HomeMy Public PortalAbout5447 HILTON AVE_Plumbing__ DBs.IT APPLICATION FOR PLUMBING PERMIT
D�SION OF BUILDING AND SAFETY 1,
Depaxtmenl of County Engineer
County of Los Angeles BING //
WM. J. FOX. COUNTY ENGINEER ADDRUILDESS
CASSATT D. GRIFFIN. SUIT OF BUILDING // p
LOCALITY / /✓J/`T
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. � -l.LiVLI.!'/
OWNER '/
DISTRICT_NO. GROUP LdeZO READY FOR INSPECTION
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PLUMBER // O INSPECTION RECORD
CITY /i'TOlA�..4,e. �44L. NO.
LICENSE NO, D C C-
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) J
BATH TUB C
SHOWER _
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER _
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO. .Bo APPROVALS
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DATE INSPECTOR'S SIGNATURE
/ GAS SYSTE! OUTLETS @ 1.00 UNDER SLAB WORK I
WATER HEATER @ 1.00 UV
ROUGH PLUMBING
PERMIT Is 1 00 GAS PIPING
TOTAL FEE C GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP [CATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY �y
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGMLATING PLUMBING FIXTURES ! tb
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED A
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOV
DESCRIBED RESIDENT] PROPERTY.
� ��
SIGNATURE
OF PERMITTE ' FINAL U (1
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
4 6 1 1 I� JON 13 3 9.4 0 In
By
DEPUTY
O // 7
�02
WORKER'S
haveCOMPENSATIONcertificate
DECLARATION 76A667 DPW 91e9 APPLICATION FOR PLUMBING PERMIT
6A666
I hereby affirm that I have a certificate of consent to sell insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec. 3800 Lab. C.)
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 5'T`/—i 17 / /_LL;0" A/t •I/,z5
r_1 Certified copy is tiled with the county building inspection ADDRESS T
department. NUMBER FIXTURE OR ITEM @ FEE /+
LOCALITY � (,G Ct(
Date Applicant WATER CLOSET
NEAREST o/.£��
CERTIFICATE OF EXEMPTION FROM WORKERS'' BATH TUB j CROSS ST.
1
COMPENSATION INSURANCE ASSESSOR
MAP BOOK PAGE PARCEL
(This section need not be completed If the work involved by the SHOWER /� //�� r �"
permit is for one hundred dollars($100)or less.) LAVATORY OWNER NMk"UL-L L7 L �IT-4G
I certify that in the performance of the work for which this permit
is issued. I shall not employ any person in any manner so as toSINK ADDRESS 1-4 -7 Z"LFON 4MAIL ,( k/l/
y
become subject to the Workers' Compensation Laws. > n
DISWASHER CITU TEL.NO.
Date Applicant CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you Should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS
provisions of the Labor Cyou must forthwith comply with such
provisions or this permit shall
be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.NO. �-
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER d
(commencing with Section 7000)of Division 3 of the Business and STATE LIC. 0
GAS SYSTEM OUTLETS LICENSE NO. CLASS U
Professions Code, and my license is in full force and affect. DISTRICT NO PROCESSED BY
OUTLETS OVER ^n l/ cc
O
5 PER SYSTEM
License Number Lie.Class V
FINAL
DATE VALIDATION
O W
�ZQ IL
Contractor Date 1 - y
❑ FINAL Z
I am exempt under Sec. By
B.BP.C.for this reason
Plan check fee ,
Date:
Signature PLUMBING PERMIT ISSUING FEE$ - .
::i•":rt
❑ TOTAL FEE r
SINGLE FAMILY Plan check applicant ACCT.i
HOME OWNER-BUILDER DECLARATION Name nn c- ,C
I hereby affirm that I am exempt from the Contractor's LicenseLaw ,j,)V I 53.
for the following reason (Section 7031.5, Business and Processions Address '
Code). S''- 1 ITEMS -
A'
IP I,as owner of the property,will do the work and the structuCity Tel. No.
re TOTAL .53. 35
is not intended or offered for sale (Section 7044, Business - — '
and Professions Code). CHECK 53.55
ffL,
CONSTRUCTION LENDING AGENCY CHANGE .UO
t hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097, //��rr11rfryy �1� p
Civ.C.) - r leJVtr-0001 11/?5/92
Lender's Name
6710 1 AM 9:15
o
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 ordinances
and Stale laws regulating Plumbing, and hereby authorize
representatives of this County to enter upon the above-mentioned
prope/rttyy�for inspecti�o/�n/pu}rRyoses. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date