HomeMy Public PortalAbout6036 IVAR AVE_Plumbing__ 76A 667-CE#817 10-62 . .
APPL:ICATION FOR. PLUMBING PERMIT
COUNTY OF LOS-ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING D��
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST `
CROSS ST.
,NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1,25 J� MAIL
BATH TUB 1.25
e ADDRESS
CITY TEL. NO.
SHOWER 1.25 / �J
LAVATORY 1.25 CONTRACTOR A 4, 9 Ga
SINK 1.25 ' ADDRESS' Z//z'
DISHWASHER 1.25 CITY ;;�L_TEL. NO. pfo33
LAUNDRY TUB 1.25 CONTRACTOR'S STATE
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 -•J DIST
RIC NO, GRO ZONE PFJOCESBY
WATER HEATER 1.50 �r
1.50 INDUSTRIAL. p�
GAS SYSTEM _OUTLETS WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
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APPROVALS DATE INSPECTOR'S SIGNATURE
y UNDER SLAB WORK
PERMIT $ 2 00 o It
ROUGH PLUMBING It 31
TOTAL FEE !, Q Q
GAS PIPING
F 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION R GAS VENT
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
_ 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANDSTATE OF GAS TEST v�
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE D CRIBED ESIDENTIAL P ERTY. UTILITY CO. NOTIFIED r:1�•4 3
SIGNATURE
OF PERMITTEE FINAL
VALIDATION ROBERT A. WOOD 1
c� M.0. CASH SUPERVISING MECHANICAL ENG'R
�r+ 02684- rAR29 5 A 15.00-
WORKERS'COMPENSATION DECLARATION w
I hereby affirm that I have a' certificate of consent to self CE: 817 (z-eo) �P n LI C AT I®N F®RP L U MMN G PER MT
insure, or a certificate of Workers'Compensation Insurance,or
a certified co9y thereof(Sec. 3800,Lab.C.)
4, ,. ��/(_�L�I,S� COUNTY F LOSA ELES BUILDING-AND SAFETY
Policy No. Company T- -
Certified copy is hereby furnished. FOR `APPLICANT TO FILL IN (PRINT OR TY E) v BUILDING -J—�/n
Certi ed opy is fil t e county buildi inspe io
NUMBER FIXTURE OR ITEM O FEE ADDRESS (�Lo p f7Ae. 1 :
LOCALITY
Date'd A WATER CLOSET NEAREST
- TH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' 'f
COMPENSATION.INSURANCE OWNER
MAIL //►� }
(This LAV �f7 section need not be completed if the work involved ADDRESS - a0
by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO U
I certify that in the performance of the work for which this DISHWASHER =
permit is issued, I shall not employ any person in any manner CONTRACTOR 0
so as to become subject to the Workers' Compensation Laws: CLOTHES WASHER
_ ADDRESS U
Date Applicant SWIMMING POOL RECEPTOR' LU
NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. N (J,' to
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM ATE LIC. Z
Compensation provisions of the Labor Code, you must forth- ATE
NO. ��� CLASS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO.
' P CESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER i of
I hereby affirm that I am licensed under provisions of Chapter 5 PE R SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL 9 VALIDATION
ness and Professions Code, and my license is in full force and DATE r
effect.
License Nu Lic.Class FINAL
Contractor' r'�' 1 Date
I am exempt from the licehs]requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ G
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE /0
Lie.or Reg.No: Date Plan check applicant'
HOME OWNER-BUILDER DECLARATION Name
I 'hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section.7031.5, Busi- City Tel.No.
ness and Professions Code):
1„as owner of the property, am exclusively contracting
with licensed contractors to construct the project. 9 1 7 69 A
(Section 7044, Business and Professions Code).
a
` #'O"o 0 0.'0 5
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency 2 o 0 1 a 0 O
for the performance of the work for which this permit is
issued(Sec. 3097,Civ.C.). 0 0 0 Q Q �
Lender's Name
Lender's Address 0 B-1 8_8.0
I certify that I have read this application and state that the
above information is correct.I agree to comply with.all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and 5h.
ting PI mbing, and hereby
authorizer esentatives of Cou t enter up t
abovemen coned property forec os
Sign o Permittee' Date