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HomeMy Public PortalAbout6453 LIVIA AVE_Plumbing__ 76A667A IC¢.81 175)- 1 1/76 • APPL OCATION ICOR PLUMBING PERMIT d� BUILDING A D AFETY DIV��IS//ION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS `/�J� /�!////� NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET LOCALITY7�:�w, BATH TUB NEAREST CROSS ST L d A, Qi/1/ /S/!✓�, SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL NO 7J DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS f^h C 2 SWIMMING POOL RECEPTOR CITY 370,5€ TEL NO 2 LAWN SPRINKLER SYSTEM _ STATE LIC WATER HEATER LICENSE NO �/�v 7 CLASS GAS SYSTEM OUTLETS DISTRICT NO GROUP ONE ROCESSED G 7 OUTLETS OVER (>U -/— 5 PER SYSTEM INDUSTRIAL 91. WASTE APPROVAL O INSPECTION RECORD U 0 P.- d r� z Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant Name s�fjt APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK Address �2 ROUGH PLUMBING City Zj, Tel No ��6 GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED �J SIGNATURE OF PERM,IpTTEE �+��,�,t�-� FINAL i PLA 41l fflA lfl� ®1Y1�¢k ll1.�M1� 9 w�+y�l. PERMIT VALIDATION cK M O CASH 6 7 4'r--SEP s 5 © 1 3.5 U �= POILICY MOLDER: _ . ®5 POLICY NUMBER: � � 76A667A 1SE 8178)- 11/76 1 APPLOCATHON FOR FLUMBONG PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS / WATER CLOSET LOCALITYn,Z� Ci NEAREST -Ar BATH TUB CROSS ST Z d��/'A SHOWER .3 OWNER c N N LAVATORY MAIL ADDRESS SINK CITY Z e�E (:71XTEL NO2,0' DISHWASHER CONTRACTOR �SG�iC CLOTHES WASHER � ADDRESS SWIMMING POOL RECEPTOR CITY tis TEL NO_2 eo Z 3 LAWN SPRINKLER SYSTEM _ Lj/' WATER HEATER STAfELIC LICENSE NO 311:5 15 CLASS GAS SYSTEM OUTLETS DISTRICT NO GROUP WINE OCES E BY t OUTLETS OVER 5 PER SYSTEMINDUSTRIAL WASTE APPROVAL,: 0 INSPECTION RECORD ¢A¢� V 61d Vf Plan check fee r PLUMBING PERMIT ISSUING FEE$ C� TOTAL FEE S� ' Plan check applicant APPROVALS DATE INSPECTOR S SIGNATURE Name ,P/ (�� UNDER SLAB WORK Address S12 2 ROUGH PLUMBING City SF Ejy/J Tel No X23 GAS PIPING HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITYCO NOTIFIED I ! SIGNATURE y OF PERM ITTEE FINAL PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION cli M o CASH 95 1'iNOV j 5 n 7.5 0 r� ps WORKERS'COMPENSATION DECLARATION AP UCAMN FOR PLUMENG ANG PERM8T I hereby offirm'that I have a certificate of consent to self 76A667A `fl insure, or,a•certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certified copy thereof (Sec 3800, La C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli No Company Certified copy is hereby furnished - ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department NUMBER FIXTURE OR ITEM Q FEE LOCALITY - WATER CLOSET " Date' Applicant ie I NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER OL (This section need not be completed if the work Involved by MAIL :1 81A the permit Is for one hundred dollars ($100)or less.) LAVATORY ADDRESS VL Q, I certify that in the performance of the work for which this 12 permit is issued, I shall not employ any person in any manner CITY TEL N so as to become subject to the Workers'Comp nsatia Laws DISHWASHER I /! CONTRACTOR f� Date b Applica I CLOTHES WASHER O ADDRESS r NOTICE TO APPLICANT- If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR q Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY •� as TEL NO JS Dj with comply with such provisions or this permit shall be STATE oD LICENSE N��JJ LIC J deemed revoked WATER HEATER O CLASS LICENSED CONTRACTORS DECLARATION () DISTRICT NO PR ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ' 09 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my'license is in full force and effect 5 PER SYSTEM FINAL VALIDATIOP�I License Number zlq' J z Lic Class DATE FINALU Contractor �{S �G- Date d( BY ❑ I am exempt under Sec y/1-T B&P C for this reason W Plan check fee o•. D Date PLUMBING PERMIT ISSUING FEE$ 0 "I Z Signature TOTAL FEE / SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and 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 5 3 0 A 7044, Business and Professions Code) , CONSTRUCTION LENDING AGENCY # 0 o 0 0,0 5 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued I o - 465 0 (Sec 3097, Civ C ) - 4b,505 Lender's Nome OQ92-86 Lender's Address I certify that I have read this application and state that the a ave information is correct I agree to comply with all County teo .riz nc s and State jaws regulating Plumbing, and hereby repre'sentativesof t isCountytoenter upon the -m tioned erty fo nspecti0n purposes SEE REVERSE FOR EXPLANATORY LANGUAGE sa- Signature of Permittee Date