HomeMy Public PortalAbout6267 HART AVE_Plumbing__ 76Aeq:, 17e 5-50 APPLICATION FOR PERMIT
f DEPARTMENT:OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING , I
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO.
PLUMBER Revere Service - Corp., RECEIVED BY READY FOR DATE ISSUED
FIRS 81PECTION B
ADDRESS 11$11 Teale S-t o - 1Y VY1
C ADDREBUILDSNG S mi`1o• 1H&rt gveo. .`�i VV '
CITY Cialer City TEL, NO. �'gq721.51 r
COUNTY
–LICENSE NO. 6750-Mf EXPIRES 6_JO J.1 LOCALITY Temple City
NEAREST
CROSS ST, Garabaldl Ave.
PERMITFEES
NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER HO.• L'�o. Jones:;
MAIL
WATER CLOSET (TOILET) @ 0.50 $ ADDRESS Sallie as above
BATH TUB @ 0.501 ' CITY TEL. NO.
SHOWER @ 0.501 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50I� APPLICATION AND STATE THAT THE ABOVE IS'CORRECT AND
AGREE TO COMPLY' WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.50 I STATE LAWS REGULATING' PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 I ANGELES COUNTY LICENSE. OR' I AM TH9?LEGAL OWNER
OF THE RESIDE TIAA:,�PROPERTY DESCRIBED BOVE.
GAS SYSTEM —OUTLETS- @ 0.50I
SIGNATURE O
WATER HEATER @ O.50 I11 PERMITT
Wzl�r
I SLOP SINK @ 0.501 I INSPECTION RECORD
JFLOOR SINK @ O.50 II '
sl FLOOR DRAIN @ 0.50I
DISHWASHER @ 0.501
DRINKING FOUNTAIN @ 0.501
URINAL @ 0.501 „J
HOUSE SEWER @ 0.50 I I Q
Z
MISCELLANEOUS I D
1 1 Water boftener I 0 0
I I
I
I
APPROVALS
DATE INSPECTOR'S NAME
I
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 I CESSPOOL
SEPTIC TANK: I SEPTIC TANK
I DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT 1,00 - GAS TEST
I 1 JO UTILITY CO. NOTIFIED
$
TOTAL FEE - I>
FINAL
WORKERS'COMPENSATION DECLARATION 76A667A p
I hereby affirm that I have a certificate of consent to self ce 617 (2-90) �P P IL I C A T I ON FOR PLUMBING PERMOU
insure, or a certificate of Workers'Compensation Insurance,or
a ce tifi* copy the eof(Sec. 3800,Lab.
COUNTY OF LOS AfVGE.L6 ILDING AND SAFETY
Polic�/NoCompany
ertified copy is hereby furnished. / FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
A D D R�ESS
cll�certified copy is filed with t county b ildin inspection. NUMBER FIXTURE OR ITEM O FEE
e'art e _ WATER CLOSET LOCALITY
Date� rApplicant NEAREST .
BATH TUB CROSS ST.-
CERTIFICATE
ORKER
COMPENSATION INSURANCE SHOWER OWNER be e * oBr�
LAVATORY MAIL
(This section need not be completed if the work involved ADDRESS GL
'by the permit is for one, hundred dollars ($100) or less.) SINK CITY L.NO. �J
I certify that in the performance of the work for which this DISHWASHER - t
permit is issued, I shall not employ any person in any manner CONTRACTOR �� 0
so as to become subject to theW rkers' C pensation Laws CLOTHES WASHER V
[y L ADDRESS
Date Applicant SWIMMING POOL RECEPTOR ` doe LU
NOTICE TO APPLICANT: If; afte aking this Certificate of CITY V �� -,- TEL.NO. 6 .
Exemption, you should beco subject to the Workers' LAWNS PRINKLER SYSTEM STATE > LIC. _
Compensation provisions of the Labor Code, you must forth- LICENSE NO. G- CLASS 4Q
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. DISTRICT OC SSED BY
GAS SYSTEM ! OUTLETS C � �/
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3'of the Busi- FINAL r,�
ness and Professions'Code, and my license is in full force and DATE �® ', rn, 6 VALIDATION
effect:
FINAL
License Number Lib.Class BY r
Contractor Date
ElI am exempt from the licensing requirements as I am a Plan check fee .
licensed'architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
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
License Law for the following reason (Section.7031.5, Busi- City Tel.No.
ness and Professions Code):
I, as owner of the property, am exclusively contracting 228-0. 1 A
.with licensed contractors to construct the project
(Section 7044, Business and Professions Code). / GI '#.o o o:o o 5
CONSTRUCTION LENDING AGENCY 2 0 0 0.00
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is o 0 a 1 0,00=
U
issued(Sec. 3097,Civ.C.).
Lender's Name 10,27-80
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State law regulating Plumbing, and hereby
author' representativ f th' County to enter upon the
abov ntioned pr ty f spection purposes.
Si a e Permi tee