HomeMy Public PortalAbout4856 HELEO AVE_Plumbing__ �sAeer Ir >s-as �5 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY; PLUMBING
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COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE I PERMIT NO.
PLUMBER ' - _�,r IF"I'ar RECFIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
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ADDRESS ,
y BUILDING /4
CITY TEL. NO. 11DDRES S' (!
7
COUNTY LOCALITY 7.3S.� t7/. .
LICENSE NO. EXPIRES NEAREST f ' }
PERMIT FEES CROSS ST. N
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
r. MAIL
WATER CLOSET (TOILET) @ 0.501$ I ADDRESS
-_I BATH TUB @ 0.501 I CITY TEL. NO.
r I SHOWER Q 0.501 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LAVATORY (WASH BASIN) @ 0.50 I AGRFE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING.
KITCHEN SINK @ 0.50 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 I ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM a' OUTLETS @ 0.501 SIGNATURE OF /
WATER HEATER @ 0.501 1 PERMITTEE -/... ' („
SLOP SINK @ 0.501 1 INSPECTION RECORD
FLOOR SINK @ 0.50 1�
�I1I FLOOR DRAIN @ 0.501
I DISHWASHER @ 0.501
DRINKING FOUNTAIN @ 0.501
1. URINAL @ 0.501 1 J
I HOUSESEWER @ 0.501 1 Q
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MISCELLANEOUS
I
I�
(1 APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING (f 1
GAS PIPING
GAS VENT r-
I CESSPOOL Q 1.00 I 1 CESSPOOL I 1'
I SEPTIC TANK: I I SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.001 I SEWER '
PERMIT . I 1.00 GAS TEST
d
TOTAL FEE $ UTILITY CO. NOTIFIED
I ,
FINAL
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7#AS67 17 5-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
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COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRIClAIO. qaguP I ZONE PERMIT NO��
PLUMBERRECEIVED BY ...� READY FOR DATE ISSUED
/ FIRST INSPECTION
ADDRESS —"v
BUILDING ^' r
CITY 1 'TEL. NO. ADDRESS
III COUNTY LOCALITY
LICENSE NO. EXPIRES
NEAREST �
PERMli FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER •�
MAIL
WATER CLOSET (TOILET) @ 0.50 $ I ADDRESS
BATH TUBchi 0.50 I I CITY TEL. NO.
SHOWER @ 0.501 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS
--{II CORRECT AND
LAVATORY (WASH BASIN) @ 0.50 I I.� AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING.
KITCHEN SINK @ 0.501 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM_—OUTLETS @ 0.501 1 _
SIGNATURE OF
WATER HEATER @ 0.501 1 PERMITTEE
SLOP SINK @ 0.501 1 INSPECTION RECORD
FLOOR SINK @ 0.501
1 FLOOR DRAIN @ 0.501
DISHWASHER @ 0.50I�
DRINKING FOUNTAIN @ 0.501
URINAL @ 0.501
� a
HOUSESEWER (e 0.501 1 ' Z
—I MISCELLANEOUS 1 1 U9
I o
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
1 I GAS VENT
CESSPOOL @ 1.00 1 CESSPOOL
1 SEPTIC TANK: 1 SEPTIC TANK
I DRAIN ( ) PIT ( ) @ 1.00 I SEWER
PERMIT . . I t.00 GAS TEST
TOTAL FEE $ ^'�" UTILITY CO. NOTIFIED
I
FINAL
L
WORKERS'COMPENSATION DECLARATIONY APPLICATION FOR PLUMBING PERMIT
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I Aereby-affirm. at I have g certificate of consent to self 10- 76 66�ADPW 4/s0
sure;or a certificate-of Workers'Compensation Insurance,or a
certified copy thereof (Sec. 3800, Lab. C.)
Policy No. -� ompany ?.f COUNTY OF-LOS ANGELES DEPT. OF PUBLIC WORKS
Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN (PRINT OR TYPE)
Certified copy is filed with the count wilding inspection ADDRESS O �®
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date Applicant �. /t/Ut�f.' !J�"' I MATER CLOSET(TOILET) �� NEAREST
CERTIFICATE OF EXEMPTION FWORKERS-t_7// / BATH TUB CROSS ST.
FIR
COMPENSATION INSURANCE SHOWER OWNER 7W /
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this per- ' SINK CITY TEL. NO.
mit is issued, I shall not employ any person in any manner so
as to become subject to the Workers'Compensation Laws'.' DISHWASHER J_GONTRACTOR c
Date Applicant CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY {/ it TEL.NC� �tL
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS_
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. 6j� CLASS y>
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER G
and Professions Code, and my license.is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fect. HOSE BIB DATE 3�
License Number `" / / Lic. Class 3303 91',70 A
Contractor % (' Y� '�("' 'Date �' `� TGTp IT E o 70 o
I am exempt under Sec. �j 0 91°70 0
B.BP.C. for this reason ► CHECK ��� �
Plan check fee GHAh{GE
Date: PLUMBING PERMIT ISSUING FEE$ a
Signature
SINGLE FAMILY TOTAL FEE 0000-0001 11/29/95
HOME OWNER-BUILDER DECLARATION Plan check applicant 3481 1 PM12a31
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
❑ I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044,
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 'nr
fomation is,correct. I agree to comply with all County
ordi ncs and State laws regulating Plumbing, and hereby
aut riz� representatives of this County to enter upon the
ab entioned proprty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature"e' er tj Date