HomeMy Public PortalAbout6257 GOLDEN WEST AVE_Plumbing__ [D.B.S.17 ZS" SETS 2
-47 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ��������
COUNTY OF LOS ANGELES 1
WM. J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE _
HEATER 1-1 RECEIVED BY READY FOR DATE ISSUED
CESSPOOL SEPTIC TANK FIRST INSPECTION
GAS- MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
G JOBAD
DRES®
W
m ADDRESS
LOCALITY
-IT ? NEAREST
y CITY TEL.No. / / CROSS ST.
COUNTY
CERT.No. el'yQ EXPIRES ICNAME
LOCATION OF SEPTIC TANK, OR CESSPOOL 3 M'DRE88 /
NORTH O
CITY TEL.No.
1 AM THE LpdAL POSSEPOR OF THE ABOVE LOS
ANGELES COUN7Y CERTIF CA OF QUALIFICATION.
PwMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
to ABOVE.
W D
3 OWNER
CORRECTIONS
.6
SOUTH w
J
DESCRIPTION OF WORK a
f
Z_
BATH TUB -FURNACE E3
[Y
SHOWER DISHWASHER 13
—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 HEATER DENTAL LAVATORY
ROUGH PLUMBING
-METER--:—GAS SODA FOUNTAIN GAS PIPING
OUTL !
GAS VENT II i
CESSPOOL
TOTAL NUMBER OF FIXTURES
SEPTIC TANK
-'� CESSPOO] SEPTIC TANK SEWER
UTILITY CO.NOTIFIED
I
TOTAL FEE
FINAL
o.e.s.17 25,1 SETS 2-47 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ������
COUNTY OF LOS ANGELES G
Wm. J. FOX. CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GRoula ZONE PIIRMIT NO.
ROUGH FIXTURES COMPLETE RECEIVED BY -
READY FOR DATISSUED
HEATER CESSPOOL I-I SEPTIC TANK _ FIRST INSPECTION
AS MISCELLANEOU 6" /
APPLICANT FILL. IN HEAVILY OUTLINED PORTIION ONLY
JOB
It NAME _ ADDRESS
W
m
ADDRESS LOCALITY !'
E
D NEAREST
CITY TEL.No. 1 CROSS ST.
COUNTY
CERT.No. EXPIRESIr
NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL a MAIL
3 ADDRESS
NORTH O
CITY TEL.No.
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
E
ANGLES COUNTY CERTIFICATE OF QUALIFICATION.
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
�ry ABOVE.
Ili D
3 i OWNER
CORRECTIONS
SOUTH
J
DESCRIPTION OF WORK Q
z
BATH TUB FURNACE
SHOWER DISHWASHER p
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
GLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN
DATE INSPECTOR'S NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I
METER GAS SODA FOUNTAIN
OUTL 6A9 PIPING
GAS VENT I I
CESSPOOL I I
TOTAL NUMBER OF FIXTURES SEPTIC TANK I I
. -CESSPOOI SEPTIC TANK SEWER
S
UTILITY CO.NOTIFIED
TOTAL FEE i
FINAL
I hero670aRffirmRStOMPS�TIONflD�ECLiFdk�IObf o ����ai�" (APPLICATION FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.38Q0,Lab.C.) 7/ �/ BUILDING AND SAFETY
COUNTY OF LOS ANGELES
Policy No._Company
Certified copy Y hereby furnl#hed. FOR APPLICANT TO FILL IN (PMNT OR TYPE) BUILDING
ADDRESS G Z 7 �OLO�- -'t C
Certified copy Y NUMBER FIXTURE OR rrEM FEE flied with the count?building inspection LOCALITY
department. WATER CLOSET
Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' OWNER
COMPE14SATION INSURANCE I SHOWER Ilk
I
MAI L,
(Thio sectlon need not be Com leted it the wprt b�otred LAVATORY ADDRESS M'
by the permit is for one hundred dollars ($100) or len.) SINK C I TY G TEL. N O.
I certify that in the performance of the work for which this DISHWASHER
permit Y twued, I ah&H not amp any n in any manner CONTRACTOR
w m me sub)ect to 6rs' �►nlation Laws. CLOTHES WASHER
�5;
ADDRESS
y�Datp App - `" 8WtTAMING POOL RECEPTOR
NOTIC -TO APPLIC : If, after making this Certificate of CITY t) TEC.NO. W
Exemption, you should become subJect to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. 0-
Compensaflon provisions of the Labor Code, you must forth- WATER HEATER LICE NO. CLASS Z
with comply with such provisions or this permit &hall be DISTRICT NO. PR CESSED BY
deemed reroy ed. OAS SYSTEM OUTLETS
LICENSED CONTRACTORS DECLARA'T'ION OUTLETS OVER O
I hereby }ffirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commenctgg with Section 7000) of 1?tviston $ of the Buri, D�
FINAL
near and Profwsiom VALIDATION
Code, and my license Is in full force and DATE V—(
effect.
FINAL
License Number Lic-Cissa- - - BY r
Contractor Date
I ■m exempt tram the licensing requirements as I am ■ Plan check fee
licensed architect or a registered profeadonal engineer PLUMBING PERMIT ISSUING FEE_
acting in my professional capacity (Section 7051, Bus- `
lness and Professions Code). TOTAL FEE V
Llc.or Re(.No. Data Plan chsok applicant
(� HOME OWNER-BUILDER DECLARA Nems
I hereby affirm that 1 im exerftpZ-tromthe Contractor's eddy l/ �i+C7 � ���� �✓V
License Law for the following reason (Section.7031.5, Busi- Cky Td.No. 0
nee and ProfeWons Code):
;14723A
1, as owner of the property, am excluah+ely contracting
with licensed contractors to construct the proPKt # 0 ro 0 0 0 5
If (Section 7044, Business and Professions Code). 2 002
'. . .. I .0
CONSTRUCTION LENDING ApENCY
I hereby affirm that these is ■ construction lending agency o 0'0 2,4 5 0 6
for the performance of the work for which this permit Is
issued(Sec.3097,Ctv.C.). 7. 0 1 8 2
Lehder's Name
Lender's Address
I certify that I have read this application and state that the
abo information is correct.I agree to comply with tII County
ord ances and State 1 regulating Plumbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE
au orire representatty of this County to enter upon the
ab mentio pro for inspection purposes. t
of Perml ee Date