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HomeMy Public PortalAbout4923 HALLOWELL AVE_Plumbing__ 76 A 6.657 CE 817,8/68 - • APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ADDRESS BUILDING AND SAFETY DIVISION JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY ZMPLe ' FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH 41EE _ OWNER WATER CLOSET f'5 5 MAIL ' BATH TUB 150 "� ADDRESS SHOWER AS CITY - TEL. NO. LAVATORY 1. 0 - CONTRACTOR i SINK 150 ADDRESS -32-7 DISHWASHER 1. 0 7 CITYCy L -� TEL. NO. _ CLOTHES WASHER 1. 0STATE LIC LICENSE NO S 3 © CLASS 5-1 SWIMMING POOL RECEPTOR 1. 0 DISTRICT NO.J�x P ZONE PROCESSED BY a LAWN SPRINKLER SYSTEM 2. 0 S�� WATER HEATER 1. 0 INDUSTRLAL WASTE APPROVAL GAS SYSTEM OUTLETS 1. 0 INSPECTION RECORD U Lu OUTLETS OVER a- 5 PER SYSTEM .30 Z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 � 00 ' TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicanL UNDER WOR Name ROUGH PLUMBING Address 53 GAS PIPING �j� GAS VENT CILy Tel. N "' HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION "AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST ,I�'j f '� PLUMBING. - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED- LICENSED AS REQUIRED BY LOS ELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL NER OF,AND INTEND TO 04 RESIDE IN,THE V DEYC �D REBID NT L P PE RTV. FINAL SIGNATURE JACK R. ALLEN, SUP RV 'RINGCHANICALENG'R OF PERMITT EPERMIT VALIDATIOM.O. CASH PLAN CHECK VALIDATION CK. M O. CASH -LAC,o 2 4 3:6. 2 n .D 1 5~ • WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT i hereby afftrrim that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) qr ct certified lcopy thereof (Sec 3800, ab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N ompany Certified copy is hereby furnished. • ;FOR APPLICANT TO FILL IM(PRINT OR TYPE) BUILDING Certified copy is filed with-the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date, ` Appliganl 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 ($100)or less.) LAVATORY , ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINKCIT TEL. NO so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS l _ NOTICE TO APPLICANT If, after making this Certificate'of SWIMMING POOL RECEPTOR Exemption, -you should become subject to the Workers' A24/ Compensation provisions of the Labor Code, you must forth- CITY TEL N LAWN SPRINKLER SYSTEM Adil with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASSe LICENSED CONTRACTORS DECLARATION -. DISTRICT NO. OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS [^ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ` J and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL DATE may• VALID TION 4 License Number qovhqLic. Class- 1 7 � � �^C FI 0 Contract ocJ IC `• Date ✓ U ❑ ra f I am exempt under Sec L l V B.BP C. for this reason 2107,2A Z Plan check fee ' e # 0,00005 Dat PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Sv o'o3Q,50 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 q Q Professions Code) City Tel. No ❑ j, 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 ) /�j—� Lender's Name "�� Lender's Address I certify that I have-read this application and state that the pool information is correct. I agree to comply with all County ordinances and State jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- nhopr er y for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date