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Home My Public Portal About4840 HELEO AVE_Plumbing__ '176 '�;.i7 25b1 SETS 1-40 - APiILICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES 4 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT To FILL IN -DISTRICT GROUP ZONE PERMIT NEI. PLUMBER K.0 Rae Chandler -/1 6 9.4 i'l RECEIVED BY READY FOR DATE ISSUED. 'S �t t�7 /�- �/A1 An FIRST INSPECTION ADDRESS 14.2.1 FaslQffia. A#entre. 1`� 1!V\A Ow ��ccTT SP CITY TEL. Na. Rg 5rJ21 JOB ADDRESS -4840 X. Rules COUNTY �t q LICENSE N17. EXPIRES LOCALITY TT Temple le C1t� 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS NEAR EST ANGELES COUNTY LICENSE. ST.y�O eT Asa:. 8C EtaCinita 7� OWNER �e B6 Hai;sett MAIL ,,y PLUMBER ADDRESS ag' above PERMIT FEE IS $1.00 FOR THE FIRST FIXTURE OR _ CITY TEL. No. ITEM LISTED BELOW, PLUS 50c FOR EACH ADDITIONAL I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- ITEM. FOR EACH SEPTIC TANK AND PIT OR DRAINFIELD ERTY DESCRIBED ABOVE. $1.00. MINIMUM FEE FOR ANY PERMIT $1.00. -EACH GAS SYSTEM IS A SEPARATE ITEM. OWNER NUMBER TYPE OF FIXTURE OR ITEM WATER CLOSET (TOILET) CORRECTIONS BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK LAUNDRY TUB OR TRAY - 1 GAS SYSTEMOUTLETS WATER HEATER SLOP SINK J Q FLOOR SINK Z FLOOR DRAIN L7 DISHWASHER O DRINKING FOUNTAIN URINAL MISCELLANEOUS APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING I GAS PIPING I I - GAS VENT CESSPOOL 1]4 EHSE TIC TANK - DRAIN ( ) PIT ( ) $ SEPTIC TANK SPOOL $ SEWER OUSEN/ER $ GAS TEST TOTAL FEE $ UTILITY CO.NOTIFIED FINAL WORKERS' COMPENSATION DECLARATION ' . a' 20-0026 DPW 4/87 apG°�WCAT 0O H FOR. I�LUM a MIG, PERNn T I'he eby>;affirm that I have certificate of consent to self in- 76A667A . surd ora certificate of Workers'Compensation Insurance;.or a =CE 817(REV.'8/86) certified.copy thereof (Sec. 3800;Lab C:,) Policy No; Company COUNTY OF.LOS ANGELES ' DEPT. OF PUBLIC WORKS, • �. .! Certified copy') hereby furnished FOR APPLICANT TO FILL IN(PRINT OR)TYPE) BUILDING FCertified copy is filed with the county building inspection ADDRESS �. department.: ". NUMBER FIXTURE'OR ITEM Ca FEE LOCALITY Date A licani - WATER.CLOSET(TOILETj'. PP , NEAREST:. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB_ CROSS ST. COMPENSATION INSURANCE O OWNER SHOWER.•' (This section need not,be completed if the:work involved by. :MAIL the permit is for one hundred dollars•($100)or less.) LAVATORY: " ADDRESS " I certify,that in the performance of the'work for.which this.per- mit is:issued,Gshall not employ any person in'any manner so SINK CITY TEL. NO. as to become subject to the Workers'Compensation Laws. - DISHWASHER CONTRACTOR ^� Date Applicant - CLOTHES WASHER NOTICE TO APPLICANT: If, after'making this Certificate of fz= emption,•,you should become.sublectto the Workers'Compen- SWIMMING POOL,RECEPTOR ADDRESS CITY TEL, NO. cation provisions'of the Labor Code, you'mustforthwith comp- LAWN SPRINKLER SYSTEM Iy with such-provisions or this permit shall be deemed revok •, STATE' LIC.ed: LICENSE NO. CLASS WATER HEATER ' LICENSED CONTRACTORS DECLARATION ESS I•hereby affirm;tbat I am li'censed•under provisions of Chapter GAS SYSTEM ,< OUTLETS DISTRICT'NO. 00 ED BY 9{commencing with Section.7000)of Division.3 of the Business OUTLETS OVER and Professions.Code, and my license is in full force and ef= 5 PER SYSTEM.. FINAL VALIDATION fect: ` . - - O .. DATE yy 9 License Number• Lic Class U -FINAL Contractor Date' BY O FI ani eze•mpt•under.Sec. .. W ason Plan he Date: k f - ccee B�&P.C. for this re ` a •• :' .PLUMBING PERMIT.ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY. Plan check:a licant, O� HOME OWNER-BUILDER DECLARATION: _ PP I hereby affirm that l am exempt from the Contractor's License Name Law.for the following-reason (Section 7031.5, Business'ond N.l �7rjons Code) Address s +Laas;owner of the property;`:will do the work and the City.. - •. Tel. No. 7ucture,is'•hot intended or offered for sale(Section 7044, -_ Bu siness'ond,Professions Code). 7 1 .ii "= s. _ 3 CONSTRUCTION LENDING_AGENCY a. 1 . I hereby affirm that there is a construciion lending.agency for __ _ the performance of.the work for which this,permit is issued ;[ E�h3r (Sec.'j.697, Civ` C.). Lender's-Nameq —jr Lender's Address 5995 1 ?NJ2-1 1 .I certify that'I have read this application.and state that the above information is correct. I agree to comply with all County D' ordinances and State'laws regulating Plumbing,:and hereby authorise representatives of this County.to enter-upon the Lbovae-me",,one' � property for xispecti- ILon purposes., SEE REVERSE FOREXPLANATORY LANGUAGE Signature of PermeeDate V10PKERSs COMPENSATION DECLARATION o �p F hereby,affirm That i have a certificate of consent to self 76A667A AFFM A790M FOR PLUM ENG PERMT insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 8/86) or a certified copy thereof (Sec. Lab.C:) COUNTY OF LOS' AiLIGELES' DEPT. OF-PUBLIC•-UNORKS .Policy No. Company "• , C ed copy'is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING D Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM. _ @ FEE LOCALITY' WATER CLOSET Date Appli4ont NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB Q CROSS ST COMPENSATION INSURANCE SHOWER Q OWNER (This section"ed not be completed lit 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 permit is issued, I shall not employ any person in any manner SINK O CITY TEL. NO. /' sous to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER- NOTICE TO APPLICANT: If, after making this Certificate of - ADDRESS Exemption,' you should become subject to the Workers' SWIMMING POOL RECEPTOR 'CITY � TEL. N?. D Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM T with 'comply with such provisions or this permit shall be,. STATELIC. deemed revoked. WATER HEATER LICENSE NO. 7 CLASS � LICENSED CONTRACTORS DECLARATION P DJS�ICT NO PRO SSED BY I herebyaffirm that I am licensed under provisions of Chapter 9 GAS SYSTEM 'OUTLETS �L V J�,j /J (commencing with Section 76W) of Division 3 ofithe Business OUTLETS OVER t✓ ESL and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL Gl VALIDATION JJ DAT License Number /� //`�� Lic. Class � � It //!F'GCS=moo � p� F �G Contractor, g Date 11J F1I am exempt under Sec. B..BP,,C. for this reason Plan Check fee D �� Date: PLUMBING PERMIT ISSUING FEE Signature TOTAL FEE o Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER.DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for.the following.reason (Section 7031.5, Business and ( ;o 6 3 4.5 Q Professions Code): City Te 1. No. I, as owner of the property„ will do the work and theo;o 03(�5 0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). D CONSTRUCTION LENDING AGENCY 8 a$7 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 D above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize epresentatives of this County to'enter upon the • above- Mion property�forinspection purpose • SEE REVERSE F013 EXPLANATORY LANGUAGE• Signature of Peri ed' Da /