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Home My Public Portal About6203 HART AVE_Plumbing__ 76A667-CE4817 10-67 7 APPLICATION FOR PL�UMBIN PERMi;-;"z COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ZC)3 . ��T v e JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 44 COLEMAN W. JENKINS. 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 ADDRESS SHOWER 1.50 CITY TEL. NO. c LAVATORY 1.50 CONTRACTOR �� e SINK 1.50 ADDRESS DISHWASHER 1.50 CITY l._-C.1 Id k L)EnA TEL. NO 9 Cj 2 SATE LIC CLOTHES WASHER 1.50 LICENSE NO. �o CLASS �� - SWIMMING POOL RECEPTOR 1:50 s m - ' DISTRICT NQ, GROUP •ZONE P D B O LAWN SPRINKLER SYSTEM 2.00 U WATER HEATER 1.50 INDUSTRIALWASTE APPROVAL O GAS SYSTEM OUTLETS 1.50 IN§PECTION RECORD OUTLETS OVER5 30 W PER SYSTEM > 0— Plan check fee 25% of above. See reverse. A PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE o APPROVALS DATE INSPECTOR'S SIGNATURE Plan cheek applicant UNDER SLAB WORK - Name ROUGH PLUMBING " Address n 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. 1 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 DESCRIBED RESIDENTIAL PROPERTY. FINAL SIGNATURE _ )ACK R. ALLEN, SUPERVISING HANICAL ENG'R..-_ OF PERM/ PERMIT VALIDATION cK. , m.o. CASH PLAN CHECK VALIDATION CK. M.O. CASH 41:52- APR 4 5 J 350LAW . 76A667-CE817-8-58 APPLICATION FOR PLUMBING -PERMIT COUNTY OF'LOS ANGELES .J_ DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION•a BU LADDRESS DIN C L I JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN,Supt of Building o, ., a . ` LOCALITY � FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM + ' OWNER w WATER CLOSET BATH TUB ADDRESS Q SHOWER CITY TEL. NO. LAVATORY CONTRACTOR SINK ADDRESS DISHWASHER CITY TEL NO. LAUNDRY TUB CONTRACTOR'S STATE ❑ REGISTRATION N COUNTY k CLOTHES WASHER DISTRICT NO. GR� I ZONE FAROCESSED BY WATER HEATER Z: GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD a /�V Jnr, .rr Til)�? F - APPROVALS @ $1.00 PER ITEM OR FIXTURE $ / (}—(� DATE INSPECTOR'S SIGNATURE x UNDER SLAB WORK PERMIT $ 2100 ROUGH PLUMBING TOTAL FEE GAS PIPING - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION r. GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ` HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING c. PLUMBING. PLUMBING FIXTURES 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST '{ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ' CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTI - P 'OPERTY. SIGNATURE L ✓` FINAL �D� /�r1�/ �' � OF PERMITTEE 7,� SUPERVISING OBERT A.WOOD. ®F VALIDATIOMECHANICAL ENG'RCK. M.O. L`o323fl� iiia 9 5 h 3.00 - �vl 76A667-CE#817 5-61 r - " APPUCATRON FOR PLUMBING, PERMRT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIMION BUILDING ®u JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 62,03 NO e Hart AV @ WILLIAM A. JENSEN+,SUP'T OF BUILDING ® - LOCALTI7 �. FOR"APPLICANT TO FILL IN #ARESST.OSS y NUMBER FIXTURE OR ITEM WATER-CLOSET OWNER D u L. Hackett. BATH TUB ADDRESS:,, rap,03 ATO. 'Hart Ave. CITY t TEL NO. SHOWER LAVATORY CONMCTOa ,ARC.0 -PLUMBII IG C,0 0 SINS ADDRESS DISHWASHER CITYNO. , 3®9;055 CONTRACTOR S BYATE LAUNDRY TOB REGISTRATION NO. a, COUNTY Cl CLOTHES WASHER DISTRICT NO. GROUP' ZONE P SSED BY WATER HEATER OAS SYSTEM M"Uma"U. O� WASTE APPROVAL DNSPECYION RECORD tat N z Q $1.00 PER ITEM L OR FIXTURE' N APPROVALS DATE INSPECTOR'S SIGNATURE 1.50 PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEE — ROUGH PLUMBING j 5'O' GAS PIPING t /_ �n I HEREBY.ACKNOWLEDGE THAT t HAVE READ THIS _APPLICATION / AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT" 411 rl WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING • I ° y+ j t itill PLUMBING. - HOT WATER HEATER I -L /(lJ'ill!,�, j- 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF LASTEST ' CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED }%1 ° SIGNATURE ) I OF PERMITTEE FINAL ALIDATION ROBERT A. WOOD r EK. M.0. CASH -SUPERVISING MECHANICAL ENG'R WORKERS'COMPENSATION DECLARATION � p 20-0026'DPW 4/90 6=�1 L� `V fi=�1 ® L�V 11 R( 11 I hereby,'affirm that I have a certificate of consent to self in 76A667A sure or a certificate of Workers Compensation Insurance,ora n certified copy thereof(Sec. 3800, Lab. C.) 1„ hull it) COUNTY OF LOS ARIGELE& DEPT. OF PUBLIC WORKS Policy No. ompany Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING' fie copy is filed with the county building inspection ADDRESS . NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET). i Date Applicant "' NEAREST CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE OWNER ' ta SHOWER . (This section need not'be completed if the work involved-by MAIL the permit is for one hundred dollars($100)or'less.)' LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to-the'Workers'Compensation Laws: DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER _ NOTICE TO APPLICANT: If, after.making This Certificate of Ex- ADDRESS SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Co mpen- CITY' TEL. NO. �/ sation provisions of the Labor Code,you,must forthwith comp- LAWN'SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC: ed. ' WATER HEATER • LICENSE NO.. CLASSL LICENSED CONTRACTORS DECLARATION t DISTRIC . PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 1 GAS SYSTEM ' L OUTLETS43 a 9(commencing'with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Codev �P', and m lice se.is in full force and ef- 5 PER-SYSTEM FINAL fect. r VALIDATION r] HOSE BIB _ DATE �!r 'Z..�'�• 2- License Number Lica Class(-//,/,,v O FINAL c U Contracto Rate BY I am exempt under Sec. 'agt B.&P.C. for this reason LU U Plan check..fee1 ITEMS N Date:' PLUMBING PERMIT ISSUING FEE$ 4 7s 1��1{ Signature TOTAL 46o • _ TOTAL FEE , SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant (: NGE aQa 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 . aoaa-0001 11/ 8/95 1,1as owner of the property, will: do the,work and the City, Tel. No. 30 1 'PM "6a 14 . structure is not intended or offered for sale,(Section 7044; "F v 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 I certify that I have read this application and,state that the above information is correct. I agree to comply with all County ordin ces and State laws regulating Plumbing,and hereby auth ze representatives of this County to enter upo .th ab -mentioned p op r r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE nature of Pe ittee Date '