HomeMy Public PortalAbout6312 GOLDEN WEST AVE_Plumbing__ 76A667 -CE4617 4-64
'APPLICATION FOR PLUMBING PERN�
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COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS T.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER O r e
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS `-
SHOWER 1.25 CITY TEL. NO
LAVATORY 1.25 CONTRAC OA
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
LAUNDRY TUB 1.25 CONTRACTOR'S STATE ❑
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT Nq� G P Z E O E BY
WATER HEATER 1.50 C
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL n
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 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 HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF -
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE A VE DESCRI D RESIDENT AL PROP RTY. . UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTE
VALIDATI ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
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76AGG7•CE#817 4-64 /f
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS (Cj
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY '}'
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. 43 Y-,
NUMBER FIXTURE OR ITEM EACH FEE OWNER
WATER CLOSET $1.25 O MAIL
BATH TUB 1.25 ADDRESS Q Q
SHOWER 1.25 CITY 1 TEL. NO.
LAVATORY 1.2S CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL.
RIM—CONTRACTOR'S STATE ❑
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE CESSED BY
WATER HEATER 1.50 , /q f
GAS SYSTEM OUTLETS 1'50 INDUSTRIAL ELO
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
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W
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APPACIVAL5 I?ATg INSPECTOR'S SIGNjtTURk
PERMIT S 2 00 UNOE B WORK 'Alv
ROUGH PLUMBING V, 2 " ° s. 1
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS AP LICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT ` I►/j r ''
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER -
LRFSIDE
HE
CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
S REQUIRED BY LOS ANGELES COUNTY AND STATE OF
OR THAT i AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
ME ABOVE D RIBED RE I NTI(.L PROPERTY. UTILITY CO. NOTIFIEDE /�ITTEE��
FINAL
VALIDATIOROBE T A. WOOD
CK. M.o. CASH ) SUPER ISING MECHANICAL ENG'R
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X 4 9 9 4-0. OCT 19 5 0 9.5 0—
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yWORIERS'CQMPENSATION DECLARATION APPLICATION- Dpw 4/� ��R PLUMBING PERN�IT
I hereby„affirm that I have a qertlflcate.'gf consgnt to self 7p- �76A66TA
sure,or a,c6rtIfIcQte of Workers'Compena iFo Insur nce; CE 817(REV.8/86)
cerdlf(ed copy thereof (Sec. 3800, Lab
:COUNTY OF LOS ANGELES: DEPT. OF PUBLIC.WORKS
Poll No Com -
❑ If s hereby fumished. ,
FOR APPLICANT TO`FILL IN (PRINT OR TYPE) BUILDING.JI
Ceftifled copy'(s filed with the t6urt btilldinfl Irispbctlon ADDRESS
de nI.y. NUMBER FIX1'l1RE OR ITEM FEE LOCALITY �
Pate AppilcaTit WATER CLOSET(TOILET) NEAREST
LA
RyIFIC.P�1�E OF DOATlbN F RKERS', BATH-TUB
CROSS ST.`.
-COMPENSATION INSQ CE SHOWER OWNER
(This settlors' no+be.ccrt�pleted. the work-involved by MAIL
-t irmM.fs_ r ori*hundred dollars ($100)or{Mr.r LAVATORY ADD��,
I c'ertlfy That In-tli fl. Ge of tie work for which thli Par-' SINK.. C
mit Is Issued, l;holt not employ any person In any ih5dnner to Jwl
-
ITY Na?
as to become sublect to the Workers'Compensation Laws` DISrIWASF�R
Dgte Applicant CLOTFI ES WASHER
ADDTJOTICE TO AIiPU�ANT: If,alter mbkin9 tlil�Certificate of Ex- RE i
SWIMMfNG POOL RECEPTOR
am' Rtlon,yoy'shgyld become sublIect'to the Workers'Compen- a-TY >$
satlon provisions of the'Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM .
ly-wgtfl such provlslons'or this,permit shall bb deemed-revok- STA UC-
ad..
C
ed: WATER HEATER LK3FTJSE NO. CLASS to
LICENSE CON7RAC%ORS DECLARATION .. DiSTR1CT D BY
GAS SYMM OUTLETS
1 hereby affirm that I am Licensed under'{u-oYl:loru'of Chapter. L
9(commencing with Section7000)of Division 3 of-the Business SOUTLETS r M
and Profeulons Cod Q, and my llcense Is In full forte end of- FINAL �-
fect.. - _ �(AL TION
DATE r
Llc umber Lla.'C16ss [V�
FIN O
r ' Date ' BY
( ❑ I aril b mpt and LLI
BAP• ..for this bason r Plan check fee
a
Dote.-- . ►
PLUMBING PERMIT ISSUING FEE$
Slig"ture -
S TOTAL �U
SIW,- E'FAMILY
HOME OWNER-BUILDER RE>`l WTION Plan check appllca[it'
-2
13Q
3A
I herj�y affl(m that I am exerhpt froNfLq Contractor's License Nome
Law ibr the fol-lowing reason (Sectlorr, 331.5, Business and # bl� 00a Jr
Professlons Code): Address '
�{ I, as owQar of the property, will do,the work and the City. Tel. No. 1 6 1 650
structure lsn t intended or offerbd_fbr sale(Secllgn 7044, o 0 0
'1 &506-
Business ar�d-Rfofeul as Coda). }
C0NSTRQtTIQN LENDING ACENCY r
1 hereby tr{flrm that there Is a,tonstfyctiori lending ogenSy for z
the”performance-of the work for which'this pawnit Is Issued -
(Sdc,.3097, Cly. C.).
Lender's Name
Lenders Address
I certify that. I}opve reed this appllcaflon and state that the f
above Informatlgn Is correct l agree to tamely wltl�all County 1
ordinances and State laws rggylotlnp Plumbing, and hereby
authorize.r ntatives hls County fo enter upo the
abov noon pro Inspection pu,rpoiers
q/ SEE REVERSE.FOR EXPLANATORY LANGUAGE
Sip re ifWr1nhte.
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