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HomeMy Public PortalAbout5534 HALLOWELL AVE_Plumbing__ D.B.S.-17 25M SETS 12-45 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ��� ' WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRI. T NO. GROUP Z NE PERMIT NO. ROUGH FIXTURES COMPLETE J/ / �/0 � / HEATER _ CESSPOOL -I SEPTiC TANK RECEIV BY READY FOR DATE.ISSUED _ F ST INfSP,ECTPON GAS MISCELLANEOUS s APPLICANT JFILL IN HEAVILY OUTLINED PORTION 'ONLY JOB tY NAME ADDRESS W m ADDRESS S o (j �/Y'//GGLGb t� LOCALITY .J LZ A I• 7�dl b NEAREST OJ. _ CITY �J TEL.No. � CROSS ST. COUNTY , CERT.NO. EXPIRES iK NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z_ MAIL1/ NORTH O ADDRESS --30 r) CITY TEL.No.;4 d`6 7 IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMERR I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. (� OWNER CORRECTIONS SOUTH DESCRIPTION OF WORK ATH TUB FURNACE � ROWER DISHWASHER AVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER -:-MOOR SINK 'RAND TRAP LOP SINK FLOOR DRAIN O WASH TRAY URINAL APPROVALS )�f WATER CLOSET DRINKING FOUNTAIN DATE tNerHeTORJNUAMa J—!WATER HEATER DENTAL LAVATORY ROUGH PLUMBING -.2-4"k I �, METER.-_"F GAS SODA FOUNTAIN OUTL GAS PIPING GAS VENT b¢All 4 (- (� CESSPOOL TdVTAL NUMBER OF FIXTURES A�le� �. SEPTIC TANK CESSPOOI!,,;� SEPTIC TANK SEWER O m UTILITY CO.NOTIFIED TOTAL FEE fir FINAL ?/> D.B.S.-17 25M SETS 12-4:5 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ' COUNTY OF LOS ANGELES `UB' WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP /Zc/�JONE1 PERMIT NO. ROUGH __ FIXTURES _I COMPLETE /Z4 ONE REG, IVED BY READY FOR DATE ISSUED HEATER CESSPOOL SEPTIC TANK !D n FIRST INSPECTION ®,/ GAS MISCELLANEOUS `! .�JY Immm, �r �^ APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB E NAME Ay ADDRESS W +� B ADDRESS �4, /le LOCALITY I Al -1 NEARE8T IL CITY a TEL o CROSS BT. COUNTY CERT.No. EXPIRES C NAME W LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRESS J NORTH O CITY :TEL. No. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OFn QUALIFICATION. PLUMB,HjI I AM THE LEGAL OWNER OF THE PROPERpJf= DESCRIBED ABOVE. ~ yA s -4 , OWNBIt CORRECTIONS A 2 �Y SOUTH �' a DESCRIPTION OF WORK I ATH TUB FURNACE M SHOWER DISHWASHER LAVATORY REFRIGERATOR KITCHEN SINK" WATER SOFTENER FLOOR SINK SAND TRAP LOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME , WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I METER GAS SODA FOUNTAIN GAS PIPING I ! OUTL GAS VENT CESSPOOL ��✓ TOTAL NUMBER OF FIXTURES SEPTIC TANK I Y CESSPOOPEPTICTANK OV SEWER !S ' 1 UTILITY CO.NOTIFIED I TOTAL FEE ! I a FINAL WbRKERS'COM1 20-0026 PENSATIOJI DECLARATION PW 4/87 APPLICATION FOR PLUMBING PERMIT ^ I.hereby,:affirm that I have a certi6icate of consent to self in- 76A667A sure,or a certificate o,{Workers'Compensation Insurance,or a CE 817(REV. 8/86) 'lUl eertified coley thereof (Sec. 3800, Lab. C.) ' COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS .Policy No. Company �- Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 3 1 b el a 'Certified copy is filed with the county building inspection ADDRESS (( department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY W J2 Date Applicant I WATER CLOSET(TOILET) Q© NEAREST L� I CERTIFICATE OF EXEMPTION,FROM WORKERS' I BATH TUB cod 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.) Z LAVATORY ADDRESS ag E, I certify that in the performance of the work for which this per- I SINK • d � � mit is issued, I shall not employ any person in any manner so CITY ip Uc EL. NO. as to become subject to the,Workers' Compensation Laws DISHWASHER Vc J Date Applicant �w� K�r� �tC� , CLOTHES WASHER CONTRACTOR f7� NOTICE TO tion, you should LICANToubecome subSWIMMING POOL RECEPTOR: If, after making this Certificate.of Ex-ect to the WorkersADDRESS em hld bj 'Comen- P Y I P CITY +u 1 �1 TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM / !•b ly with such provisions or this permit shall be deemed revok- STATE f� LIC. ed. WATER HEATER LICENSE NO. t�j V CLASS LICENSED CONTRACTORS DECLARATIONDISTRICT NO. P CESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER .and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL r/+ VsALIDATION fe DATE `. , h_. = License Number Lic. Class O -•-• a p•'� FINAL A, `a ContractoatQl--615-4) Date 3113L<lq BY L.3:i7 itti.r�3,_(� F] I am exempt under Sec. i 1TrE Iv W !3J B.BP.C. for this reason9Z Plan check fee ► TI!;AL 46 - 502 Date: - PLUMBING PERMIT ISSUING FEED CHECK 46.50 Signature TOTACTEE CHANGE ; } a ' SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 1 hereby affirm that I am exempt from the Contractor's License Name �(� �C` :lla��—f ;11?a _,V 14/6 Y Law for the following reason (Section 7031.5, Business and "^ ut Professions Code): Address tq— F-- V?-iVA i>: 1 A € Y a i i I, as owner of the property, will do the work and the City 1AA +�V Tel. No.s�g 336, Y' 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-me.tionedproperty for inspection purposes. — 3/l31b� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of.Permittee Date