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Home My Public Portal About6121 HART AVE_Plumbing__ 76A667-CE4817 6-66 APPLICATION FOR PLUMBiNPERMIT IT [I'nIII LJ COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING )� J JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS A i 'I COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. I,i NUMBER FIXTURE OR ITEM EACH FEE OWNER ^I WATER CLOSET $1.25 IS(—) — MAIL f BATH TUB 1.25 ` Z S ADDRESS S� ' SHOWER 1.25 ` CITY TEL. NO. LAVATORY 1.25 CONTRACTOR kok/i tE2L PhRk RUC Co SINK 1.25 �� ADDRESS 7 S G 2 I L L Q DISHWASHER 1.25 CITY // ( TEL. NO. 3�Q q09 STATELIC LAUNDRY TUB 1.25 LICENSE NO. I k7 b� / CLASS CLOTHES WASHER 1.25 2DISTRICT NO. GROUPZ E P OCE D Y WATER HEATER 1.50 S(� GAS SYSTEM _OUTLETS 1.50 INDUSTRIAL CL WASTE APPROVAL 0 OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V Ir Iw 0 H V w o_ < lc, z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK of ROUGH PLUMBING TOTAL FEE U GAS PIPING c IH EREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT _ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES o LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNF�R OF,AND INTEND TO RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED V" SIGNATURE _ OF PERMITTEE FINAL _qL�L _ $(� LIDATION M.O. CASH 02 w . . `. Lr� o7 0'5:9 FEB 9 5 'D 1..5..030 15- 76A667 (CE-817) - 5/73CETY CSI-� - „ � } TEMPLE CITY APPLICATION FOR* PLUMBING PERMIT ' COUNTY OF LOS.ANGELES DEPARTMENT OF COUNTY ENGINEER .BUILDING AND SAFETY DIVISION . MAKE CHECKS PAYABLE TO: BUILDING , 'ADDRESS Avehiie HARVEY T. BRANDT, COUNTY ENGINEER - LOCALITY TeMple City` FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM @ FEE OWNER - WATER CLOSET 1.75 S MAIL BATH TUB 1.75 ADDRESS' SHOWER 1,75 CITY L. N1.,285_;.5341 LAVATORY 1,75` CONTRACTOR Trane HCC SINK 1.75 ADDRESS DISHWASHER 1'.75 CITY O Ell •Mont6EL�ND 5797- 7982 CLOTHES WASHER 1.75 STATE LIC, LICENSE NO. 26509'4, CLASS 'C-,2'0"• SWIMMING POOL RECEPTOR 1.75 DIST T NO. GROUP ON CESSED B' LAWN SPRINKLER.SYSTEM 1.•75 IF ")a WATER HEATER 1,75 INDUSTRIAL WASTE APPROVAL } GAS SYSTEM OUTLETS 1.75 L 7 INSPECTION RECORD OUTLETS OVER rJ 5 PER SYSTEM .30 Q Plan Check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 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 WATER HEATER ' I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION Ik AND STATE THAT THE ABOVE.IS, CORRECT AND AGREE.,TO'COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLU_MBI NG. ,- GAS TEST 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 OW EROF, AND INTEND TO J• RESIDE IN THE ABOVE DESCRIBED RESI ENTI L PROPERTY. FINAL SIGNATURE �'D� i OF PERMITTEE PERMIT VALIDATIONcK. M.O. CASH • PLAN CHECK VALIDATION CK. M.O. CASH. 0 s.1 VL'_'MAR 75 , 4.7 5 0)o 76A667C (CE-817B) -975 APPLICATION FOR PLUBING PERMIT r BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /1�-7�1 / �1 ^� ,f� ✓�J , NUMBER FIXTURE OR ITEM @ FEE ADDRESS 6f - WATER.CLOSET LOCALITY n BATH TUB NEARESTCROSS ST. Zd SHOWER OWNER JA .er S ,9A0L10 LAVATORY AIL MDDRESS /� .••yam A / SINK00 1 CI7y r TEL. NO,,25^ -34 FT DISHWASHER .. 0 () CONTRACTOR , CLOTHES WASHER DO ADDRESS7yf9�L� 2 ZJ SWIMMING POOL RECEPTOR CITY /Y) TEL. NO. LAWN SPRINKLER SYSTEM J STATE LIC WATER HEATER CENSE NOA CLASSCD / a} 3 DISTRICT NO. GROUP ZONE P CE ED BY V GAS SYSTEM OUTLETS � {{ !, y, J —v2-'(T ' OUTLETS OVER �J vV 1 �` �_ 5 PER SYSTEM INDUSTRIAL w WASTE APPROVAL INSPECTION RECORD Z Plan check fee arc PLUMBING PERMIT ISSUING FEE $ -� TOTAL FEE , Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. NO. GAS PIPING - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DES RIBED RESIDENTI PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M,O: LASH 6.6 0 r-DEC 2.1 ) U � 2 8 `] l) ®:iia WORKERS'COMPENSATION DECLARATION APPUCQTpON FOR PLUM IG PERMP7 I aereby affirm that I have,a certifiGdle of consent to•self 20-0026 DPW 6/87 insure, or a certificate of Workers' ConYperisation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lob. 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 Q Z I ��2T .4d� Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY T�1 PLL G{TY Date Applicant 'I WATER CLOSET- �� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE 6 OWNER SHOWER C! (This section need not be completed if the work involved by MAIL ' the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS A `2' A I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY 77�t TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER( /�JJ,�'� CONTRACTOR T:>01`0 Date �� Applicant `[�' ��6 �Fl— CLOTHES WASHER (� C27 49 NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR ADDRESS �3 C .� Exemption, you should become subject to the Workers' CITY CCA- (i( TELNO.L� /—�7j Compensation provisions of the Labor Code, you must forth- `1`� with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC. hh deemed revoked. WATER HEATER LICENSE NO. CLASS D t 6 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESS BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 8 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINA VALIDA IOW DAT Q, License Number Lic. Class Q FINAL Contractor Date BY ❑ I am exempt under Sec. �J Edd B.&P.C. for this reason Plan check fee cn. Date: j3 0� PLUMBING PERMIT ISSUING FEE$ Signature i TOTAL FEE Plan check applicant c SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name ACCT I hereby affirm that I am exempt from the Contractor's License Address '7307 43.011Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. IS Q ... f ITEM,: I, as owner of the property, will do the work and the T+ITt�� , m � structure is not intended or offered for sale (Section 7044, Business and Professions Code). CHECK 43.00 CONSTRUCTION LENDING AGENCY jr. .011I 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 13000-0001 5/23/90 "Lender's Address /�' �—' CIS 61 1 Ari 7:50 I certify that I have read this application and state that the above information is correct. I agree to comply with all County e ordinances and State lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the abo entioned roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 5-z1,- gnoture Permittee Date