISHWASHER CONTRACTOR U permit-is issued, I shall not employ any person in any manner Add � so as to become subject to the Workers' Compensation:Laws CLOTHES WASHER ADDRESS � 0 Date Applicant SWIMMING POOL RECEPTOR NOTICE TO APPLICANT If, after making this Certificate of CITY • TEL N , Exem tionyou should become subject to the Workers' LAWN SPRINKLER SYSTEM P Y STATE LIC. to Compensation provisions of the Labor Code, you'must-forth- LICENSE NO CLASS with comply with such provisions or this permit shall be WATER HEATER deemed revoked GAS SYSTEM OUTLETS DISTRICT NO AR O O SD 8 t LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby aff4m that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- �S t DATEL2�/ VALIDATION ness and Professions Code, and my license is in full force and effect License Numb yLic Class C *UJ 7� FBY INAL, r ContractDate I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ll acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE F§ ~n Lic,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) I, as owner of the property, am exclusively contracting 2 9 6 7 A with licensed contractors to construct , the project #'o 0,0 0 0 (Section 7044,Business and Professions Code) 5 .o . CONSTRUCTION LENDING AGENCY -'1 '?,2 5 0, ' I hereby affirm that there is a construction lending agency o�o+0'1 '2"` Y c=i for the performance of the work for which this permit is issued(Sec. 3097,Civ C.) 0'21 6 8 2 Lender's Name b Lender's Address I certify that I have read this applic d state that the e information is correct.I agree o co y with all County SEE REVERSE FOR EXPLANATORY•LANGUAGE ' ordman and State I regul ing P burg, and hereby authorize re esent tiv s of t Cou to enter upon the abovg-mention d pr for ns purposes Signature of Permittee Date