HomeMy Public PortalAbout6233 GOLDEN WEST AVE_Plumbing__ PLUMBING , 1
DEPARTMENT OF COUNTY ENGINEER
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING'
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
1 77-
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
DSS
ADRER CROSS ST. T
DISTRICT NO. GROUP Z NE PERM N0.
LOCALITY � _/ / �
NEAREST If j
CROSS ST. `j RECEIVED B Ready for Inspection E ISSU D
�� � � �' �(„�
OWNER z5-"n. ���F{ s m c
MAILWASTE TAPPROVAL
ADDRESS C'fd a y' ��-t-.
CITY /�L ,,,,, ,b y SEL.No. /},r- O INSPECTION RECORD
PLUMBER �f7 V"- b
ADDRESS ! 1p
CITY j. TEL.NO.,j-ra-7,r.3y
p STATE
LICENSE N0. O COUNTY .J
P RNMIT FEES O Al Sd d 7h
-4umgER TYPE OF FIXTURE OR ITEM FEE ��D(7 7-,'/-,0Z
EGA
WATER CLOSET(TOILET) @ 0.80 S D D N'F1A1AZ.•
O
BATH TUB @ 0.80 ID
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80 9) Z(—A-,Y /VU
KITCHEN SINK @ 0.80 go /:% -7,,,,,) P P /VI 5 4!/7�72 ,r 7°
LAUNDRY TUB OR TRAY @ 0.80 O
L Fc�-,eo
SLOP SINK @ 0.60
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM.---.&....OUTLETS @ IAO V O
WATER HEATER @ 1.00 60
MISCELLANEOUS
APPROVALS
DATE / INSPECTOR'S SIGNATURE
UNDER SLAB WORK 40 —4
PERMIT $ I 00 ROUGH PLUMBING
TOTAL FEE Q 0 GAS PIPING
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURE�pSHEREBY CE �� /
AND/OR LIICENSERD THAT
REQUIRE DA BY LOS ANGELESREGISTERED
GAS TEST F'/!V)�, Ho
PROPERLY
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL WN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE //�
OF PERM ITTEE-•-' ... ......... .-------------- ...............
FINAL
76A667 DES 17 1/53
lit WORKERS' COMPENSATION DECLARATION ` APPLICATION FOR PLUMBING-PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A
insure, or a,certijeate of Workers' Compensation InsuFance, CE 817.(REV 10/81)
or a certified,co thereof (Sec, 3800�La'b�-]C�) �j •/�� COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No; v/ ompanY . ti/
❑ Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / 1 i,,
❑ Certified copy-is filed with the county building mspec- ADDRESS (pd (j—O'/�(�EILJ Yl/�'.4
Tion depart eent NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Date 3 FrAppli4al7
nl " ` � �•
WATER CLOSETf or �
NEAREST.
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB h CROSS ST.
COMPENSATION INSURANCE OWNER L'e rti
SHOWER
(This section need not be completed if th'e work involved by MAIL
the permit is for one'hundred dollars ($100)or less.) LAVATORY 4 ADDRESS (V 3 " tVyiti
I'certify that in the performance of the work for which this
permit is issued, 1 shall not'employ any person in any manner, SINK CITY Ci TEL NO.
so,as to become subject to the Workers.Compensation Laws DISHWASHERIV
r,
CONTRACTOR
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT ADDRESS if, after making this Certificate of D. cc
Exempt on,
xem Tion, you should become sub ect to^ the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITYS t+ TEL N0
LAWN SPRINKLER SYSTEM C
with comply with such Provisions or this permit shall be STATE LIC.
deemed revoked. / WATER HEATER / QO LICENSE NO // / QS CLASS G
LICENSED.CONTRACTORS DECLARATION (� DISTRICT NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 700.0) of Division 3 of the.Business OUTLETS OVER
and Professions Code, and my license is in full force and effect 5 PER SYSTEM CL
FINAL Z GQ VALIDATION V
DATE ✓ [�s
License NumberLic. Class_p�
FINAJ O
Contractor Date BY
LU
I am exempt'under Sec H
B &P C for this reason
Plan check fee
Date PLUMBING PERMIT ISSUING FEE$- 19638
Signature _ _
TOTAL FEE .
0 oio,o,o 5
Plan check applicant )o o f 650
SINGLE FAMILY ; Q HOME OWNER-BUILDER DECLARATION Nome, o 0 o 1 451 8 -
I hereby affirm that I am exempt from the Contractor's License Address
Law for the following reason (Section 7031.5, Business and
Professions Code)- City 'Tel. No
❑ I, as owner of the property,'wi I I do the work and the.
„
No-
' is not intended or offered for sale (Section. pop.
•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-1 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
outhonz repr sentotives of this•County to enter upon the
ab ve enti d prope ty for inspection purposes
SEER-EVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date ;