HomeMy Public PortalAbout6203 GOLDEN WEST AVE_Plumbing__ D.S. 17 25M SETS I2-43 APPLICATION FOR PERMIT
DEP,AI3.T&!ENT OF BUILDING AND SAFETY' PLUMBING 'COUNTY OF LOS ANGELES
WM.J. FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT N . GROUP /ZO E P RJMIT.may .
ROUGH FIXTURES COMPLETE ✓ / _`� .! -4
NEATER CESSPOOL 1-1 SEPTIC TANK REC IVSD BY READY FOR DATE 18BUED
_ FIRST INSPECTION G
AS MISCELLANEOUS ?!.1/f0 ^7 ��
APPLICANT FILL IN HEAVILY OUTLINEED PORTION ONLY
JOB
E NAME ��� ADDRESS 4 fill I
�W AI LOCALI Y�ti(.-TI
ADDRESS ,�
NEAREST
A CITY EL.NO.ro H H CROSS8T.
IL
COUNTY e
CERT.NO. II EXPIRES 0® ,n `4 It NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
NORTH O ADDRESS
CITY TEL.No.
IAM THE GAL'Poo SOR OF THE •ABOVE LOS
ANGELES COON Y CERTIFI ATS OALIRL,CAT �
ArLIADER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
W DN
3 1 OWNER
-7 CORRECTIONS
SOUTH J
DESCRIPTION OF WORD _i
BATH TUB FURNACE 9
lY
SHOWER DISHWASHER 0
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S
NAME.-
WATER HETER DENTAL LAVATORY ROUGH PLUMBING d I n /
METER S GAS SODA FOUNTAIN
OUTL GAS PIPING t
GAS VENT 1
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK I I
CESSPOOL SEPTIC TANK SEWER
$ �p
TOTAL FEE UTILITY CO.NOTIFIED I .
FINAL ~
7sw687A (Ce 8176) -4/77
APPLICATION FOR PLUMBING PERMIT
BUILDIN AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING O
NUMBER FIXTURE OR ITEM ® FEE ADDRESS
WATER CLOSET LOCALITY otgA
c i
NEAREST
BATH TUB
CROSS ST
SHOWER OWNER
LAVATORY MAIL �J_ f
ADDRESS �(
SINK CITYTEL NO
DISHWASHER CONTRACTOR
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR '--�
CITYo-: �' TEL NO G�
LAWN SPRINKLER SYSTEM
STATE LIC
WATER HEATER LICENSE NO / CLASS
GAS SYSTEM OUTLETS DISTRICT NO UP NE PR ESSED
,O� 3 CD
OUTLETS OVER p
5 PER SYSTEM INDUSTRIAL V
WASTE APPROVAL
INSPECTION RECORD
H
U
W
co
- co
Z
Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTALFEE
Plan check applicant
Name APPROVALS DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
Address ,
ROUGH PLUMBING
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
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 I AM PROPERLY REGISTERED AND/OR ICENSED AS PLUMBING FIXTURES -
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA O AT I AM THE GAS TEST j
LEGAL OWNER OF AND INT ESJ,DE IN TH BOVE ESCR E RESIDENTIAL
PROPERTY � UTILITY CO NOTIFIED
SIGNATURE ,
CFPERMITTE - FINAL -7
PLAN
o '
PLAN CHECK VALIDATION CK M o CASH PERMIT'VALIDATION CK M o CASH
3 6 0 AWC 17 5 D 1 0-0 (D ,&
COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer am � '
DIVISION OF BUILDING & SAFETY i
WILLIAM J. FOX, County Engineer PLUm
D1 ROUP ZDNEPERMIT
FOR APPLICANT TO FILL IN / 4/6
PLUMBER j w RECEIVED BY READY FOR DATE ISSUED
ADORES H t p 6l � �1 FIRST INSPECTION
/BUILDING
CITY TEL.NO. ADDREB9 A •_ `�`1 C! I
COUNTY LOCALITY
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES CROSS ST.
