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Home My Public Portal About5944 HART AVE_Plumbing__ I C 76 A 667 CE 817' 7-69 ' APPLICATOON FO R41T COUNTY OF LOS ANGELES DEPARTMENT OF"COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADDRENG JOHN A. LAMBIE, COUNTY ENGINEER ' ADDRESS COLEMAN W. JENKINS..SUP'T. OF BUILDING .1 LOCALIT NEAREST FOR APPLICANT TO FILL IN (PR NT OR"TYPE) CROSS ST. NUMBER FIXTURE OR.ITEM EACH FEE ' OWNER WATER CLOSET - 1.50 .. • MAIL. BATH TUB - 1.50 ADDRESS SHOWER 1.50 CITY • TEL. NO., - LAVATORY 1.50 -CONTRACTOR SINK 1.50 j ADDRESS DISHWASHER 1.50 CI CLOTHES WASHER 1.50 STATE �ry�i CLASS /v `.LICENSE N !;74 SWIMMING,POOL RECEPTOR 1.50 DISTRICT N 7P ZONE PROC S BY LAWN SPRINKLER SYSTEM 2.00_ D WATER HEATER 1.50 ° -INDUSTRIAL O WASTE APPROVAL GAS SYSTEM/ OUTLETS 1.50 - - I ECTION R OR OUTLETS OVER - ' 5 PER SYSTEM •30 — -f 1 n !} O J 7/ y, -.dC G �C . Lu 136.111-711h Planc heck fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 -00 TOTAL FEEzyu �3 ►`°.aLKf�'sP_r 't t>� �° APPROVALS DATE INSPECTOR'S SIGNATURE- Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING 'GAS VENT - City, Tel. No, HOT WATER HEATER _ I 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 PLUMBING. GAS TEST /'�1.{✓5 `8 �1 I' HEREBY CERTIFY THAT I AM PROPERLY•REGISTERED .AND/OR. ,UTILITY CO."NOTIFIED o LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL JV11171 SIGNATURE JACK•R. ALLEN, SUPERVISIN CHANICAL ENG'R. .OF PERM ITTE - PERM I]C VALIDATION ,c K. M.o. CASH PLAN CHECK VALIDATION CK. M.o. CASH& 1 1 JAN !� j� 7.6 A 667 817. 7-69 COUNTY OF' LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ¢` BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER fit' v COLEMAN W. JENK INS. SUPT. OF BUILDING LOCALITY _ �:. FOR APPLICANT TO FILL IN(PR NT OR TYPE) -NEAREST ' CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE .OWNER WATER CLOSET 1.50 MAIL .BATH TUB "1.50 ADDRES - SHOWER 1.50 CITYTEL.NO,� LAVATORY - 1.50 CONTRACTOR _ SINK 1.50 ADDRESS4Z Zo DISHWASHER _ 1.50 CITY TEL. NO. CLOTHES'WASHER 1.50 STATE 4, LIC LICENSE NO. - CLASS - - SWIMMING POOL RECEPTOR 1.50 - DISTRICT NO. GRQUW ZONE I P CESS D BY LAWN SPRINKLER SYSTEM 2.00 d L ' WATER HEATER 1.50 aINDUSTRWASTE APAL PROVAL GAS SYSTEM OUTLETS 1.50 INSPECTI.OWRECO OUTLETS OVER. 5 PER SYSTEM .30 e - a H Z 0 Plan check fee"••25'% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE APPROVALS DATEINSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ' ROUGH PLUMBING Address - - a GAS PIPING GAS VENT City, Tel No. -? HOT WATER HEATER I 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 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM'THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DE ' IAB//EJD RESIDENTIAL PROPER Y. FINAL SIGNATURE ` / " .TACK R. ALLEN SUPERVISING MECHANICAL ENG'R. OF PERMITTE / - f,.�-•--,..� . T.i PERMIT VALIDATION C K. M.O. C A S�. ;PLAN CHECK VALIDATIO GK. M.O. CASH • WORKERS' COMPENSA1.TION DECLARATION APPUCATPOIN FOR PLUMENG R NG 1�15QII T I.hereby-affirm that I have a certificate of consent,to.self 20-0026 DPW 6/87 injure, or d certificate of Workers' Compgnsation Insurance, 76A667A •or'.•�f certified copy thereof (Sec. 800, Lab. C:) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.—Company "Certified o. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appligont WATER CLOSET 5 NEAREST CERTIFICATE'OF EXEMPTION FROM WORKERS' BATH TUB v:2.:2- CROSS ST. ( I . COMPENSATION INSURANCE � SHOWER OWNER (This section need not be completed If the work Involved by the permit is for one hundred dollars ($100)or lose.) LAVATORY MAIL ADDRESS lel b "V I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK 8v CITY TEL. N01_9* so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should .become subject-to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO.. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. C SED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS v (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER J u and Professions Code,and m license is in full force and effect. 5 PER SYSTEM Y FINAL VALIDATION Oe DATE9 License Number Lic. Class rL `w �: FINAL Contractor _Date BY 0. ❑ I am exempt under Sec. J W B.&P.C. for this reason ` i o E Plan check fee - U) Date: PLUMBING PERMIT ISSUING FEE$ - �I'•+ 17 "=CO— Signature i�� TOTAL FEE NS O AL 1713" 00- Plan check applicant a� SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 4•HE Kl)l t I herebyaffirm that I am exempt from the Contractor's License - Law fothe for reason(Section 7031.5, Business and Address !•±-iFi t� oU.� Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the CiCllil.{_l?t3 t L J; r!{7i_t structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1491 1 Ho 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 D above information is correct. I agree to comply with all County or �nceas and State laws regulating Plumbing, and hereby uthor rep esentatives of this County to enter upon the �ove enti ed propert .f inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE (04,1/Q1 azure of Permitto t a