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HomeMy Public PortalAbout6004 HART AVE_Plumbing__ 76A667-C E#817 10-67 APPLICAT�O' I FOR PLUMAB ISG PER;rT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /fin 7� JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �I./ COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY r FOR APPLICANT TO FILL IN (PR NT OR TYPE) 'NEAREST CROSS ST. r NUMBER • FIXTURE OR ITEM EACH FEE • /� OWNER WATER CLOSET 1.50 MAIL BATH TUB 1.50 ADDRESS SHOWER 1.50 CITY TEL. NO.S 3 /� , LAVATORY 1.50 CONTRACTOR $ NSr /LL O.(DN1 SINK 1.50 ADD • 2V LU/( ( DISHWASHER 1.50 CITY V �(JA5727 A CLOTHES WASHER 1.50 STATELIC LICENSE NO. -2-q-q,2-1,-2— ,-2— CLASS SWIMMING POOL RECEPTOR I.S0 .1 o ' ' DISTRICT NJ GRO P ZONE P OCESS€D BY LAWN SPRINKLER SYSTEM 2.00 �� WATER HEATER 1.50 INDUSTRIAL U WASTE APPROVAL O GAS SYSTEM OUTLETS 1.50 _ INSPECTION RECORD U OUTLETS OVER .30 d 5 PER SYSTEM N Plan check fee 257, of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE _ '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 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 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 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL �e SIGNATUR ,TACK R. ALLEN, SUPERVISIN ME ANICAL ENG-R. OF PERMI TEE PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH Leo4 3 9.2IS; AFR24 5 D` . 3.50f COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer DISTRICT NO. GROUP ZONE PER T FORPPLICANT TO FILL IN �a I e_1 PLUMBER „y- _ � �/ �.:"'1�. �C..-`� RECEIV BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS dyl; .Y e_lyC.�'eel P BUILDING le, CITY ��((' '��'" TEL No!�. ' cj` ADDRESS COUNTY/ / / LICENSEir // /rY(i ! EXPIRESO ©1 LOCALITY 1✓yjiy✓ ����' --, -,-'� f _ �RDB555, PERMIT FEES OWNER NUMBER TYPE OF FIXTURE OR ITEM FEE MAIL . WATER CLOSET(TOILET) C� 0.50 $ ADDRG,ES`S,/� BATH TU.B Q 0.50 \ ,. ;rl/ TEL. No. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK - @ 0.50 AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE,/C1R I AM THE_LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. p GAS SYSTEM OUTLETS 0.50 BIGNATURE OF JJ WATER HEATER @ 0.50 PERMITTEES �-� "� SLOP SINK @ O.sO INSPECTION RECORD FLOOR SINK r@ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 i DRINKIND FOUNTAIN @ 0.50 URINAL 4 0.50 J _ Q HOUSE SEWER @ 0.50 Z MISCELLANEOUS I - !Y APPROVALS ' DATE INSPECTOR'S NAME i ROUGH PLUMBING l GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT f ) @ 1.00 SEWER PERMIT 1,00 GAS TEST UTILITY CO.NOTIFIED .. /,a TOTAL FEE FINAL ® � ! id 76#667 DBS.#'17 6-52 WORKERS' COMPENSATION DECLARATION' o 0 0 oR (�� a Omenn `� • I•hereby gffirm that I have a certificate of consent to s If 76A66 AI-- ' • APPLOC �,YMN FOR Il L�UUVIlMMG PISllUlll/❑� ll it ure, 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 ❑ Certified copy is filed with the county building inspec- ADDRES, ]G , i �(+ tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE.OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.42-4 COMPENSATION INSURANCE SHOWER OWNER' `, �' (This section need not be completed if the work involved by MAIL J ` the permit is for one hundred dollars ($100)or less.) , LAVATORY ��� ADDRES C)04J I certify that in the performance of the.work for which this permit is issued, I shall not employ an erson in an ma ner SINK CITY 1 r TEL. NO,�-�/f so as to become subject to the War rs'Compensat o w ./ '" /� �f , DISHWASHER CONTRACTOR /� Date ��� ""} Applicants l�i�' r� CLOTHES WASHER ADDRESS / NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code;you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �' 9L and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINALVALIDATION 0 DATE License Number Lic. Class A0 FINAL O Contractor Date BY G` U U its I am exempt under Sec. H B.BP.C. for this reason Date: Plan check fee D PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License i Law for the following reason (Section 7031.5, Business and Address '7 ',f) ' j 0 5.0 9 A . Professions Code) City �, ❑ r�. �! /C' Tel. N6 � .S Z 'o•o o o 0 5 I, as owner of the property, will do.the work and the ' t • structure is not intended or offered for sale (Section D C'o -40.5 0 7044, Business and Professians.Code). .� CONSTRUCTION LENDING AGENCY •o,o+o ��,0 5 0 U: I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 0 6_8,4 (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 ordinances and State laws regulating Plumbing, and hereby author' a representatives of this County to enter upon the .bo entioned property fol inspect,ion purposes. / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date '.: •` I WOR+ER'S�CONiPENSATIONDECLARATION 20-0026 DPW 9/89 76A667A ��^������®Iltl ®� ��n nrxn��n r���n��� i"nereby affir#n thatT,havt a Certificate of consent to self insure, P NI UM �I P u�u or a Qertificatd of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF�PUBLIC WORKS DIV. Policy No. Company Certified copy is hereby.furnished. BUILDING ❑ Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS department.. NUMBER FIXTURE OR ITEM p FEE LOCALITY r^ PLS C � / li Date Applicant• WATER CLOSET - NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. S COMPENSATION INSURANCE I ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK` PAGE PARCEL permit is for,one hundred dollars($100)or less.) LAVATORY OWNE I certify that in the performance of the work,for which this permit MAIL is issued, I shall not employ any p rson in any manner so as to SINK ADDRESSP Q , V�W5,1 become subject to the Workers' Co tion Laws. DISWASHER Cff7t - M Pt = C'4_4 TEL.- g� O_ LV Date 1' Applic nt h CLOTHES WASHER �G (FJ NOTICE TO APPLICANT: If, ter making this Certificate of, CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR 10 provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. >' I hereby affirm that I.am licensed under provisions of Chapter 9 WATER HEATER 0 (commencing with Section 7000 of Division 3 of the Business and STATE LIC. o ( 9 ) LICENSE NO. CLASS Professions Code,and my license is in full force and effect. GAS SYSTEM - � OUTLETS (� OUTLETS OVER DISTRI�O, t= � PROCESSED BY D 5 PER SYSTEM Q License Number Lic.Class FINAL vm DATE ® VALIDATION Contractor Date (n ❑ FINAL ` Z I am exempt under Sec. BY B.&P.C.for this reason Plan check fee -- ;; — _- Date: j Signature PLUMBING PERMIT ISSUING FEE$ O r• !zr• ❑ TOTAL FEE i ITS?;: 103 l -_3 Plan check applicant I�—r: SINGLE FAMILY' �..('. �.�•..:�l:' HOMEOWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law CHANGE ±NNGE .for the following reason (Section 7031.5, Business and Professions Address ^1, r Code): City e-V\A IpLtS Ct,,. Tel.NON s; 71 ;�_. I,as owner of the property,will do the work and the structure {_I is not intended or offered for sale (Section 7044, Business and Professions Code). ' 1036 � AM �6% 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 Sta laws regulating Plumbing, and hereby authorize represe tatives of this County to enter upon the above-mentioned pro r inspection purp ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date