OWNER.
NUMBER TYPE OF FIXTURE OR ITEM FEE
MAIL
WATER CLOSET(TOILET) Q 0.56 $ ADDRESS
BATH TUB Q 0.50 CITY TEL No.
SHOWER , Q 0.50 1 HEREBY q KNOWLEDG THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK Q 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY - @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
h 13A9 SYSTEM_ OUTLET9 ® 0.50 OF THE RESI DENTIA PRO RTY DESCRIBED ABOVE.
L V
BIONATURE OF
WATER HEATER @ 0.50 PERMITTE
SLOP SINK 0.50 '{NSPECTION RECORD
c FLOOR SINK 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN Q 0.50
URINAL Q 0.50 J
_ Q
HOUSE SEWER ® 0.50 _Z
MISCELLANEOUS 3
O
c
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING ,/EO �?iV
GAS VENT
CESSPOOL ® 1.130 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) Q 1.130 SEWER
%.PERMIT1.013 GAS TEST
• ,j UTILITY CO. NOTIFIED _7_n -I 1 f On •�
TOTAL FEE # L. 10c)
FINAL
76A667 DBS#17 10/52
ION
WORKER'S 1, vIe a certificate
of consent to 76A667 DPW 9/89 APPLICATION FOR PLUMBING PERMIT
76A667A
I hereby affirm that I,have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified 1
copy thereof(Sec 3800 Lab C) -
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
Policy No Company 1 f
Certified copy is hereby furnished BUILDING
El `� L/FOR APPLICANT TO FILL IN(PRINT OR TYPE) (p D.Z � �/lJ
Certified copy Is filed with the county building inspection 7-4
j
ADDRESS uv'es /
department [NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date Applicant WATER CLOSET �� NEAREST I �r�i A \ y'
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST L_V�l/ +✓
BATH TUB \ �� p
COMPENSATION INSURANCE ASSESSOR MAP,BOOK 0� PAGE�fl PARCEJ i�
(This section need not be completed if the work Involved by the SHOWER ``- '
permit is for one hundred dollars($100)or less.) OWNER ^�
LAVATORY
o-o G=i-J L i
I certify that In the performance of the work for which this permit MAIL ' ( `
Is issued, I shall not employ any person In any manner so as to SINK ADDRESS 61 � I
become subject to the Workers'Compensation Laws
DISWASHER CIT7_�_ � ,- TEL NO T�
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT If, after making this Certificate of _ CONTRACTOR
Exemption,you should-become subject to the Workers"Com pensation SWIMMING POOL RECEPTOR ADDRESS
provisions of the Labor Code, you must forthwith comply with such
provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL NO d
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(commencing with Section 7000) of Division 3 of the Business andSTATE LIC
LICENSE NO CLASS O
Professions Code,and my license is In full force and effect GAS SYSTEM OUTLETS V
OUTLETS OVER DISTRICT NO PROCESSED BY Q
5 PER SYSTEM Cr O O Q
License Number Lic Class a U
FINA--L•..r�//tt 9 VALIDATION LU
DATE.L // _ a
Contractor Date LLCLLC////// to
I am exempt under Sec BY AL { .t I o s ?
r
B&P C for this reason
Date " Plan check fee i ITEM
�� m
Signature �I IT("{I_
PLUMBING PERMIT ISSUING FEE$ �ji 65
El TOTAL FEE $ CHECK i,ttI
Plan check applicant
SINGLE FAMILY [;lFtit3 oiii}
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031 5, Business and Professions Address
Code) UJJ-►.ICil1 ;t� t, 3:
City Tel No _ t �M � ,:t •
I I,as owner of the property,will do the work and the structure ► i]r3 y tit t o(!+
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 agree to comply with all County ordinances
and St to laws regulate Plum Ing, and hereby authorize '
rep es tatrves of thI Co 6ty to a er upon the above-mentioned -
pr er for mspectlo pu s s SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date l