HomeMy Public PortalAbout10244 GREEN ST_Plumbing__ 76Aee7'(Cf--817) - 8/73 ' -
I � 1 •
APPLICATION F PL-U I.NG PERMIT
COUNTY OF LOS ANGELES I
DEPARTMENT OF COUN'T'Y ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: BUILDING
ADDRESS
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY. Lt - , 4'
FOR APPLICANT TO FILL IN (PRINT 04 TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM • FEE /�
WATER CLOSET
1.75
- OWNER LL P,
MAIL rt,
BAT}i TUB T.7b ADDRESS
SHOWER 1.75 CITY^ TEjN
LAVATORY 1.75 CONTRACTOR
SINK 1.75 ADD { -�
DISHWASHER 1.75 CIAI- I TE
CLOTHES WASH-ER 1.75 STATE 410ENSE N0. S
SWIMMING POOL RECEPTOR 1.75
b1 T`N0. �yG PRO `ESSEb Y
LAWN SPRINKLER SYSTEM 1.75 (d
WATER HEATER 1.75 W�TE APAPROVAL II.
GAS SYSTEM OUTLETS 1.75 INSPECTION BEC 05 D S
OUTLETS OVER CC
6 PER SYSTEM. .30 1
W
f1
Plan check fee SM Reverse
PLUMBING PERMIT ISSUING FEE 8 3 00
TOTAL FEE
APPROVALS DATE ■rccTOKe 514NAruKc
Plan check applicant UNbE I It
Name ROUGH PLUMBING S 16*S
Address GAS PIPING
City Tel. N0. GAS VENT
HOT WATER HEATER
I HUREBY ACKNOWLEDSE THAT I HAVE READ Pry 16 APPLICATION
A14
D STATE THAT THE A40VK Il C.ORRIZCT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATIMS
PLUM BIN
a., GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR UTILITY CO. NOTIFIED J
LICENSED AS REQUIRED BY LOS AMGELES COUNTY AND STATE OF
CACI FORNIA 011 THAT I AM THE LEGAL MER OF, AND INTEND TO '
RESIDE IN THE ABOVE DESCRIBED REDID T L ROPERTY. FINAL
SIGNATURE
Or7 PERMITTEE
PERMIT VALIDATION CK. M.OFjCASH
PLAN CHECK VAL TION CK. M.O CA
�, 1.29 L 1 1 6 6.50w%
78AB87�E817$-57
APPLICATION FaR PLUMBING PERMIT 1
COMM OF LOS ANGELES
DEPARTbM T OF COUNTY ExGl 11
]trUMDING AND SAFETY Drvmox FBUILDTUqG02JOHN A. LAMBIE, COUNTY ENGINEERC 8GATT D. GRIFFIN. SUP OF BUILDING TeIA-DIO CityFOR APPLICANT O FILL
NUMBER TIXTURS: OR ITQM
WATER CLOSET owxEa Z.argWOOd CoI>e
BATH TUB ADD Egs 912 Yallambro8a-
SHOWER. crrY ' Pasadena m xo.
XAVATORT oonracmiRiahard Cavaiiatgh Plumb,.
enfz ADDRESS 15354 Central Ave
DUlHWABHER C=y Chino TEL xd+Y 8-4921
LAUNDRY TUB CoNTRAqroH^s
TIO^x0. 15164 C--36STATE
CLOTHES WABHE� I DISI CT NO. G z¢N` IRuDY Fb7 impriE IOX
WATER HEATER //�
GAS$TBTEM 110UBTRM
WABTE o
ox
,A
APPROVALS
51, 0 m nmm DATE INSPECTOR'S Sj4NArURE
9 OR FIrrM s 9 UNDER SLAB WORK
PERMIT $ 11 00 ROUGH PLUMBING
GAp PIPING
TOTAL FEE 4AS PENT
I HEREBY- ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEAT[R
AN STATS THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LUMEIING FIXTURES
PLUMBING. r
4 HEREBY CERTIFY THAT I AM -PROPERLY REGISTCRED AN R GAB TaBT
L
ED AS REQUIRED BY LOS ANGELES COUNTY AND ST OF '
RMjA dR THAT 1 A THE LEGAL OWNER OF TH ABOVE UTILITY CO. NOTIFIED
BED RESIgBN
T{.IRE MI FINAL
SROBERT A. WOOD,
OON i
A SUPERVISING MECHANICAL ENG'R
.L[. ■.P. CAI
2263OR MAR24 . 3 A 1Q.00 9
��o
vrORKFRS'COMPENSATION DECLARATION 20-0026 DPW 4/9D APPLICATION FOR PLUMBING P E RM I T
I.hereby, affirm that I have acertificate of consent to self In- 76A667A
sure,or a certificate of Workers'Comperuatl Insurance,ora
certfflthereof Company 38(X}, La
Policy �
Is'-_" COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
C ertffled copy Is hereby furnlahed. //- 4,3
FOR APPIJCANT TO RLL Ito (PRINT OR TYPE) BUILDM -7
n_Ca tfied copy Is fl led with the c bullding Inspection APES !— T I
'�'�epartment. NUA�BER �OR SEEM 0 FEE 'LOCALITY
Date / IlcanWATER CIOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM,W0 S' BATH TUB CROSS ST.
COMPENSATION INSURANCE OWNER
SHCWER
(Th Is section need not be cornpleted if the work I..v04 d br MAIL
the permlt Is for one hundred dollars (;100)or less.) LAVATORY ADDRESS
I certify that In the performance of the work for which this per- SINK CITY
mit Is Issued, I shall not employ any person In any manner to
as to become subject to the Workers'trompensation.Laws. DISHWASHER
CON'T'RA(.-TOR
Date. Applicant CLOTHES WASI-ER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption,you should become subject to the Workeri Compen, LNG POOL TOR CITY
satlon provisions of the Labor Code,'you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provlslons or this permit shall be deemed revok- STATELIC
ed. WATER HEATER UCBISE NO. <NN CLASS
LICENSED CONTRACTORS DECLARATIONDISTRICT NO. pROCESSEb BY
I hereby affirm that I am licensed under provlslbns of Chapter CAS SYSTEM OUTLETS
9(commencing with Section 7000)of Dlvlsloo 3 of the Business CXfTIErS ODER
and Professions Code, and my license Is In full force and ef- BIB FINAL VALIDATION h
fect. l� HOSE
License Num Llt. ClassLL�
� FINAL V
Contractor Date ID BY T
1 am exempt under Sec. U
B.BP.C. for this reason Plan check foe w
Date: ,
PLUMBING PERMIT ISSUING Fes;
Slgnature TOTALS 6EE
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION- Plan check applicant -
I hereby afflrm that I am expmpt from the Contractor's License Name r` -
Low for the following reason (Section 7031.5, Buslness and
Professlons Code): Address
❑ 1, as owner of the property, will.do the work and the CIty Tel. No. '
structure Is not intended or offered for sale(Sectlon 7044,
Business and Professions Code).
CONSTRUCTION LENDING AGENCY, t _
I hereby affirm that there Is a corutructlon lending agency for I the performance of the work for which this permit Is Issued = �.M+=.=r•
(Sec. 3097, Civ. C.). - • '-
Lender's Name
Lender's Address
I certify that I have read this appJlcatlon and state that the ,
above Information Is correct. I agree to comply with all County
ordinances a e laws regulating Plumbing, and hereby
authorize re taTlves of this County to enter upon the
above- en n roparty for Inspection pu
/5 7Z SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Daft