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Home My Public Portal About4837 HALLOWELL AVE_Plumbing__ 7GA667-CEB17-11-57 ' APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County. Engineer ADDRESS CASSATT D. GRIFFIN, Sup t of Building y FOR APPLICANT TO FILL IN NEAREST �� _ �- JS NUMBER FIXTURE OR ITEM CROSS ST.40, JQ WATER CLOSET OWNER 4,SG �`�JC� (r. BATH TUB ADADRESS, /;i4 1-V U YV777- t L SHOWER CITY �i7' TEL. NO. 3 LAVATORY CONTRACTOR t7 SINK ADDRESS DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT N� GROUP ZONE READY FOR INSPECTION I WATER HEATER " GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD APPROVALS @ $1.00 PER ITEM - DATE 1 SPECTOR'S SIGNATURE OR FIXTURE $ UNDER SLAB WORK PERMIT $ 00 ROUGH PLUMBING TOTAL FEE GAS PIPING, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND•STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO:NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE OF PERM 117EW FINAL ROBERT A.WOOD. t ®r VALIDATION SUPERVISING MECHANICAL ENG'R s CK. H.O. CASH rCo3379r MAR8.00 APPLICATION FOR 'PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING .3 � 11A ]!OHN A. LAM T- %—ly En eea _ CASSATT D. GRIFFIN, 3nD t ofnildia8 LOCALITY % �G FOR APPLICANT TO FILL IN N`ARmo Ei v NUMBER FIXTURE OR ITEM CROSS OWNER.6- SC F WATER CLOSET �j p �/� BATH TUB, AMAIL RESS T b 3 SHOWER CITY �/7JPL (, T Z TEL NO. .�/^ AQG 3 LAVATORY CONTRACTOR n i SINS ADDRESS DISHWASHER CITY TEL. NO. LAUNDRY TUB CONTRACTOR'S STATE ❑ REGISTRATION NO. COUNTY El CLOTHES WASHER DISTR Y GROUP ZONE READY FOR INSPECTION WATER HEATER `. GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD„ fig rl APPROVALS dal $1.00 PER ITEM D �, DATE INSPECTOR'S SIGNATURE OR FIXTURE UNDER SLAB WORK PERMIT 00 ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLICATION GAS VENT - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES _ 1ICHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. NATURE F PERMIT'TE L"'�'F � / ! FINAL ' ROBERTA.WOOD. ®F _ VALIDATION SUPERVISING MECHANICAL ENG'R CK. M.O. CASH ' L 2,6 8 6 A FEB 2 5 A 3.0 O M VtT WORKERS'COMPENSATION DECLARATION 76A667AZ f`` , I hereby affirm that I have a' certificate of consent to•self cE 617 (2-90) A P P L I C A T,I N F O PLUMBING PERM,I T , insure, or a certificate of Workers'-Compensation•Insurance,or a a certified copy thereof(Sec. 3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING"AND SAFETY . Policy No.-• Company _Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING g ADDRESS �3 jECJe-M Certified copy,is filed with the county building•inspectron NUMBER. FIXTURE OR ITEM FEE department. LOCALITY- WATER CLOSET Date' Applicant NEAREST- BATH TUB CROSS ST.AX>&I CERTIFICATE OF EXEMPTION'FROM WORKERS" COMPENSATION INSURANCE' SHOWER OWNE �, I� .� LAVATORY, MAIL } (This section need not .be completed 'if the:work involved T ADDRESS O by the 'permit is for one hundred dollars ($100) or less.) SINK 'tee TEL. N U CITY m.� �1 ,d-' / I certify that in the performance,of the work for which this ' DISHWASHER r�/ � ;O permit is issued, I shall not employ any person in any manner CONTRACTOR. tv W so as to co a subject to the- orkers' 'o pensatio Laws. CLOTHES WASHER • ADDRESS Date' ZApplicani SWIMMING POOL RECEPTOR- d NOTI E T APPLICANT: If, after making this Ce ate o CITY TEL. NO. (n .Exemption, you should become-sub'ect to •the' Workers I LAWN SPRINKLER.SYSTEM - p 1 STATE LIC. 'Compensation provisions-of the Labor Code, you must forth- LICENSE NO. CLASS- with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER �1. 0� I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3.of the Busi- FINAL ness and Professions.Code, and my license is in full force and DATE VALIDATION'. effect. , FINAL � License Number Lic.Class BY Contractor• Date I am exempt from the licensing requirements as I am a' Plan check fee licensed •architect, or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ' acting•in my professional capacity,(Section 7051, Bus- ; mess and,Professions Code). TOTAL FEE Lic.or Reg',No. Date Plan check'applicant HOME OWNER-BUILDER DECLARATION Name I, herebyaffirm that I am exempt ,from the Contractor's Address License Law for the following reascn'•(Section 7031.5, B-usi- City' Tel.No. ness•and Professions Code): ; I, as'owner of the property,-am exclusively contracting ,r ' with`licensed `contractors to ,construct. the ,project p (Section 7044, Business and Professions Code). �i4 1 ca 3 A CONSTRUCTION LENDING AGENCY #'0 0.0,0 o,5 I hereby affirm ,that there is a,construction lending agency 20;0 i 5 0: , for the performance of the work for which this•permit is , issued,(Sec. 3097,Civ.C.). G 0,01,2,505' Lender's Name Lender's Address , `6 0.1 —'8 2 I certify that I,have read this application and state that the above information is correct.I agree,to comply with all County SEE'REVERSE'FOR EXPLANATORY LANGUAGE , ordinances and State laws regulating Plumbing, and hereby authorize representatives of,this County to enter upon the a ove=mentioned pr erty for inspection purposes. Signature of Permittee Date -