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HomeMy Public PortalAbout5635 HALLOWELL AVE_Plumbing__ D.S.S.17 25M SETS 10-47 _ APPLICATION PPL ICATION FOR PERMIT ` DEPARTMENT OF BUILDING AND SAFETYLVJC JLIltI COUNTY OF LOS ANGELES WN.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION OSSTRI NU. GROUP o E PlO. ROUGH FIXTURES COMPLETE 9 7 HEATER CESSPOOL 1 # SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION r A$ MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTI®N ONLY JOB a. NAME 0'J�/Q/_„/,,..s( - ADDRESS 2 y ,o .y'iJ�•Na.4w_� w 9ADDRESS �dy _ LOCALITY sft n r — - NEAREST ^L CITY TEL.No. CROSS ST. AV-1"00 COUNTY CERT.No. EXPIRES - 11 NAME a.^ie�7� •f hirh✓ LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL ADDRESS NORTH O CITY TEL.No. I AM THE LEGAL. POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. � ,_� . V PLUMBER I AM THE LEGAL OWNER..OF.THE PROPERTY DESCRIBED ABOVE. a 3 W7 OWNER i CORRECTIONS SOUTH Q DESCRIPTI®N OF WORK z BATH TUB FURNACE SHOWER DISHWASHER LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR BINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS . WATER CLOSET DRINKING FOUNTAINDATE/ IN323CT R'6 HAMK WATER HEATER DENTAL LAVATORY, P¢OUGH PLUMBING METER. GAS SODA FOUNTAIN GAS PIPING tI/ OUTL ! /- GAS VENT I S 1l mamazzlilm CESSPOOL I /•-'/'1� TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOL - SEPTIC TANKIohwrKF UTILITY CO.NOTIFIlZD TOTAL FEE /S c FINAL V 76 A 867-CE 817 8/68 I TMA�� Ot,.�4� APPLICATION" FOR ' PLUMBONG. PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY-DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN (P NT OR TYPE) NEAREST � . NUMBER FIXTURE OR ITEM EACH FEE CROSS ST. C.�!► OWNER WATER CLOSET 1.5 MAIL BATH TUB 1.5 ADDRESS SHOWER 1.5 CITY TEL. NO. LAVATORY 1.5 CONTRACTOR ' tel SINK 1.5 ADDRESS ('Yj -- �Y c DISHWASHER 1.50 .� CITY TEL. NO. CLOTHES WASHER 1.5 STATE �`/� LIC LICENSE NO. s Q 7 CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE PRO SSED BY a LAWN SPRINKLER SYSTEM 2.0 c U B ` U WATER HEATER 1.5 S� INDUSTRIAL ZO WASTE APPROVAL' GAS SYSTEM OUTLETS 1..5 ,•S -- -INSPECTION RECORD V w OUTLETS OVER - - 5 PER SYSTEM % rn — � Z Plan check fee 2FI o of above. See reverse. PLUMBING PERMIT ISSUING FEE, $ 00 DOTAL FEE APPROVALS• DATE NSPECTOR'S SIGNATURE Plan Cheek applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT - Cit}' 7 eI. No' HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I 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 PLUMBING. I I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED, LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT 1 AM THE LEGAL ;�MTENDTO RESIDE IN,THE ABO IE D R RE$1D FINAL 1 SIGNATURE JACK R.,ALLEN, SUPERVISI G M CHANICAL 'R. OF PERMITTEV PEIItMIIII VALIDATION M.O. CASH PLAN CHECK VALIIDATII CK. M.O. C SH 7 3 173, dPR24 5 D 5.25- � . ' o. B. ,� a-ao APPLICATION• FOR PERMIT DEPA U& �-g� •of BUILDING AND SAFES PLLTI ING COUNTY OF LOS ANGELES- WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GRs/pQUP ma PERMIIT NO. ROUGH N Q� �{ •� �� ,moi - I -1° 1 a lklqgp-5q 12 PLUMBING FFIXTURES 0�� COMPLETE RECEIVED BY,. READY FOR - DATE ISSUED. - .HEATER - .CESSPOOL i,SEPTIC TANK FIRST INSPECTION GAS G� MISCELLANEOUS qi �/am / APPLICANT FILL IN HEAVILY OUTLINED PP,,ORTION ONLY AD :J � NAME I I � ADDRESS, - � ADDRESS LOCALITY f NEAREST IL CITY / y TEL II .U CROSS ST. ?C o CUN CERT TNO. /f/ C'J� EXPIRES�f�ra` -� y�j NAME LOCATION OF SEPTIC TANK, OR CESSPOOL O ADDRESS NORTH - CITY TEL No. . 