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Home My Public Portal About5519 HILTON AVE_Plumbing__ 76AGG7-CE;tF17 4-67 / ' APPLICATION FOR PLUM ING /PER�M' YI�//j�f�i/ COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALIT (� FOR APPLICANT TO FILL IN NEAREST +� . CROSS ST. i( NUMBER FI%TURE OR ITEM EACH FEE "OWN � WATER CLOSET 81.25 MAIL HATH TUB 1,25 ADDRESS s/ I TEL. NO. SHOWER 1.25 LAVATORY 1,25 CONTRA OR SINK 1.25 ADDRESS d/ 0 +' DISHWASHER 1.25 CITY G EL. NO. STATE �`/� LIC /.� _ �� LAUNDRY TUB 1.25 LICENSE NO. CLASS -o�Q'J CLOTHES WASHER 1.25 DISTRICT NO//�/ GR P E PROS BY WATER HEATER 1.50 C7 .✓ ) �J �'S C. ( (Y2 GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .80 INSPECTION RECORD a O U w O H U W d y Z APPROVALS DATE INSPECTOR5 SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK Q ROUGH PLUMBING TOTAL FEE _33 GAS PIPING HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGU LgTING HOT WATER HEATER PLUMBING, HEREBY CERTIFY THAT 1 AM PgOPERLY REGIST D AND/OR PLUMBING FIXTURES LICENSED A5 REQUIRED BY LOS ANGELES COUNTY AN AT OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER AN INT O TO RE51DE IN. THE ABOVE DESC ED RESIDENTIAL P qTY, UTILITY CO. NOTIFIED SIGNATURE ERM OF PI TT l!re FINAL .Z. DATION JACK R. ALLEN cR M.D. cnSN SUPERVISING MECHANICAL ENG-R. 0 I, %� Lko142aQG OCTG /7J v 3.55 V" a i WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate.of consent to self in- 20-0026 DPN 4/90 sure,or a certificate of Workers Compensation Insurance,ar a 76A667A �I certified copy thereof(Sec. 3Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS [IILIIII Policy No.-Company ny ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING a I I _ Certified copy is filed with the county building inspection ADDRESS / t. List lik �- department. ' NUMBER FIXTURE OR ITEM. @ FEE / LOCALITY �; WATER CLOSET(TOILET) Dote Applicant 'NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' �' BATH TUB CROSS SL AA t•�TG COMPENSATION INSURANCE - OWNER SHOWER Wa KIIN4 (This section need not be completed If the work Involved by NAIL the permit is for one hundred dollars ($100)or less.) _ LAVATORY ADDRESS j e / Icertify that in the performance of the work for which this per- SINK CITY �. '\ TEL.NO. b mit is issued, I shall not employ any person in any manner so 316 as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR L Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS emption, you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITU TEL. NO. lotion provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER' LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. p PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM 3 OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE. License Number Lic. Class d FINAL y�O Contractor Date BY g=8 2263.11dc am exempt under Sec. t- 6 0 B.BP.C. for this reason W Plan check fee ► a Date: PLUMBING PERMIT ISSUING FEE$ i T E4J Signature O TtT T�iL /' .�.�� }{ _ TOTAL FEE (i IEC(ri J.L.f SINGLE FAMILY r HOME OWNER-BUILDER DECLARATION Plan check applicant 41) CHANGE •00 I hereby affirm that I am exempt from the Contractor's License Nome WALaw for the following reason (Section 7031.5, Business and Professions Code): Address & 0000_GJC01 5.'23,r'95 E) I, as owner of the property, will do the work and the City TA�p4 e;t C Tel No.�� y 6 OcGO 1 AM:1=�t 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, Ci, C.). Lender's Name 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 State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. IS--21-'fF SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION - APPLICATION FOR PLUMBING PERMIT I hereby, affirmrm that I have a certificate of consent to self in- 20-0026 DPW 4/90 sure,or o certificate of Workers'Compensation Insurance,or a 76AZA certified copy thereof(Sec. 3Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.-Company ny Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING /- I Certified copy is filed with the county building inspection _ ADDRESS �7�! fTj 66hVQ_ department. _ NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) •t 0 >! Dote Applicant. NEAREST rI CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER u (This section neod not be completed If the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 4 t certify that in the performance of the work for which this per- SINK CITYiiih TEL. NO. _��D mit is issued, I shall not employ any person in any manner soTPC;t as to become subject to the Workers Compensation Laws. DISHWASHER CONTRALTO Date. Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption, you should become subject to the Workers'Comport- CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- ` LAWN SPRINKLER SYSTEMS `�Q g46 �(e ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION ,_ DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINALVALIDATION ' fect. HOSE BIB DATE _g >_License Number Lic. Class a FINAL U Contractor Date BY O am exempt under Sec U B.BP.C. for this reason W Plan check fee ► a N Date:- PLUMBING PERMIT ISSUING FEE$ X7 () ? Signature TOTAL FEE P SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant yG�' 1 hereby affirm that I am exempt from the Contractor's License Name s FW`�.`T.a Low for the following reason (Section 7031.5, Business and _ Professions Code): Address 9 Ndtci, Ave. - I, as owner of the property, will do the work and the City et Tel. No. 33031 17.90 structure is not intended or offered for sale(Section 7044, _ ER-COR Business and Professions Code). - 110. 3303 _12.90CONSTRUCTION LENDING AGENCY rJ 1 hereby affirm that there is a construction lending agency for wr. the performance of the work for which this permit is issued AGCT.i (Sec. 3097, Civ. C.). 3303 123.90 Lender's Name 1 ITEMS Lender's Address TOTAL 123- 90 pFf 1 certify that I have read this application and state that the - ► - WE E i73:/.,µ above information is correct. I agree to comply with all County (,'H '{�j UU ordinances and State lows regulating Plumbing, and hereby f authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. O'zW_) SEE REVERSE FOR EXPLANATORY LANGUAGE 0001Z(Q'L Signature of Permittee Date 1 11M TION J. - WORKERS't I hove acertNcate of corse APPLICATION FOR PLUMING PERMIT . 1 hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, ar, a certificate of Workers' Compensation Insurance, 76A667A or o certified copy thereof (Sec. 3800, Lab, C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.l4/.)C-:OS3� a-nDy� �L�C.OS;✓ &46e A_ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING i Certified copy is filed with the county building inspec- ADDRESS tion epa meat. NUMBER FIXTURE OR ITEM C FEE LOCALITY rr-- —� I WATER CLOSET 1. ` `-' r L Dale "r Applicant 0 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST, COMPENSATION INSURANCE OWNER (This section need not be completed If the work Involved by SHOWER P 7f 1 .I% FT the permit is for one hundred dollars($100)or less.) / O MAIL L "� t ..� I certify that in the performance of the work for which this LAVATORY ADDRESS f—h-1, permit is issued, I shall not employ any person in any manner SINK n CITY ^ .�I TEL NO. so as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR \r Date Applicant CLOTHES WASHER ADDRESS - NOTICE TO APPLICANT. If, after making this Certificate of � `. - fn -t�O ILL Exemption, ,you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY rrx ' f TEL NO. •� Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM `-rel fJ l" 17{I !� With comply with such provisions or this permit shall be STATELIC. deemed revoked. / WATER HEATER /� LICENSE NO. J — CLASS _ LICENSED CONTRACTORS DECLARATION V DISS�ICT NO. PR ESSED BY I hereby off irm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE License Number Z�77�^� Lic Class '/�/-/Z�LL/' 'J/`�'�T FIN p Contractor-T40 �L�1Mf^Date BY 0, ❑ I am exempt under Sec. W'. B.BP.C. for this reason N1 Plan check fee Dote: Z PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant -- 5 HOME OWNER-BUILDER DECLARATION Ar. 1 hereby affirm that I am exempt from the Contractor's License - ACCTr• Address T Law for the following reason (Section 703 1.5, Business and - t �r•s Professions Code): City Tel. No. - '3307 40.50 ❑ 1, as owner of the property, will do the work and the 1 ITM. structure is not intended or offered for sale (Section . 7044, Business and Professions Code). ® TOTAL - 40.- Q CONSTRUCTION LENDING AGENCY CHECK 40.5D 1 hereby affirm that there is a construction lending agency for rR� the performance of the work for which this permit is issued _ "'^'� .W (Sec. 3097,Civ. C.). t +T- Lender's Nome GDODWW-0001 O/`17y7 Lender's Address 4103 1 AH11:45 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 State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dote—�7