The URL can be used to link to this page

Home My Public Portal About5547-49 HALLOWELL AVE_Plumbing__ 76A667A(CE817A) - 8/75 APPLICATEO OR PLUNnING PERMIT COUNTY"OF LOS ANGELES -DEPARTMENT OF-COUNTY-,ENGfiNEER BUILDING•AND SAFETY DIVISION FDDRESSNG"MAKECHECKS PAYABLE TO: HARVEY T. BRANDT, COUNTY ENGINEER ITY FOR APPLICANT TO FILLIN (PRINT.OR TYPE) NEAREST CROSS ST. FIXTURE OR ITEM @ FEE OWNER ° WATER CLOSET 14 MAIL BATH TUB ADDRESS NUMBER SHOWER Cd TY TEL. NO. LAVATORY CONTRACTOR SINK ADDRESS DISHWASHER CITY TEL. N0. CLOTHES WASHER STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR DISTRICT NO. GROUP E PR CESSED BY LAWN SPRINKLER SYSTEM w."''J" �.i WATER HEATER INDUSTRIAL WASTE APPROVAL . GAS SYSTEM :OUTLETS ' INSPECTION RECORD d OUTLETS OVER O 5 PER SYSTEM V 0. " V W 911. r{_ z 1 Plan Check fee See Reverse PLUMBING PERMIT ISSUING FEE TOTAL FEE _.-_ APPROVALS - DATE INSPECTOR'S SIGNATURE Plan check applicant ', UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. NO. • ' GAS VENT HOT W I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITHALL COUNTY. ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST '� f I HEREBY CERTIFY THAT I AM .PROPERLY REGISTERED AND/OR UTILITY CO. OTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATEOF - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO ------- RESIDE IN THE ABOVE SCRIBED RESIDENTIAL PROPE TY. FINAL ems' SIGNATURE OF PERMITTEE / o PERMIT VALIDATION CK. M.0. PLAN CHECK VALIDATION CK. M.0. CASH . . WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 20-0026 DPW 4/87 I hereby, affirm that I have a certificate of consent to self in- 76A667A sure, or ti certifinte of Workers'Compensation Insurance,ora CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company' . Certified copy is hereby furnished.. BUILDING v FOR APPLICANT TO FILL IN (PRINT OR TYPE) Certified copy is filed with the county building inspection, ADDRESS �. department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if the work involved by- MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS U — / I certify that in the performance of the work for which this per- { SINK / (� Tit is issued; I shall not employ any person in any manner so CITY �� TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER ' CONTRACTOR: Date Applicant CLOTHES'WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS en tion, ou should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR U VV P Y I P CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with-such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT PRo SSED�' I hereby affirm that I am licensed under prbvisions'of Chapter GAS SYSTEM OUTLETS (fl] 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALID TION fect. , DATE License Number Lic. Class 0 FIN Contractor Date BY fl Q I am exempt,under Sec. z 8 4 S.5 A LUB.&P.C. for this reason , # o;° ° 0.0 5 g Plan check fee - Date: PLUMBING PERMIT ISSUING-FEE$ i ) ) U ( ° ° 2 8 50 Signature TAL OTFEE o 0 0 2 8.5 0 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I 1.3.0-8.7 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5; Business and Professions Code): Address- I, as owner of the property, will-do the work and the City Tel. No. 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 t 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 her authorize representatives of this County to enter upon the a pve-mentioned prop or inspection purposes. �. n y�c� � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date . WORKERS'COMPENSATION DECLARATION- 2®I7 (�Lp �11/l o �11f1� 'fo�2fo�n/��T :d 20-0026 DPW 4/87 /i�1ll-1!-L� G�1 Il IIV FOR a IUJIIVII llG I!"1Sll�llV.Il I hereby,.affirm that I'have a certificate of consent`to self in-'' 76A667A sure or a certificate of Workers Compensation Insurance,ora CE 817(REV 8/86) ce[tifie copy':thereof (Sec. 3800, Lab C.) COUNTY OF LOS ANGELES _, DEPT. OF. PUBLIC WORKS. Policy No Company Q Certified copy is hereby furnished o r ' Py y. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING - - Certified co s filed with the count building inspection ADDRESS department: NUMBER FIVURE'OR ITEM FEE Y :_ . WATER CLOSET(TOILET). LOCALIT Date Applicant NEAREST CERTIFICATE OF,EXEMPTION FROM'WORKERS' CROSS S T. BATH TUB ', COMPENSATION INSURANCE' = OWNER' v 'SHOWER (This''.section need not.be completed if the work involved by MAIL the:permit is for one hundred dollors ($100)or less.) LAVATORY ADDRESS ' "certify that in`t 'e,performance of.the work for which this per- .. .'7 •.