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Home My Public Portal About6047 IVAR AVE_Plumbing__ 76A667-CE817 6-60 APPLICATION FOR PLUMBING PERMIT RETOFOAYGE DEPARTMENT LOS ANGELES w BUILDING AND SAFETY DIVISION suILnING� JOHN A. LAMBIE. COUNTY ENGINEER ? ADDRESS WILLIAM A. JENSEN, SUPT OF BUILDING t? LOCALITY FOR APPLICANT TO FILL IN NEAREST +' CROSS ST NUMBER FIXTURE OR ITEM OWNER e WATER CLOSET MAIL BATH TUB ADDRESS . SHOWER C TEL. NO. • %7—-577X,2 � - LAVATORY CONTRACTOR SINK ADDRESS DISHWASHER CITY TEL NO. I CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ,El CLOTHES WASHER DISTRICT NO. G577 I ZONE C ED B WATER HEATER / GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD a O U ' I: O .k F U W - vat t / O1.00 PER ITEM RF TURF $ / APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK'` TOTAL FEE I I ROUGH PLUMBING A n �,. GAS PIPING °` -41 AHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT 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 AND STATE OF GAS TEST CALIFORNIA OR THAT IAM THE LEGAL OWNER OF THE ABOVE �: DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMIT �g FINAL - ®P VALIDATION ROBERT A. WOOD, cs. M.0. CABR SUPERVISING MECHANICAL ENG'R 76A667 DSS 17 7-51 - APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER ISTR'.CT O. GROUP ZONE P M F APPLI/ T TO FILL IN // r� PLUMB ) READY FOR `Y-` / I�§C,EIVEDaY FIRST INSPECTION DATE ISSUED ADDRESS I'QJj./Y/c lJ 6, BUILDING ®� CITY r TEL. No. ADDRESS COUNTY l LOCALITY IO 8E NO. !� EXPIRES �p17 Ria 'NEAREST PERMIT FEES CROSS ST. ° i NUMBER TYPE OF FIXTURE OR ITEM FEE 1 OWNERMAIL WATER CLOSET(TOILET) Q 0.50 s ADDRESS BATH TUB Q 0.50 CITY / TEL NO. SHOWER Q O.SO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) Q 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK Q 0.50 AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q 0.50 ANGELES COUNTY LI ENSE, OR 1 AM THE LEGAL OWNER GA9 SYSTEM OUTLETS 0.50 Qf' THE RESIDENTIA' PROPERTY DESCRIBED ABOVE. ® SIDNATURE OF WATER HEATER Q 0.50 PERMITTE SLOP SINK Q 0.50 , SPECTION RECORD FLOOR SINK Q 0.50 FLOOR DRAIN Q 0:50 DISHWASHER Q 0.50 DRINKING FOUKTAIN Q 0.50 URINAL Q 0.50 Q HOUSE SEWER Q 0.50 _Z MISCELLANEOUS C7 R' D APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL Q 1:00 CESSPOOL SEPTIC TANKO - SEPTIC TANK DRAIN ( ) PIT ( ) Q 1.00 SEWER PERMIT I 1.00 GAS TEST TOTAL FEE UTILITY CO.NOTIFIED � ® h �j / FINAL /(/ 1� • ''•WORKERS'COMPENSATION DECLARATION Ap P l!—UCAMN FOR PLUM o MIG pERM7 r "I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate,of Workers' Compensation Insurance, 76A667A or a certified cb'iy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 'Policy'No. Company Certified copy is hereby furnished. • FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / �y• � �,�]p ❑' Certified copy is filed with the county building.inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM FEE LOCALITY WATER CLOSET Date ApplicantNEAREST CERTIFICATE OF EXEMPTION FROM WORKERS" BATH TUB CROSS ST. 1ele4&D J COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY �+� TEL. NO.;2J'6-7b33 ACTOR so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS D� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER } and Professions Code,and my license is in full force and effect. 5 PER/SYSTEM FINAL VALIDATION DATE U. License Number Lic. Class j I FINAL Contractor Date BY ❑ 1 am exempt under Sec. LLJ B.BP.C. for this reason 90 Plan check fee . D UZ Date: �. PLUMBING PERMIT ISSUING FEE$ / ��- Signature TOTAL FEE �a SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name - I hereby affirm that I am exempt from the Contractor's License Addresst"k I °;L Law for the following reason (Section 7031.5, Business and _,y� 1 F st Professions Code): City Tel. No. -' 1, as owner of the property, will do the work and the 1 FEN'S 'S structure is not intended or offered for sale (Section 7044, Business and Professions Code). D 1)-I`s HL 0 FJ CONSTRUCTION LENDING AGENCY e:i-jil i, 0 1 hereby affirm that there is a construction lending agency for the performance of the work for which tFiis•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 '� '� I Hid r~Ea 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 aLyove-mentioned property for inspection purposes. � �J� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ermittee Date r Om that I'S COMPENSATION DECLARATION 20-0026 76A66 ADPW 9f89 APPn CATMn n FOR PLUMBING Ln nM p I^nG PE, RMT I hereby affirm that I have a certificate of consent to self insure, (� �fl �J �I (J 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. �9_ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �/�� J��q� El- Certified copy is filed with the'county building inspection ADDRESS tom/ �V department. - NUMBER FIXTURE OR ITEM @ FEE 'LOCALITY Date Applicant WATER CLOSET NEAREST BATH TUB CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. A Jt�jALD MAPASSBOO �!