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HomeMy Public PortalAbout6275 IVAR AVE_Plumbing__ 76A667-C E*817 10-67 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKiNS. SUPT. of BUILDING LOCALITY, CROSS FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM EACH FEE CROSS ST. ..".,._ OWNER WATER CLOSET 1.50 MAIL " BATH TUB 1.50 ADDRESS SHOWER 1.50 CITY TEL. NO. LAVATORY 1.5 0 CONTRALTO SINK 1.50 ADDRESS DISHWASHER 1.50 CITYTC-;:' - CLOTHES WASHER 1.50 STATE / LIC - LICENSE NO. -/ i0t1CLASS SWIMMING POOL RECEPTOR 1.50 c - m - - DISTRICT NO. GROUP ZONE PR� ESSED BY , LAWN SPRINKLER SYSTEM 2.00 vY �-�/ O CL C.) WATER HEATER 1.50 WINDUSTRIAL WASTE _ _ � O GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD ~ U OUTLETS OVER 5 PER SVSTEM .30 CL N e Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 2 00 TOTAL FEE a 19 APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK - -- Name ROUGH PLUMBING Address GAS PIPING GAS VENT City. Tel. No. a HOT WATER HEATER _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES- - ---- c WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST - • PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTI PROPERTY. FINAL Y ---- SIGNATURE - - .JACK R. ALLEN,-SUPERVISING,MECHANICAL NG'R. T OF PERMIT / PERMIT VALIDATION o. C ASH PLAN CHECK VALIDATION CK. M.O. CASH LAC o 6�8 7 72 GCT16 5 -D 3.�!�" �. fV 4 WORKERS'COMPtNSATION-DECLARATION -APPUC TM F©[, PLUMMMIG I!"L5RN 1J I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 nsurti, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS. Policy No. Company Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) * 7 .� Certified copy is filed with the county building inspec- ADDRESS IV` ✓� �� FIXTURE OR ITEM' NUMBER @ FEE' tion department. LOCALIT* C A t ql WATER CLOSET Date Appligant NEAREST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Z(JC(l1/ COMPENSATION INSURANCE OWNER (This section need not be completed if the work Involved by 111-4 SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL i, ADDRESS U J� Ve— I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY l�M rL i TEL. N - 7 so as to become subject to the Workers Compensation Laws. -DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT- If, after making this Certificate of you Exemption, should .become subject to the Workers' SWIMMING POOL RECEPTOR P Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. . WATER HEATERLICENSE NO. CIASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCESSE I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL ALID TION C�.1 DATE. Q' License Number Lic. Class U. FINAL Contractor Date BY 0. ❑ i--' I dm exempt under Sec. U B.&P.C. for this reason 0.i Plan check fee Z Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name _..,. I hereby affirm that I am exempt from the Contractor's License ACCT 's Address Law for the following reason (Section 7031.5 Business and �a€f • 20 Ct, Pr essions Code): City Tel. No. ITEMS ' I, as owner of the property, will do the work and the structure is not intended or offered for sale. (Section }"€�€}Fh; 20 7044,Business,and Professions Code). --50 . CONSTRUCTION LENDING AGENCY -HECK 10-'-'� I hereby affirm that there is a construction lending agency forF' r C `}i€ CHANGE performance of the work for which this permit is issued (Sec. 3097,'Civ. C.). Lender's Name ;• 1- Lender's Address rca='` 1 AM 9 1:'o'ff 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 inspectionpurposes. O SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PermitteV Date •WORKERS COMPENSATION DECLARATION :�, o 4` o �; O O. ��l�pIEQ [:�Of f ,®l ' �G 1[34��Ccs PE�l�f 5 (`.hereby jaffrrm chat I have a certificate of`corrsent,t6 self i6 76A667A PW 4/87 O sure or:a,certi£rcate.of Workers Compensation Insurance,ora :EE 817(REV 8/66) certified copy thereof (Sec;`3800,'Lab C )' r; r .:• DEPT OF PUBLIC-WORKS COUNTY OF,LOS A'NGEIES Rolicy Nose Campan'y,' r Certified copy is hae`reby furnished _ FOR APPLICANT TO FILL IN'(PRINT.OR TYPE) BUILDING/ n pp�,�� rr 3 Certified'copy rs filed.