HomeMy Public PortalAbout4908 HALLOWELL AVE_Plumbing__ 76A667•CENS17 9/63 L h
< APPLICATION F'OR PLUMBING PERMIT
COUNTY OF LOS ANGELES u
DEPARTMENT. OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCA FOR APPLICANT TO FILL IN• NEARES
CROSS S .
NUMBER FIXTURE OR ITEM EACH FEE
OWNER'
WATER CLOSET $1.25
MAIL
BATH TUB' 1.25 ADDRESS
CITY: TEL. N• .
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS fQ
DISHWASHER 1.25, CITY' TEL. NO. o�/p'l�
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. 2,11 COUNTY ❑
CLOTHES WASHER 1.25 ^ DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1'50 INDUSTRIAL D_
WASTE APPROVAL Q
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 ' 00
UNDER SLAB WORK
ROUGH PLUMBING
TOTAL-FEE
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 2d' �'"•9
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. _
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA.OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED ID NTIAL PR UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL
LIDATION ROBERT A. WOOD
j' CK M O CASH SUPERVISING MECHANICAL ENG'R
L, X9256 rAR 5 D 3.50
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
❑ Certified copy is hereby furnished.
F-1Certified
APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec- NADDRESS
tion department. UMBER FIXTURE OR ITEM a FEE
P LOCALITY
Date Applicant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of 1!
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
CITY TEL. NO.
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION
DATE
License Number Lic. Class
FINAL
Contractor Date BY
❑ 1 am exempt under Sec.
B.BP.C. for this reason ►
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address
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, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance 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 laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date