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Home My Public Portal About6224 HART AVE_Plumbing__ 76A667 DBS 17 11-50 - ' APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER TR O ROUP PERMIT NE3w FOR APPLICANT TO FILL IN PLUMBER RECEIVED"dBY READY FOR. DATE ISSUED �////�.`IY,",��,"� FIRST INSPECTION .r1 ADDRESS BUILDING CITY TEL. No. ADDRESS ✓ COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS sT. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) ADDRESS BATH TUB 0.50 CITY TEL. N.� sa6.JaO SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL'COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 AN13ELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE REHIDENTIA PROPERTY DE8C IBED ABOVE. GAS SYSTEM OUTLETS @ 0.50 SIGNATURE OF HEATER @ 0.50 PERMITTE SLOP SINK @ 0.50 INSPECTI® CORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN Q 0.50 URINAL @ O.SD -I HOUSE SEWER @ 0.50 - Z MISCELLANEOUS - O O APPROVALS DATE INBPECTOR'9 NAME 3 ROUGH PLUMBING (OWL'/ GAS PIPING ...^.. GAS VENT '�LI,I! l.:J(•/\ CESSPOOL @ 1.00 CESSPOOL ` SEPTIC TANK, SEPTIC TANK DRAIN ) PIT ( ) @ 1.00 SEWER PERMIT . I 1.00 GAS TEST p_0 UTILITY CO.NOTIFIED , TOTAL FEE �� FINAL 3 r L('O T,—."D d , WORKERS'COMPENSATION DECLARATION 7ewe67A p I hereby.affirm that I have, a certificate of consent to self _ CE 81i (z-e0) A P P L��CATION F®R P L lel M B NG P E RW T insure', or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C.) COUNTY OF LOS ANGELES T, �., BUILDING AND SAFETY Policy No.C1677+6tnpany Pacific Employers' / Certified copy is hereby furnished. Ins. Co. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS 6224 No. Hart Ave. Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM O FEE, ,ri LOCALITY department. WATER CLOSET Temple City Date'2-27-Rl Applicant Anthon� POOLS NEAREST BATH TUB CROSS ST. IZ6 ^`� .CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER Louise Glignett LAVATORY MAIL (This section need not be completed if the work involved ADDRESS .6224 No.. Hart Ave. } by the permit is for one hundred dollars ($100) or less.) SINK CITYTEL. N,O _ CL I certify that in the performance of the work for which this DISHWASHERU permit is issued, I shall not employ any person in any manner CONTRACTOR Cr so as to become subject to the Workers' Compensation Laws. CLOTHES WASHERADDRE0 SS 58 Firestone Blvd. Date Applicant / SWIMMING POOL RECEPTORU NOTICE TO APPLICANT: If, after making this Certificate of CITYSo Gate 928-3381 TEL.NO: d.LU Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS Z with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- / per" J FINAL VALIDATION 'ness and Professions Code, and my license is in full force and f T/yL l/ DATE effect. - FINAL License Number19Q 179 Lic.Class 53 BY ContractoAnthony Pools Date 2-27-81 11. I am exempt -. from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address '5871 Firestone Blvd. License Law for the following reason (Section.7031.5, Busi- City Tel.,No.' (�(i $A ness and Professions Code): • El1, as owner of the property, am exclusively contracting # o 0 0 0 0 5 with licensed contractors to construct the project I (Section 7044,Business and Professions Code). 2 0.0 1 600 r CONSTRUCTION LENDING AGENCY 0 0 0 1 (a 0 0 U ,`I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0 -3 1 8-81 issued(Sec. 3097,Civ.C.). J Lender's Name rash I Lender's Address I certify that I have read this application and state that the above irArmation is correct.1 agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE- ordin c s a State laws regulating Plumbing, and hereby aut r' a resents ive�this County to enter upon the a e-me r inspection purposes. /Anthony Pools 2-27-81 Si nature of Permittee Date