`wrth the eounty'building'inspectio ADDRESS til :1 Zl�uf`- w` CZE(` dep6rtment '<, ;. a' FIXTURE,OR IT FEE f: 3 k " . NUMBER VJATER,CLOSET(TOILET) LOCALITY -Date plicant ' NEAREST r tJ T (ROSS ST , M CERTIFICATE OF EXEMPTI`ON`FROM.;WORKERS' .. .,� iBATH'•TUB , <. COMPENSATION INSURAhlCE SHOWER! u OWNER (T,hks section need;'not b"e complete8 if the work involved.,by MAi f she permit is forone.hundred dollars ($1.00)'or less.) LAVATORY ADDRESS ''' , :n...-_ - v I certify„that m-the'performance•of'the work for''which;thrsper-.: a. I� �mrt is:issued, lshall not°employ any.person-.rp-any,manner,;,so • NK TY: -\ 17VtS CT.(, L. NO bs to,became"sabject to,„the Worker§ Compensdtion Caws: - >„x < : DISHWASHER CONTRACTOR r < • c: - Date Applicant :� CLOTHES+WASHER i NOTICE TO APPLICANT If iditer',making at th'i's Certifice"of'Ez ADDRESS empirony'you shou'Id',become``'subject to ihe.Worker's';Ca,mpen= SWIMMING POOL RECEPTOR sation provrsrons'of`the Ldbor Code;'you must forth,,vith comp- - "LAWN SPRINKLER,SYSTEM ; Ly with such provisions',or this permit shall.be.deemed revok- STI ATE LIC. N ed y NSE NO .CLASS O WATER'HE LICENSED CONTRACTORS.DECLARATION• : - a`: - t ST IGT NO OC ED BY p ovcka,pter ,., AS SYSTEMtOUTLETS 9,(com"mendingwahlSi'tilon7000},ofDevisionl3'of;jheBusiness'• LJIETSOVER ` .'.; ,. __ � and Prafessrons Code and„my lice se is rn•full force and of-. FIN F feet V� DATE ER SYS License Number,-=' ' Lic.+Class U, • •• - � �►LIDATION < FINAL - - Contract' Date BY r Q I am'exempt'under Sec B.,&P.Cfor this reason 7 it ti w ” Plan check fee Date- `= PLUMBII PERMIT ISSUING FEE$ Q � D t Signature TOTAL FEE <. r - , SINGLE FAMILY - f HOME OWNER-BUILDER DECLARATION PP .. t Plan,check a Inca ` F hereby 6ffirm than l am exempt from-the.Controctor s,License Name Law for,+the'-follavvtng reason (Section 703,1.5 Business'and, " , (; Tes,' Professions Code),Ys Add.ress +V SII •T� I.os'owner of the,property:;:will do.tHe work and.the_ 'City t' e M. structure isnot not rntended.cr.04bred for.sale(Section 7044, ,,;, s ITE •� Business and'Professrons,Code) ° IAS -� �+ - 0 _ �v m CONSTRUCTION LENDING AGENCY /-'p{4 I hereby affirm that there is a construction lending-agency for. r�. the performance-of the work'forwhich this permit`is issued �' r (y; pl°4#tE ,+_r9lr (Sec, 30.97•,'Civ. C.) Lender's Name "10 CI - - ,-f 4f ,_moi, Lender's Addressx. f� 3 ri I certify that-,l have read this application and state that the • - z above information is correct.,I agree to comply with all County ordinances and'Stote laws regulating.Plumbing, and hereby authorize representatives of,this County .to-enter upon'the' abovementioned p '' t -for inspection purposes.,, —t SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date •V"6Qf t•: 0 A 25M APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ���l�1� a� � COUNTY OF LOS ANGELES WM, J. FOX, CHIEP ENGINEER NATURE OF INSTALLATIONDISTRICT NO. GROUP MUP ZONE PERT No. ROV(3H — — T PLUMHIHG F1XTl1RE8 COMPLETE _ READY FOR RECEIIVG�IED I§Y✓'' DATE 186UED HEATER CE98POOL SEPTIC TANK FIRST INSPECTION GAS MISC LANEOUS APPLICANTiFILL IN HEAVILY OUTLINED P 1, /L.ONLY JOB E NAM f / .