1 AM THE LEGAL' POSSF�SSQ� F THE�ABOVE OS 'ANGELES COUNTY CERTIF G` E gU�'IFICATION. �. ly F&ABEV I AM THE LEGAL O N OF THE PROPERTY DESCRIBED ABOVE. 3 "I OWNER t CORRECTIONS.' ' SOUTH J DESCRIPTION OFl WORK z ^6�BATH TuB FURNACE - SHO`NER' - DISHWASHER - 2-- LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRXP - - - - 'SLOP' SINK - FLOOR DRAIN z - ,.� WASH TRAY - URINAL APPROVALS - - - WATER CLOSET DRINKING FOUNTAIN - DATE INSPECTOR'S NAME WATER HEATER _ DENTAL-LAVATORY ROUGH PLUMBING 1 METER OUTL SODA FOUNTAIN GAS PIPING �74 GAS VENT _ CESSPOOL L_TOTAL NUMBER OF FIXTURES O.D SEPTIC TANK CESSPOOL - SEPTIC TANK SEWER0. - I$ 0 UTILITY CO. NOTIFIED TOTAL FEE ' FINAL lj �s7j J7 " D. B. 17. 4-40 10 APPLICATION FOR" PERMIT DEPARTMENT OF BUILDING-°AND SAFETY COUNTY:OF. LOS ANGELES... : PUIIN ' WM:`J. FOX, CHIEF ENGINEER NATiTRE QF'INSTALLATIOIV DISTRICT'NO. GROUP ZONE PERMIT NO. - - 1. .. � . c. ROUGH - - PLUMBING I FIXTURES COMPLETE � -� - EDs •� _ RECEIVED BY READY FOR DATEISSUED "HEATER CESSPOOL k SEPTIC TANK -I.FIRST INSPECTION MISCELLANEOUS �� APPLICANT FILLAN HEADILY OUTLINED PORTION ONLY . . JOB NAM de 'ADDRESS' Wm .ADDRESS _� �� _ LOCALITY' . ,;. - ' NEAR EST a, .,.CITY. - TEL - .? CROSS S COUNT . w + CERT: NO: ^,;» EXPIRES 'MAIL u OCATION OF. SEPTIC TANK, OR CESSPOOL o ADDRESS' - NORTH CITY' - - TEL No. - ' I 'AM THE LEGAL POSSESSOR OF'THE'.ABOVE LOS ANGELES COUNTY. CERTIFICATE OFA-QUALIFICATION: -. . PLUMBER - - - TAM THE LEGAL OWNER.OF`THE PROPERTY DESCRIBED - ABOVE.-- - . mI m - .. - ..1 OWNER , CORRECTIONS SOUTH . _j IDESCR.IPTIbN:.OF'WORK Z . - BATH TUB - - - FURNACE..: - l1' --SHOWER - DISHWASHER ' • -0 - --LAVATORY REFRIGERATOR - - KITCHEN-SINK - WATER SOFTENER - FLOOR SINK SAND TRAP LOP SINK - FLOOR DRAIN "WASH. TRAY` URINAL ' APPROVALS -WATER-CLOSET - DRINKING-FOUNTAINDATE - ,INSPECTORS NAME - WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER GAS SODA FOUNTAIN GAS*PIPING OUTL - - X GAS.VENT - .. 41 r CESSPOOL "� "/�' "�► - 'TOTAL NU.MBER_OF FIXTURES' SEPTIC TANK 'r SEWER CESSPOOL SEPTIC TANK .. - .. r$ UTILITY CO. .NOTIFIED - ( ... . TOTAL FEE I, / FINAL. - ` . WORKERS' COMPENSATION DECLARATION APPUC''b0 4J 0®I!`CJ Foo PL UJM p MIG PERNT T I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 irisure, or a cettificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES, DEPT. OF PUBLIC WORKS Policy No. Company Certified.copy is hereby furnished. E] FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS 67—?S &We/ Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET 0 NEAREST 1 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. L t Ye 6 COMPENSATION INSURANCE OWNER '(This section need not be completed if the work Involved by SHOWER v 2&XV, the permit is for one hundred dollars ($100)or less.) I LAVATORY O MAIL ADDRESS Q D We- I certify that in the performance of the work for which this A permit is issued, I shall not employ any person in any manner I SINKG O CITY sc4� a�r TEL. NO.,!;-;7 so as to become subject to the Workers'Compensation Laws. �� JJ t t y DISHWASHER 7D CONTRACTOR Date Applicant CLOTHES WASHER r✓ 0' ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY � TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION - DISTRICT O 550o PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS G d �j (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER G and Professions Code,and m license is in full force and effect. 