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Home My Public Portal About6210 GOLDEN WEST AVE_Plumbing__ 76A657-CE817 12/59 ` �^ " APPL.ICATION FOR PLUI PERMIT ' � COUNTY OF LOS ANGELES a DEPARTMENTA�OF COUNTY ENGINEER BUILDING A'-E,SAFETY DIVISION BUILDING JOHN A. L MBI COUNTY NGINEER ADDRESS WILLIAM A JENSEN, SUP'T OF BUILDING LOCALI FOR APPLICANT TO FILL IN NEAREST (3 CROSS ST. V NUMBER FIXTURE OR ITEM OWNER WATER CLOSET ] MAIL •�!^`/y BATH TUB '/ ADDRESS CITY > TEL. NO. r SHOWER 1 p LAVATORY ' CONTRACTOR SINS ! ADDRESS0[7 ✓ <— - G - DISHWASHER CITY' CONTRACTOR'S STATE j9 LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER - DISTRICT NO. I GROU ZONE ......... BY WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD a O _ F � U 0 $1.00 PER ITEM. OR FDCTURR $ I -0 IAAPAc5vAL9 -_DATE] INSPECT_ ' 'S SIGNATURE PERMIT $ I 2 00 UNDER SLAB WORK TOTAL FEE J p 4) ROUGH PLUM ElING,,� n �� o•1 +.� ' I l r, GAS PIPING ?1 J�II4'i I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ji �•� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT t WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES p GO LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE.OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER, OF THE ABOVE DESCRIBED RESIDENTI L PR ERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTE � d t FINAL 0.Y4 ®P ',�TLIDATION ROBERT.A, WOOD, Y.O. CASK SUPERVISING MECHANICAL ENG'R l Lk o B 9 6 8 JUN ?1 5 D 9.0 U a 76A667 (CE-817) - 5/73 APPLICATION FOR PLUMBING -PERMIT : : " COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO, ADD ESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY' W r"r FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST 041 NUMBER FIXTURE OR ITEM @ FEE ' OWNER 1, WATER CLOSET 1.75 � MAILI BATH TUB 1.75 ADDRESS a�� SHOWER 1,75 CITY TEL NO LAVATORY _ 1,75 CONTRACTO SINK 1.75 ADDRESS. DISHWASHER 1.75 CITY TEL NO CLOTHES WASHER 1.75 STATE LIC LICENSE NO CLASS SWIMMING POOL RECEPTOR 1.75 LAWN SPRINKLER SYSTEM 1.75 /(•� DISTRICT NO GROUP '7C1 E 'F QCESSED BY WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD - d O OUTLETS OVER V 5 PER SYSTEM 30 �- l7�-��•- �',n�� •/^"� �j ✓�"C I�7 O U Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR 5 SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES _ WITH ALL COUNTY ORDINANCES AND STATE LA WS'REGULATING PLUMBING GAS TEST ��/,��SG *7-f f,� I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED 4 LICENSED AS REQUIRED BY LOS GELES COUN Y AND S TE OF _ CALIFORNIA OR THAT I AM THE/ GAL OWNE , AND END TO y RESIDE IN THE ABOVE DESCRIBE ESIDENTI ROPER FINAL 7 � SIGNATURE OF PERMITTE ! oil _ PERMIT VALIDATION CK M o cnsH j) PLAN CHECK VALIDA ON CK M".. �CCA'SH `�",;:04 9i:ItRR 4 5 D 4.7 5 � a 76A667 (CE-817) - 5/73 APPLICATION FOR PLUMBING- PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO BUILDING , • 'ADDRESS - HARVEY T. BRANDT, COUNTY ENGINEER ': LOCALITYof < FOR APPLICANT TO FILL IN (PRINT OWTYPE) NEAREST CROSSIST. NUMBER FIXTURE OR ITEM @ FEE OWNER, WATER CLOSET 1.75 MAIL i/ BATH TUB 1,75 "ADDRESS SHOWER 1.j5 CITY ,/ TEL NO LAVATORY 1,75 CONTRAC R SINK 1.7,5 ADDRESS DISHWASHER 1.75 CITY a TEL NO - CLOTHES WASHER 1.75 STATE LIC LICENSE. O CUASSI SWIMMING POOL RECEPTOR 1,75 DISTRICT NO GROUP 'ZONE ' PROCESSED BY LAWN SPRINKLER SYSTEM 1.,75 D < WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL y: GAS SYSTEM OUTLETS 1.75n" INSPECTION RECORD U OUTLETS OVER 30 C=5 PER SYSTEM O I— U " W a- Cn Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL- FEE APPROVALS DATE INSPECTOR S SIGNATURE, Plan Check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address - GAS PIPING ' City Tel NO GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING I HEREBY CERTIFY THAT I AMOPERLY REGISTERED AND/OR UTILITY CO NOTIFIED - LICENSED AS REQUIRED BY LOS�A ELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAL OWNE F, AN NTENO TO RESIDE IN THE ABOVE DESCRIBE ESIDEN PROP FINAL X9.