� - COMPENSATION INSURANCE /4 MAP BOO J� PAGE PARCEL (This section need not-be completed if the work involved by the SHOWER permit is for one hundred dollars($100)or less.) OWNER 0'/X kleA� I certify that in the performance of the work for which this permit LAVATORY ! is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS ®T become subject to the Workers'Comp/ /tioaw 7 ! DISWASHER TEL.NOZ &7,5 . Date T Applicant/ CLOTHES WASHER NOTICE TO APPLICANT: If, alter making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER'SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER a. (commencing with Section 7000 of Division 3 of the Business and STATE LIC. 0 ( g ) LICENSE NO. CLASS Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS V OUTLETS OVER DISTRICT NO. PROCESSED BY 0 5 5 PER SYSTEM - y (—�L�i License Number Lic.Class �,/ O ~ FINAL V DATE _ VALIDATION W Contractor Date ~/ (A ❑ !t 4 I I am exempt under Sec. BY AL s9 e n s Z y-7 -r BAP.C.for this reason Plan check feel Date: PLUMBING PERMIT ISSUING FEE$ Signature ;_;" +� �; sa El NECK FEE t_; `4;S t n applicant SINGLE FAMILY Plan check a PP HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law 04 t 1 :? for the following reason (Section 7031.5, Business and Professions Address ! ..r'vA2 jj_I;{— €jj?! _, Code): 1 2 +—_ ,. City72F/f) .ir 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). J 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 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 prop ;Ly.jorr inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE MMIgnature of Permittee Date WORKER---',COMPENSATION DECLARATION o 0 n 0 o p p p�/� a �n n j I_h�Teby, affirm"that I have a certificate of consent to-self 76A667A APPUCATM FOR PL�IUJ�Vv MIG PERMU t insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a cer ie copy thereof-(Sec. 3800, a . C.) COUNTY OF LOS ANGELES BUILDING.AD-SAFETY U 75Yy03 acy o.. Comp6ny Certified'copy is hereby.furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE)' BUILDING t / �r(tion ertified copy is filed with.#coubuilding inspec- ADDRESS Q v 7 / //i4de'paent. NUMBER FIXTURE OR ITEM @ FEELOCALITY "- � /e ��Date Applicant WATER CLOSET NEAREST CE OF.EXEMPTIOOR RS" BATH TUBCROSS ST. COMPENSATION OWNER (This section need not be completed if the work involved by SHOWER aN �" MAIL the permit is for one hundred dollars.($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I'shall not employ any person in any manner SINK CITY TEL. NO. -7� so as to become subject.to the Workers Compensation Laws. DISHWASHER ' CONTRACTOR � ✓�/J ai �� D�� Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after, making this Certificate of D ZO "74✓//k Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR . Compensation provisions of,the Labor Code, you must forth- CITY TEL. NO. �'7rl LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE cT. LIC. / deemed revoked. WATER HEATER LICENSE NO. �J CLASS / LICENSED CONTRACTORS DECLARATION DISTRICT NO, . PR CESSED BY I hereby affirm that 1 am licensed under provisions of Chapier 9 GAS SYSTEM OUTLETS (/Jf=Jj( (commencing'with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full'force nd effect: 5 PE YSTEM I 1Z DATFINAL E VALIDATION License Number Lic. Class FINAL 09 Contractor Date BY f° ❑ I am exempt under Sec. L N B.&P.C. for this reason Plan.Check fee Date: PLUMBING PERMIT ISSUING FEE$, S� Signature3(� 9.0 A TOTAL FEE SU Plan checkapplicant # o00�005 SINGLE FAMILY • .HOME OWNER-BUILDER DECLARATION Name ( - 3050 1 hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and .0 0 o. 3 0.5 0 v Professions Code): City Tel. No. ❑ J 1J 8=85 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 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 hav read this application and state thaRthe above informatio is 6rrect. I agree to comply with all County ordinances and to laws regulating Plumbing, and hereby authorize repr s tatives of this County to enter upon the abo - e ti d property for inspection purpos s. SEE REVERSE FOR EXPLANATORY LANGUAGE Sign o ermif e Date