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Home My Public Portal About4902 HALLOWELL AVE_Plumbing__ 76 APPLICATION FOR I'LlJI�9 BIND •PERMIT DBS-17 lo•SS•17 DIVISION OF BUILDING AND SAFETY : Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS .G CA_SSATT D. GRIFFIN,SUPT OF BUILDING LOCALITY FORPPIJCANT TO FILL IN NEAREST CROSS ST. OWNER l lyY DISTRICT NO. GROUP"',, ZONE READY FOR INSPECTION MAIL ADDRESS 'O INDUSTRIAL CITY TEL. NO., WASTE APPROVAL: PLUMBER INSPECTION RECORD ADDRESS CI TEL. N LICENS O ILK /6 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 BATH TUB @ $1.00 - SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ ;$1.00 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 L APPROVALS. DATE INSPECTOR'S SIGNATURE I UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT'THE ABOVE IS -CORRECT AND' AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I 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 THE GAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED_ ' DESCRIBED •RESIDENTIAL OPE Y. SIGNATURE OF PERMITTEE FINAL JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR CK. E!.0. - CASH LIQ h �, MAY 17 3 2.0 0 .76A6 y V 81�"570 •" �`�� _�L� '-� v APPLICATION FOR PLUMBING PERMIT . COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W: JENKINS. SUPT OF BUILDING LOCALITY CT i FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST / CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER, /CJ_ WATER CLOSET .50 MAIL BATH TUB .50 ADDRESS SHOWER1. 0 CITY LAVATORY 1.5 CONTRACTOR SINK 1 0 7-5 ADDRESS / DISHWASHER .50 CITY •• TEL. NO�` CLOTHES WASHER - 1 5o STATE LIC �S / LICENSE NO. 6 CLASS SWIMMING POOL RECEPTOR 1. 0 DISTRICTN GROU ZONE P E 6D BY G.•`_ LAWN SPRINKLER SYSTEM 2. 0 WATER HEATER .50 WASTEAPPROVAL O GAS SYSTEM OUTLETS .50 INSPECTION RECORD V CUTLETS OVER 0 5 PER SYSTEM O IULN Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING 7 �.._- Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION , AND STATE'THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDIN ES AND STATE LAWS REGULATING GAS TEST ' PLUMBING. _ IHEREBY CERTIFY TH T AM PROPERLY REGIST ED D OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUN ND ST OF r i� CALIFORNIA OR THAT t A THE LEGAL OWNER AND I E TO I RESIDE IN,TH IBED RFS(IftVTIAL RTY. FINAL 7 - f .g-L + SIGNATUR PERMI EE JACK R. ALLEN, SUPERVISI ME�HA ICAL ENG'R. PERMIT VALIDATION cK. �o. CASH PLAN CHECK-VALIDATION cK M.O. CASH cc 6 2 0;,ZA t f1Y 23 .5 QN WORKERS'COMPENSATION DECLARATION APPLICATION FCR PLUMBING PERMIT I hereby Q}firm that I have a,certificate of consent to self 20-0026 DPW 6/87 rrlure,"or a certificate of Workers' Compensation I surance, 76A667A lul ora certiffii }d cop the reof (Pec 3800, La .) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Pol cy No to�mpany Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the co my b ildi pec - ADDRESS i tion deport a f. MBER FIXTURE OR ITEM @ FEE LOCALITY , Date App 11 a WATER CLOSET NEAREST CERTIFICATE OF EXEMP 10 FROM WORKERS' BATH TUB CROSS ST /hl-• COMPENSATI SURANCE OWNER (This section need not be completed if the work Involved by SHOWER il the permit Is for one hundred dollar's ($100)or less.) LAVATORY MAIL ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CIT TEL NO so as to•become subject to the Workers'Compensation Laws. -DISHWASHER CONTRACTO r� . Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT- If, after making'this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR - CITY TEL, NO Compensation provisions of the Labor Code, you must forth- ( - LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATELIC `'1 deemed revoked.- WATER HEATER LICENSE NO. CLA55 [.CJ LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY GAS SYSTEM OUTLETS p I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and m license is in full force and effect. 5 PER SYSTEM. FINAL DATE VALIDATION l ^Z -g VALIDATION. QQ License Number Lir. ,1:1 ? y U. FINAL I±. i oIr Con Rle.empt under Sec. ( r B.6P.0 for this reasonD" Plan check fee TOTAL z Date: PLUMBING PERMIT ISSUING FEE$ Signature - TOTAL FEE CHANGE AGE Plan check applicant -SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name (-if 4I , -0001 10'27/9'7 , I hereby affirm that I am exempt from the Contractor's License Address - �� i" rjCl e? Law for the following reason (Section 7031.5, Business and Professions Code) City Tel. No ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044,.Busmess and Professions Code) -CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the'perforrnance of the work for which this permit is issued (Sec 3097, Civ. C.) Lender's Name • Lender's Address I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State lows.regulating Plumbing, and_hereby authorize representatives of this Count to enter upon the v abo = ho d rprrfor in ' on purpos D SEE REVERSE FOR EXPLANATORY LANGUAGE cw��-A — . /W gnature of ermittee Dat