-7 //�'� <• SIGNATU RE �' OF PERMIT - P ' MIT VALIDATION CK M. CASH PLAN CHECK VALIDA ON M O CASH L/ - _ 4.7 5 Ab8 WORKERS'COMPENSATION DECLARATION 76AS67A [1 I �iereby affirm that I have a certificate of consent to self CE 817 (z-ao) APPLICATION FOR 'PLUMBING PERMIT U insure, or a certificate of Workers'Compensator s anc or a certified copy thereof(Sec. 3800 1.La4l,C.) --�- 1 COUNTY OF LOS,ANGE LES BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ertified copy is filed with t ounty building inspection NUMBER FIXTURE OR ITEM' FEE ADDRESS leper{ e t WATER CLOSET LOCALITY Date 77 Applicant NEAREST BATH TUB CROSS ST CERT FICATE OF EXE ION-FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORYMAIL (This section need not be completed if the work involved ADDRESS by the permit is for one hundred dollars ($100) or less.) SINK � a CITY TEL NO b" 23 C) I certify that in the performance of'the work for which this DISHWASHER, CONTRACT ,V permit is issued, I shall not employ any person in any manner so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS D J 0 Date Applicant SWIMMING POOL RECEPTOR CITY EL NO W NOTICE TO APPLICANT If, after making this Certificate of d Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM' STATE jj g� LIC to Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO / ! CLASS S Z_ with comply with such provisions or this permit shall be deemed revoked. DISTRICT NO PR ES$ED BY GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL �� 37 ness and Professions Code, and my license is in full force and DATE VALIDATION�� effect. FINAL License Numbe ,;-6 20 Lic Class ( �- BY Contractor "ate IZ $I lj lam mpt from the licensing requirements as I am a Plan check fee d /4 licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE 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 10 6 4 A ness and Professions Code) I, as owner of the property, am exclusively contracting #',O,o 0 5 with licensed contractors to construct the project 2 0 0 Q Q (Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY )-r.0 0 '�0 0 5 i hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0 9.1018,—8 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ab - enUoned prope::;,�t n purposes 9 a re of Permittee Date WC�~RKER'SCOMPENSATION DECLARATION ?66DPW9/89 A667A APPLICATION FOR PLUMBING PERMIT 6A66 I hereoy affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified_ copy thereof(Sec 3800 Lab C) - - COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS J DEPT. OF PUBLIC WORKS DIV. a Policy No Company Certified copy is hereby furnished `�j ~ FOR APPLICANT TO FILL IN(PRINT,OR TYPE) BUILDING ADDRESS Certified copy is filed with the county building inspection department NUMBERY FIXTURE OR ITEM @ FEE LOCALITY / G' Date l"'1'" Apphcan WATER CLOSET NEAREST f,G CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE ASSESSOR .a r (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or',ess) OWNER I certify that in the performance of the work for which this permit LAVATORY v is issued, I'shall not employ any person in any manner so as toMAIL become subject to the Workers'Compensation Laws SINK- ADDRESS S AM 15 - (` - DISWASHER � CITY TEL NO t Date \ Apphcantr - CLOTHES WASHER l , NOTICE TO APPLICAIJT If, after making this Certificate of CONTRACTOR vBA ve Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR D �� provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shah be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO �. } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER IL (commencing with Section 7000) of Division 3 of the Business and STATE LIC Q GAS SYSTEM OUTLETS LICENSE NO CLASS 3 (� Professions Code,and my license is m full force and effect � � , OUTLETS OVER DISTRICT N PROCESSED BY License Number /`/`3 Lic Class W o 5 PER SYSTEM �A� �� t O FINAL p,� } .Q DATE VALIDATION a Contracto`en I1f P�� +Date 7 7 ( ❑ I FINAL ' Z I am exempt under Sec BY B&P C for this reason Plan check fee Date , Signature PLUMBING PERMIT ISSUING FEE$ 0 ❑ TOTAL FEE 2.oO Plan check applicant - SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name A i"' . •t•IAIr -I hereby affirm that I am exempt from the Contractor's License Law � _ _ I�,__„•z for the following reason (Section 7031 5, Business and Professions Address _f,:+i_ Code) City t � Tel No - - - 1 i)�.�I=, ❑ I, as owner of'the property,will do the work and the structure - I is not intended or offered for sale (Section 7044, Business !.�/}�` 1 J�' `S ,�.?O I t[-� a-�� ® =j�-7 SCJ vv 14CE•vGrr V and Professions Code) _},( CONSTRUCTION LENDING AGENCY • �/�/� In3't�� q�_I)j 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 Namef Lender's Address J 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 i representatives of this County to enter upon the above-mentioned' property for inspection purposes ISEE,REVERSE FOR EXPLANATORY LANGUAGE-