HomeMy Public PortalAbout6327 LIVIA AVE_Plumbing__ 76A667-CE817 12/59
APPLICATIONFOR LU�II3I�C �,�MI`�
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY ?oF
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEMOWNER
WATER CLOSET MAILDDRESSBATH TUB
CITY '" TELSHOWERCONTRACTORLAVATORY SINGADDRESSDISHWASHER CITY TELCONTRAZE
STATE ❑
LAUNDRY TUB REGISTRN 2 �� COUNTY ❑
S WASHER
WATER
CLOTHEHEATER 6_DISTRICT I GROUP 7FE IPR CESSED BY
GAS SYSTEM INDUSTRIAL ' (J
WASTE APPROVAL
INSPECTION RECORD >.
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$1.00 PER ITEM O v
OR FIXTURE $ / APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2_j 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
I 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 REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF TH ABOVE
DESCRIBED RESIDENTIAL PROPERTY--)
1/y/ UTILITY CO.NOTIFIED
SIGNATURE VJl /
OF PERMITTEE ���777"'
FINAL K.O
OF VALIDATION ROBERT A. WOOD,
cH. N.0. CASH SUPERVISING MECHANICAL ENG'R
�a37>tl c- 3 3 7r.�C4 5 U .0 0
WORK6$S'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hEreby affirm that I have a certificate of consent to self 76A667A
nssire, or a certificate o%Workers' Compensation Insurance, CE 817(REV. 10/81)
or a certified cy)py thereof(Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. nompony
II�J Certified copy is hereby furnished. %� �yr�/ p,
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS J� 1 / ��y'
Certified copy is filed with the county building inspec-
t'11 n department. NUMBER FIXTURE OR ITEM n FEE LOCALITY
WATER CLOSET L
Dat Applicant a'� °gyp NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE OWNER
SHOWER
(This section need not be completed if the work involved by
MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY
ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY �� TEL. NO. Ko
so as to become subject to the Workers'Compensation Laws. DISHWASHERJ /��e �'�
CONTRACTOR7►
Date Applicant CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY !�� TEL. NO.
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. -7,3 .97,11t. CLA S
LICENSED CONTRACTORS DECLARATION DISTRICsi-t�O�f� SS BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS Lie, (xJ
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force an effect. 5 PER SYSTEM FINAL
'"� DATE — CL
License Nu /mber Lic. Class 0
L / BY
Contr 1 a Date
O
❑ I am exemp t unde Sec. 617S
U
B.BP.C. for this reason W
Plan check fee ® CLI
Date: N
PLUMBING PERMIT ISSUING FEE$ 5 Z
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 Address C
Low for the following reason (Section 7031.5, Business and
Professions Code): I 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
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 repre I
spfitatives of this County to enter upon the
above-mention property for inspection purposes.
_ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signatur of ermi ee Date /'•