HomeMy Public PortalAbout5936 IVAR AVE_Plumbing__ BS-17 10-55
APPLICATION FOR PLUMBING PERMIT 1 ..
DBS-' DIVISION OF BUILDING AND SAFETY
Depm'tment of County'Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D,GRIFFIN,SUPT OF BUILDING
LOCALITY L--
FOR APPLICA!V TO FILL IN NEAREST
CROSS ST.
OWNER DISTRICT O. GROUP ZONE. READY FOR INSPECTION
MAIL
ADDRES
INDUSTRIAL
CITY'
CITY TEL 1j&40t71,0 WASTE APPROVAL
PLUMBS INSPECTION RECORD
ADDRESS4QJ�®
CITY TEL. N
LICENS N ' ,
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 6-1
BATH TUB @ $1.00
SHOWER @ $1.00 (�
LAVATORY (WAS BASIN) $1.00
KITCHEN SINK .aq
_$1.00 Q(]
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00 00
CLOTHESWASHER @ $1.00 - 0
WATER HEATER ' ' @ $1.00 j 00
GAS PYSTEM @ $1.00 00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT
ROUGH PLUMBING �. t
$ 1- 00
/,, GAS PIPING – c
TOTAL FEE �// G� GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER 11-1.:s 57
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 21,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES �)�/.S'�•
I HEREBY CERTIFY THAT I M P ERLY. REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY OS GELES COUNTY AND STATE OF
CALIFORNIA OR THAT I T LEGAL OWNER 0 THE VE - UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAL 0 RTY,
SIGNATURE
OF PERMITTEE FINAL
JOHN A. LAMBIE, COUNTY ENGINEER VA ' DA ON OBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH
2 0 2 1 In SEP 5 3 9.00
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
reby'6ffirm that I have a certificate of conse to self 20-0026 DPW 6/87
e, or a certificate of Workers' Compensation ns tante, 76A667A
or7tifiiedcop they f (Sec. 3800, Lab. G �' COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
-------��.Qompany 3� �9
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with th co buil ing inspec- ADDRESS
C ime t. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
WATER CLOSET
Date Applicant NEAREST
CERICATE OF EXEMPTION FROM WO RS' BATH TUB CROSS SL
TIF
COMPENSATION INSURANCE OWNER
(This section need not be completed If the work Involved by SHOWER
the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL
ADDRESS'
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CIT TEL. NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers' CITY ��gr
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEMViZL `r
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CL S •
LICENSED CONTRACTORS DECLARATION A 1 DISTRICT NO. OCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYST 0 0 `QJ
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Cq��g
' is in full for anydy�effect. .5 PER SYSTEM FINAL t VALIDATION
��J DATE Z� — ®,
License Num r Lic. Class �.
FINA
Contractor Date BY
❑ 1 am exempt under Sec. v,
Lsd
B.BP.C. for this reason
Plan check fee N
Date: ®.
PLUMBING PERMIT ISSUING FEE$ a
Signature
TOTAL FEE '
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's LicenseAddress
Law for the following reason (Section 7031.5, Business acid
Professions Code): City Tel. No.
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section -
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY t.
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 information is correct. I agree to comply with all County
ordinances an tate laws regulating Plumbing, and hereby
authorize rep s a Ives of this County to enter upon the
above-m nti ne pr ertyr inspection po s.
S SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date