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HomeMy Public PortalAbout6239 GOLDEN WEST AVE_Plumbing__ r 76A667-CE817 12/59 APPLICATION I=OR PLUMBI NCS ,PMI`s" COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADUIIDG BUILDING N��,SP nTY RMSION JOHN A. 1 OUNTY NGINEER . WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT-TO FILL IN, NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNEB WATER CLOSET _ Y BATH TDB ADDRESS 7 7 t . - _ •- CITY TEL, NO. 7,5w?5W SHOWER _ 6� LAVATORY CONTRACTOR IS SINX ADDRESS DISHWASHER - CITY TEL NO. T ' CONTRACTOR'S . STATE ❑ LAUNDRY TUB- REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP ZONE I PROCESSEP57BY WATER HEATER ' GAS SYSTEM! INDUSTRIAL WASTE APPROVAL INSPECTION RECORD- w s/ww1 P 1.0 P. ul " 1 � $1.00 PER ITEM OR FIXTURE APPROVALS DATE / INSPECTOR'S SIGNATURE PERMIT $ 00 rUNDER SLAB WORK TOTAL FEE I 2! ,,� ROUGH PLUMBING GAS PIPING _ I HEREBY ACKNOWLEDGE THAT I.HAVE READ-THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES -AND STATE- LAWS REGULATING PLUMBING. HOT-WATERER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES TY-AND STATE OF GAS TEST 4/ CALIFORNIA OR THAT I AM THE LEGAL WN R OF T8E ABOVE ` DESCRIBED RESIDENTIAL PROPERTY. �-- UTILITY CO.NOTIFIED p SIGNATURE OF PERM ITTE ®F . VALIDATION ROBERT A. WOOD. crt. M.0. CASH SUPERVISING MECHANICAL ENG'R 6 1• 74 %a r l✓ty � �j 5 d 1 7 .0 0 i CE 817(REV.6/78) ©s APPLICA ION FOR PLUMBING PERMIT COUNTY.OFEAAN ELES(OR 'FiNA U'UD12ENCSA�FoN FOR APPLICANT'TO FILL IN(PRINT OR TYPE) BUILDING :ADDRESS NUMBER FIXTURE OR ITEM ® FEE r LOCALITY, WATER CLOSET NEAREST BATH TUB CROSS ST a SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL NO DISHWASHER CONTRAClPgCIFIC INSTALLERS CLOTHES WASHER ADDRESS 10920 E. GRAN SWIMMING POOL RECEPTOR CITYTEMPLE 0 LAWN SPRINKLER SYSTEM STATE LIC- WATER HEATER LICENSE NO CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING 6 GAS VENT u �3 HOT WATER HEATER p® PLUMBING FIXTURES QA GAS TEST Plan Ch@CIC fee UTILITYCO NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDATION Name Address City Tel No IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 26 9.7 A THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES _ ,AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION V O O O O o 2 IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS _ REQUIRED BY LOS ANGELES COUNTY AND F CALIFORNIA OR THAT 1 A THE r- 2 A 0-1. 0.0 0 LEGAL OWNER OF.AND INTEND'TO DE IN THE A ESCRIBED RESIDE TIAL ' PROPERTY - S IGNATU OF PERMITTEE 0 2 1,3—7 9 , DI TR14T t� P O INDUSTRIAL (J WASTE APPROVAL 'n ."; LWbRKERS' COMPENSATION,DECLARATION ,APP.LI,CATION-.F, R PLUMBING*PERMIT , I hereby affirm that I have a.certificate'of,consent To self :76A667A f� " insure,or a certificate of Workers' Compensatio Insurance, - CE 817(REV WEI) or'a certi d copy thereof ( c,38 Lab. C ) ' COUNTY.OF LOS ANGELES BUILDING AND SAFETY; P-olfcy N pony El - , Certified copy is hereby furnished ' BUILDING -FOR APPLICANT TO FILL'-IN(PRINT OR TYPE)' ADDRESS Certified copy is filed with the county uil ing mspec- " tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date A IicanT WATER'CLOSET " PP NEAREST CERTIFICATE OF.EXEMPTION,FROM WORKERS'- BATH TUB, CROSS S7 COMPENSATION INSURANCE• OWNER SHOWER. (This•section need not be completed if the work Involved-byMAIL the•permit is for one'hundred dollars (;100)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-iri any manner SINK CITYTEL N so as-to become subject to the Workers'Compensation Laws. DISHWASHER �' r' CONTRACT R y. Date Applicant A' CLOTHES WASHER - ADDRE NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOLRECEPTOR Exemption, you should,"b ; W ecome subject to the Workers CITY TEL. NO Compensation provisions of the Labor Code, you mus t'forth- LAWN SPRINKLER SYSTEM (,�+'illi comply with such provisions or.this permit shall, be STA LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DIST ICT F4U P C SSED•BY til hereby affirm'that I am licensed under provjsions of Chapter 9 GAS SYSTEM 'OUTLETS - C!� (commencing,with Section 7000) of Division 3 of the Business OUTLETS OVER �, and Professions Code,and my-,license is in full'force d effect" 5 PER SYSTEM FINAL VALIDATION CL > 1 -2© DAT U, License Number` / 9 Lac Class U . FIN O ConiraCto Date16' F V I am exempt under Sec A - N BAP C. for this reason' Plan check fee pop.' Date � PLUMBING PERMIT ISSUING FEE$ tt1 Signature— TOTAL J 2 7 to•7 A TOTAL FEE �v . Plan check applicant $' o:0 0 0 0 5•. -SINGLE FAMILY HOMEOWNER-BUILDER DECLARATION ' t Name - � �' 30,50 I hereby affirm that I a'm exempt from the Contractor's License Address ° ° ° 3 0 5 0 Law for the following reason (Secti'on 7031.5, Business and Professions Code) City Tel. No0.71 6.1 8.4 ❑ I,•as owner of.the,property, will do the work and the I structure is,not mte'nded or offered'for sale (Section ' poll. ' .7044, Business and Professions Code) • CONSTRUCTION LENDING AGENCY .I hereby affirm that there is a'coristruchon lending agency for the performance of the work for which this permit is issued _ (Sec 3097,"Civ" C.) Lender,'s Name / t Lender's Address I certify that I have read this application and state,that the above information,is correct. I agree to comply with 611.County { ordinances and State laws regulating Plumbing, and hereby ,authorize representatives of this County.to'enter upon the abov en on d o erty for inspection purposes. SEE REVERSE,FOR EXPLANATORY LANGUAGE __kv S ature of matte , D'ate