HomeMy Public PortalAbout4967 LOMA AVE_Plumbing__ 76A667 Des-17 11-50 APPLICATION FOR PERMIT
111JJJ DEP'ARTMEN'T-®F-BUILDING AND SAFETY PLUMBING
r' COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
N13
Al-7 ;
- FOR APPLICANT TO FILL IN DIM T NO. BR13UP I ZQA4E ERMIT 7 �� 37)j
L
PLUMBER R EIV D BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESSBUILDING
I '7 A�
CITY' TEL Na. ADDRESS f� / No Ine,MR 41`r
COUNTY J LOCALITY Tl{M� � rai?T-
LICENSE NO. EXPIRES NEAREST 11
PERMIT FEES CROSS ST.. i �r1?��e,FI/N e /�/�toll ��,
HUMBER TYPE OF FIXTURE OR ITEM FEE OWNER(,/P'g�/1I0 C/,T V;d In C_/ A V r ��G.i/,r .
MAIL
WATER CLOSET(TOILET) 0 13.30 !a V ADDRESS �^l
BATH TUB ® 0.30 sn CITY l-oNJ I r-Ir- C.ir TEL. No.
SHOWER @ 0.50 I'c' 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 IM APPLICATION AND STATE THAT THE ABOVE 19 OORRECT
AND AGREE TO COMPLY WITH ALL,COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENI P 7CRIBED
EB
GAS BYBTEM OUTLETS (� 0.502
SIGNATURE
WATER HEATER O.3D �- PERMITTE
SLOP SINK 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50 ,
FLOOR DRAIN @ 0.50
DISHWASHER 0.50
DRINKING FOUNTAIN 0.30
URINAL 0.50 J
HOUSE SEWER 0.30 A Z
MISCELLANEOUS
J O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING rJ
OAS PIPING
GAS VENT
CESSPOOL 1:00 CESSPOOL I /
SEPTIC TANK: SEPTIC TANK A %��. 2 a,,'J 2.,.
DRAIN ( ) PIT ( ) @ „1.00 040 SEWER
_
PERMIT .
I ',�.:no` GAS TEST
��UTILII CO.NOTIFIEDTOTAL FEE
�RKERS')COMPENSATION DECLARATION ;
20-002A667A PW'4/87+ APPH, �TMN FOR 11 LUMMN�e3/, PERI1C P
eb+�r firm`1+that;I'have 9 certificate of consent to self'm- ';
isu�e;or,a;certificate of Workers'Compensation Insurance,or o CE 817(REV 8/86) §'
certifie�i9, thereof•(Sec,3800, Lab,Ct),, '
'F : {', ,, '', 'COUNTY OF LOS ANGELES DEPT. OF�PUBLIC WORKS
Poiicy No' -Company
Certified copy is Hereby.furnished ;,
TYPE) BUILDING,
„FOR APPLICANT TO FILL IN(PRINT OR
Certified'copy is filed with the courity building inspection ADDRESS
V NUMBER ,FIXTURE OR ITEM' FEE-,
department" LL. @
- - LOCALITY.. ,
D6te Applicant WATER CLOSET'(TOILET) NEAREST
`CERTIFICATE-OF EXEMPTION,FROM WORKERS' BATH TUB f.� CROSS ST t
COMPENSATION INSURANCE v OWNER `
SHOWER > Nl e l�U
(This section'rieed'not be completed`if the'work involved by
MAIL /
the permit is for oris hundred dollars ($100)or less.) ' LAVATORY ADDRESS44
,( G U/ '
I certify-that in the IS&formance'of the wofk,for,which this per- - "~
mit is issued,' I shall not employ any person in any manner so - -SINK - _ �= CITY '{ - TEL NC-
6s to become sub ect," the Workers;Compensation Laws 'DISHWASHER
CONTRACTOR
Date Applicant, .• x' + 'CLOTHES WASHER ( -
ADDRESS
NOTIC6T0APPLICANT' If, after making this Certrf tate of Ex- SWIMMING
emption, you should become.sublect'to the•Workers',Compen- SWIMMING POOL RECEPTOR _
CITY - TEL ,NOM -
.sation provisions of the Labor Code,'you must forth-wrth comp- - LAWN SPRINKLER SYSTEM
ly with such-provisions'or,this permlt'shall,be deemed reyok- STATE LIC
ed WATER HEATER ti F LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO CESSED BY
I hereby affirm that I am licerised under,p�bvisrons'of Chapter GAS,SYSTEM OUTLETS - =�. 0
9(commencing v'ith Section 7000)'of D`rvision�3 of the Business OUTLETS-OVER ✓f r
sand Professions Code,-and my license'is in fulhforce'and ef- 5 PER SYSTEM '• FINAL .> VALIDATION
fect i DATE >L
. �/11�,�q
License Number Lic Class O
i FINAL,
Contractor Date t- 4 BY, O
I am exempt under Sec U
LU
B&P C for this reason N
Plan check f'ee
_ Date' e PLUMBING PERMIT ISSUING FEE$ A0 i
P y }
Signature -
aTOTAL FEE'
SINGLE FAMILY ^
HOME OWNER,BUILDER,DECLARATION Plan check applicant
I hereby affirm that-1 am exempt from the,'Contractor's License Name - -
Low for th'e following reason (Section 7031 5; Business and
Professions Code)^ A "
'Address- In r•
'•• �`- 'x. -�
I as owner of.the property, will-do'the'wo'rk,and the City Tel No
'structure isnot intended or-offered fdr,sale'(Section 7044, + • 's' 4,
Business and,Professions'Code)
_ t
CONSTRUCTION LENDING AGENCY ? h• I'rTz^4 58 °_ 5
I hereby affirm that there is a construction'lending agencV for J, i;k -t , 50.50
the performance,of the work for which this'p`ermit is-issued _
(Sec 3097, Civ'C ) x_ s•j r t��
Lender's Name
Lender's Addres's
E F.03
I certify that I have'read this applicat n and state that'the � - d _ •• �• AN '
above,information is correct I agree' comply with all County
ordinances and St to laws regulat g P tubing, and hereby
authorize repres tafives of ry to.enter upon the =
above-mentione pr rrty f r on purposes ;
'SEE REVERSE FOR EXPLANATORY LANGUAGE
ur mittee - Date