•w ® ADDRE734; �1 U .7 j '�/ •, LOCALITY ' NEAREST J, CITY TEL ' r CROSO 6T. ^ l IJ{ a RVOGN UTY NO. EXPIRES I O f W NAMIII rf✓ ` LOCATION Or SEPTIC TANK, OR CESSPOOL z MAILS t NORTH i O 4 clTv TEL No. { CORRECTIONS f a { D 3 I a i Q Z ' o SOUTH DESCRIPTION OF WORK BA7N Tus _ FURNACE amown DISHWA0HBR APPROVALS �LAYATORY REFRIGERATOR DATA INQPUCTDA 0 RAW ._.:�KtT^.I•tE:: 6iNK WAT¢R SOQTIINER ROV3H PLUMBING FLOOR OINK RAND TRAP GAG PIPING • LOP BINK FLOOR DRAIN GAG VENT WASH TRAY __URINAL CESSPOOL 4 WATER CLOSET DRINKING FOUNTAIN BEP.'IC TANK WATER HEf1TER _ -DENTAL LAVATORY, BEWCR Ht ,METER GAR SODA FOUNTAIN; UTILITY CC. NOT1R1f7D c;;TIL �- FINAL IAM THR LEGAL OP Tt"fE1II LOO ti-D S COUNTY RIIGIDTRAT NI.fAA r TOTAL NUMBER OF FiXTURIIA "BPTiC TANK � . PL dBYq CESSPOL :`a CJi AbI TNIT LIEGALRR�bF TH14 PPIOPIIRIY Dmo(:FtIDED.- ` ABOVE[ h, 4N 1. O o. 1700 ism -. APPLICATION FOR PERMIT DEPARTMENT OF•.BUILDINQ •AND SAFETY PLUMBING ��yq Qy�Yp p�v COL':`�'TY OF LOS ANGELES Jl'd�j�1j�1� W1iA. J. FOX CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO.. GROUP ZONE PERMIT No. ROUGH PLUMBING I I FIXTVit E9 ( OMPL@TZ I'e — r READY FOR RECEIVED H DATff IPOU¢D HEATER CESSPOOL SETf1C TANK( FIROT INGP¢CTION GAS I MISCELLANEOUS J ^/®e '�"� APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY NAM¢ �' JO® ADDR ZOO kd O: IC ADDRESS �f.✓i /-!Q :f LOC;ALIYY j -v NEAREST CITY TEL No. CROSS ST. COU TY' REG. NO: EX Pt RES y�j NAME LOCATION OF SEPTIC TANK, OR CESSPOOL 2 3 ADDRESS FSC ) : NORTH O. :. +--• 4 CITY TYL No. 1 C RRECTIONS Wi N fr DOUTH DESCRIPTION OF WORK ___S.:Tit Tua FURNACE ROWER __._DISHWASHER - APPROVALS . AVATORY _ REFRIGERATOR DATff 1NorccTOW O we+a _KITCHEN OINK WATER SOFT¢N4 _ROUGH PLUtAHING FLOOR"BINK' AND TRAP 8 GAS PIPING­ � '" T. .SLOP OINK _ FLOOR DRAIN - GAO VENT ____..WASH TRAY URINAL CESSPOOL WATER CLOOET DRINKING FOUNTAIN OEPTIC TANK WATER HEATER _ D`n`NTAL'LAVATORY REWER b M¢TER__.CAO SODA POUNTAIN UTILITY CO. NOTIFIED OUTL FINAL '` - ,�•f 1'AM THE LEGAL OWNER OF THE ABOVE CS APY LILU ' ��OUNTY REGIOTRATIO 139R... ' TOTAL NUMH¢R OF F'IXTUR¢.S SCEPTIC TANK. , vttlgOBR :'- 3 C¢B®POOL I+.w 1�AM THQ C6OWW¢R OF THE[PROP4RTV O Et, TOTAL.FE ovrm¢a s RI DEPARTMENT' OF BIIILLrNG ANb SRF IEP AFPLYCAp:ION FOR k ggY �, COUNTY OF LOS ANGELES', 1 BIG nY ' WILLIAM J. FOX. CHt¢F ENOIN[tR O APPLICANT T F.LL DISTRICT NO. OltOUT 1. zoux .l - PlatiUI NO. -� LUMP¢ � RQCQI QD OY � RQAOY FOR p1(� MOT INGPECTION e y,,rad �J co ADORt49 P - �,.ITT -"7 T .. COUNTYtRQfl - !y1 } LOCAL NEARCUT - _ F T FEFS _ �';I�ca4 a gwraaa l TTP¢of niNw4*4 M.4 T63 .J! OWtt II T.•:. 1 MAIL AT - CL0447(TML-r) 0 0,59's •—� �� R 9 - ON IR O ``�( 1 R T OWL E0 08 THAT 1 MAVIC READ TRIO ` A VATIOR\'rWAOH OAfrIN O.0 -�" .APPLt A ON TATA THAT TNQ ABOVQ 14 CORK[CT AND ,'IS _�._. - , AM O C WITH ALL COV NTY OROINANC¢71 AMC _ OTA M'II R GULATIIi PLUM A ,O' _ 1 CQRTIF ' �rk*Ar 1 TME ABOVE VALID Loa � • LAUNDRY TU9QR TRAY ANO[lC C^VNTY LI - a¢. R I AM Ng LEGAL Cv"am OF THE REW TIA O TY D S V ep I Q�A84T19TCMJ__...,-OVTLTr9 Q O. ! " LIONATURE OP y WAT'1[R MEATIER 0.DO -;ry P[Rw1T7¢Q ' OL PO NIC - O-sic�" 1"�'• . _ --=;ECTIOM RECORD �41hi( o.po ^�9 I R DRAIN ? O _ RIN KING FOUNTAIN � _ ' URINAL _ 0.80� •J y_ MOv4¢Dewey a 0.90 4 ( •- �:+ Z DATI: Iwr_:rClr WAW9 ' VENT •.i:....�.:.crpT OQPTr TA '(1 � " "�- a4i DIPTIC TANK - x: Tex:,ER[+CfT ra a fir, +/ W?`. ��' 1 n[at'>:s r� d -�TIu?cY lL i ri '! r �•S1<„ St3+ .. ,..v7� �a+5x.,.�:.�..w-.r r�`. _.' ;•.� .ki yew I �" :.t;� r�/ ._;tl;.ap` ia..a.vSiEt'.L�-; x�•�---'I"�S++w e:P '6e�'ixa�i .• �'. �-d.Y.�...+ rtr�.a.'i iRi�:-�"�hTd':;:ik �c�.�tr.."u.ter�o vw- 0