5 PER SYSTEM >; y DATE L 7 VALIDATION al License Number Lic. Class _Z3 y O, U. FINAL • • � Contractor Date BY OF- ❑ I am exempt under Sec. U Lal B.BP.C. for this reason �D 0.I Plan check fee co Z Date: PLUMBING PER ISSUING FEE$ / a Signature TOTAL FEE G Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name1:.:f_. , 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 D iC1;;;1I. 9a 7044, Business and Professions Code). ;•.tt- CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for �_•E�'., •: ,€II the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name _" 1 Lender's Address ' I certify that I have read this application and state that the . D 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 abov�ntioned pr erty f r in pe ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE F //h Signatur Pe ittee Date I To WORKERS'COMPENSATION DECLARATION n❑ o o b o 0 I hereby offirin 'that I have a certificate of consent to self 76A667A �U��������0 ©� �������� ������ 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. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING §b _ Certified copy is filed with the county building inspec- ADDRESS d [� f/ tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST / `a CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER �I (This section need not be completed if the work involved by SHOWER k , (-! / j MAIL X1_ the permit is for one hundred dollars $100 or less. ADDRESS t�)Z L3� �✓ G` A/ Z1t IV P ( � � LAVATORY I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY /' f/1f1L. NO so as to become subject to the Workers Co pensation Laws. ;(/ (! DISHWASHER CONTRACTOR I/ Datei Applicant �' CLOTHES WASHER ADDRESS / �y NOTICE TO APPLICANT: If, after making this Ce ficate SWIMMING POOL RECEPTOR Exemption', you should become subject to th Workers' 1 n r CITY TEL. NO. Compensation provisions of the Labor Code, you.must,forth- LAWN SPRINKLER SYSTEM with comply with such provisions, or this permit shall be STATE LIC. deemed revoked. WATER HEATER, LICENSE NO. / C 9 1 SS (� 7 LICENSED CONTRACTORS DECLARATION DISTRICT /)/PROCESSED BY I hereby affirm that.I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVERt and Professions Code, and my license is in full force and effect. 5 PER SYSTEM. ];;z 0 VA ATION �O License Numb / Lic.Class_ F� Contractor Date a I � � I am exempt and Sec. a- B.&P.C. for this reason / Pldn check fee {\ Date: J �/ 0 g 7.9 A PLUMBING PERMIT ISSUING FEE$ M 1,570 Signature _ TOTAL FEE '#'a 0 0 0 0 5 Plan check applicant SINGLE FAMILY I °''O 2 2 5 Q HOME-OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's License o'0 0225 d Law for the following reason (Section 7031.5, Business and Address" Professions Code): ,City Tel. No. I Q 3 0-8 4 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sole (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 Icertify 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-menti ned property for inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE , Signature of Pefl ttee Date