�: .:SINK CITY •-TEL: NO, C mit is issued;'I shall"not employ any persyn , any manner � ` - `' — ,12d as'to becomesubject to the Workers' Co' satipn/^'�Law . DISHWASHER ` bate`. Applicant CLOTHES WASHER CONTRACTO NOTICE TO APPLICANT:'If, after rriaking;ihis Certificate of Ex- SWIMMING POOL RECEPTOR ADDRESS emotion,you should become subject to ttie.Workers'Compen- CITY TEL. NO sgtioni rovisions of the`Labor•Code,-'you_mustforthwitF comp- .LAWN,SPRINKLER SYSTEM; •A ly with s'uch'p'rovisions:"or this permit shall'be deemed•revok STATE ,��. - LIC. . ed. _ WATER HEATER L'^ICENSE NO.. ]�j CLASS LICENSED CONTRACTORS•DECLARATION? % DISTRICT NO. q2l�)�,CEES_SED BY I hereby•affirm,that I•am,licensed under provisions of'Chapter GAS SYSTEM OUTLETS a O e > 9(commencing with Section 7000)of Division3 of the'Business OUTLETS OVER ^,d 5 PER SYSTEM and Professions Code,and my license is in full:fooj e-andef- FINAL / �1 'VALIDATION •fect`.; . DATE License Number 693 i . Lic ClassU ' O ✓`•/ FINAL' Contrac f � •-r Date i .BY (' a p ram exempt underSec - CD/ 9Uj B.&P.0 for this reason Plan check fee D Date: PLUMBING PERMIT ISSUING FEE$ - 5 .,Signature TOTAL*FEE :. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION. Plan check applicant r' I hereby affirm that I am exempt from the-Contractor's•License Name _ "+ Law for the followin reason Section 7031.5; Business.and 4.- ACCT Professions,Code): Address _ - I; as ownerof the property, will•do the work and the City. Tel. No: t t structure is not intended oroffered for sale(Section 7044, Business and Professions Code) Rt^ � s—YO t�e 0 s CONSTRUCTION LENDING AGENCY A, 7 I hereby affirm that there is a construction lendmg agency for the performance of the work for•which this permit'is issued iS:Ffif3� {i_`s (Ser. 3097,,Civ. C.). Lender's Name ili3CiI —nn i ?/ `7;r:t .. - • - - 'H' i • i Lender's Address CS"49y j `yf'Ij; I.certify.that l have read this application and state that the above information is correct:,I agree to-comply with all County D ordinance and State laws regulating Plumbing, and hereby. authoriz representativ s f is County- to enter upon the abov entioned pro If -, spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sigrfature of-Permittee Date WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING. PERMIT 11�reby, affirm that I have a certificate of consent to self in- . 7gg667A PW.4/87 sure, or a certificate of Workers'Compensation Insurance;or a CE 817(REV 8/86) I1Lfll certified,copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS' Policy 140: Company F Certified copy is hereby furnished. FOR APPLICANT TO FILL IN.(PRINT OR TYPE) BUILDING F1 Certified copy is filed with the countybuilding inspection ADDRESS, department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) � Date Applicant 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($100)or less.) LAVATORY ADDRESS - I certify that in the performance of the work for which this per- SINK mii is issued I shall not employ any personrt anan o CITY TEL. NO. �h 0. as'to become subject to the Workers' o pensaDISHWASHER G f CONTRACT s�—7— / Date Applican CLOTHES WASHER ` - ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption, you should become subject to the Workers'Compen- CITYeg TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLERSYSTEM ly with such provisions or this.permit shall be deemed revok- STATE LIC. / ed. WATER HEATER LICENSE NO. ( CLASS yr o LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm'that I am licensed.under provisions of Chapter GAS SYSTEM OUTLETS 9,(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, andel my license is in full force and ef- 5 PER SYSTEM FINAL �� VALIDATION fect. .�, J DATE �� O License Number Lic. Class - V FINAL 7 �f Conrracto Date BYE/L �[' 00 ' P— I am.exempt under Sec. UJ B.BP.C. for this reason Plan check.fee Date: PLUMBING_•PERMIT ISSUING FEE$ f3 Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following.reason (Section 7031.5, Business and I't't•+_•: a� Professions Code): Address i ;.- ElI, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, Business and Professions Code). -70 _s ;'.:fir--•,: -, [';"t 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 ;'t 3—'t L:' i tf i L� Lender's Address sr• j LL I certify that I have read this application-.and state that the above information is correct. I'agree to coply with all County ► ordinances and State laws regulating Plumbing, and hereby authorize 1representatives of this County to enter upon the aC bo ntioned pro r f inspection purposes. 7_q / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date