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Home My Public Portal About5402 LOMA AVE_Plumbing__ ---::,7- 7SAS67 17 5-50 10 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT 7TOFILL IN DISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS BUILDING CITY TEL NO. ADDRESS ��77 COUNTY LOCALITY l�C�.�t•"�� LICENSE NO EXPIRES — y NEAREST (! PERMIT FEES CROSS ST. �m NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) Q O 50 $ ADDRESS BATH TUB Q O 50 1 CITY TEL. NO. 1 SHOWER Q O 50 IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN) Q 0 50 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK O 50 STATE LAWS REGULATING PLUMBING 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q O 50 ANGELES COUNTY LICENSE. OR,Is1AM THE LEGAL OWNER 1 OUTLETS O.50 GAS SYSTEM OF THE RESIDENTLA ROPERTY DESCRIBED ABOVE. Q ISIGNATURE OFIL 4&1.111 WATER HEATER Q O 50 PERMITTE SLOP SINK Q 0 50 I INSPECTION RECORD FLOOR SINK Q 0.50 FLOOR DRAIN Q O 501 DISHWASHER Q O 50 1 1 DRINKING FOUNTAIN Q O 50 I URINAL Q O 501 .J OUSESEWER Q O 50I 1 ��.~{ Z MISCELLANEOUS 1 1 1� O I� APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL Q 1001 CESSPOOL 1 SEPTIC TANK 1 SEPTIC TANK DRAIN ( ) PIT ( ) Q 7 00 SEWER J PERMIT . I 1pp GAS TEST TOTAL FEE $ UTILITY CO NOTIFIED � !f / FINAL 76Aee7 17 5-49 ® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES LUMS 5Gy I WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTCT NO. GF�OUP 1�OO PERMI PLUMBER V LIT (� .!. RECEIVED B t1 READY FOR 5`�DP�Ad1TE ISSUED Q �/ � FIRST INSPECTION [ADDRESS G A R d t y / BUILDING .� L O�` CITY O►'I YO TEL. NO. )4T_ (��7 ADDRESSCOUNTY LOCALITY t� LICENSE NO. EXPIRES NEAREST 1 •r, ` t'rYL►- CROSS ST. ��l '�� R PERMIT FEES �yA� `' NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER 7 \up Pq y 0S• MAIL WATER CLOSET (TOILET) @ 050 $ /106 ADDRESS ,SOn� J l`F✓0�LO �U I-11�,iiD I BATH TUB @ O 50 CITY��i ArTtr I F TEL. NOPL- -r I b 2 e1.t4t%I R. TEL. NO P L- -r I SHOWER @ 0.50 / O 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ O 50 / 0 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ O 50 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O 50 ANGELES COUNTY LICENSE, OR 1_AM THE LEGAL OWNER OF THE RESIDENTIAL r/PROPERTY DESCRIBED ABOVE. GAS SYSTEM�OUTLETS @ O 50 SIGNATURE OF l� ,�'0�� WATER HEATER @ O 50 Ira PERMITTER ./; "'uuuii___ SLOP SINK @ 0 5o INSPECTION RECORD FLOOR SINK @ O 501 1 FLOOR DRAIN @ 0.50 DISHWASHER O SO DRINKING FOUNTAIN @ O 50 URINAL @ O 50i�:: ..1 HOUSESEWER @ O 50 Q Z MISCELLANEOUS O 1. tr O APPROVALS DATE /INSP,ECTOR'9 NAME ROUGH PLUMBING 3 "Y2'-' GAS PIPING ` GAS VENT CESSPOOL @ 1 OO CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ( ) PIT ( @ 1 00 SEWER / PERMIT 1 00 GAS TEST /.y TOTAL FEE UTILITY CO NOTIFIED •�:'�' f / $ FINAL WORKERS' COMPENSATION DECLARATION APPUCKNON POR PLUMONG PUNT �I I hereby affirm-that I have a certificate of consent to self 20-0026 DPW 6/87 msuP2,4or 6-certificate of Workers' Compensation Insurance, 76A667A _or a certified copy thereof (Sec 3800, Lab ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Poli 0l Ed4f any 46:�/vro/e ��Ce ed copy is hereby furnishedFOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING rtified copy is filed with the county wilding inspec- ADDRESS h L!t' tion d partm nt NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date z r Applicant WATER CLOSET NEAREST ERTIFICATE OF EXEMPTION FROM WORKERS' 14V BATH TUB CROSS ST COMPENSATION INSURANCESHOWER OWNER J C ( a L (This section need not be completed If the work Involved by MA the permit Is for one hundred dollars ($100)or less.) LAVATORY IL ADDRESS o L o k-a �- I certify that in the performance of the work for which this 7 �� permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER l CONTRACTOR Y �119" L Date Applicant CLOTHES WASHER ADDRESS . r, / NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL NO 4s$6 with comply with such provisions or this permit shall be STATE �F LIC 9 deemed revoked WATER HEATER LICENSE NO )7 7 CLASS — C LICENSED CONTRACTORS DECLARATIONDISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS y (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (J and Professions Code,and m license is in full force and effect 5 PER SYSTEM Y FINAL VALIDATION tl: Sc�7 DATE O Q O License Number / Lic. Class C Z� U L y FINAL Contractor Date BY ❑ O I am exempt under Sec IU BAP.C. for this reason �- Plan check fee y Z Date. PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Name A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Address ":C _ Professions Code) Gty 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) HL m CONSTRUCTION LENDING AGENCY `_ �' Pe 3 1 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 l�'7: I certify that I have read this application and state that the above information is correct I agree to comply with all County D ordinances and State jaws regulating Plumbing, and hereby authorize reprelentatives of this County to enter upon the above- e t i`eli propert for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKEkS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT ' 1 hereby,/affirm that I have a certificate of consent to self in- 76A667A sure,or a•certificate of Workers'Compensation Insurance,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 ,FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING f F-1Certifiedcopy is filed with the county building inspection ADDRESS U Z department NUMBER FIXTURE OR ITEM z;. @ FEE LOCALITY WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 'L BATHTUB CROSS ST COMPENSATION INSURANCE a SHOWER OWNER 9t- e-1 .SC � �O✓I� (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) Ic v LAVATORY ADDRESS,� /Q LQ f�i✓ I certify that in the performance of the work for which This per- SINK mit is issued, I shall not employ any person in any manner so CITYIeM24f &A TEL NO � as to become subject to the Workers'Compensation Laws- , DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of Ex- ADDRESS SWIMMING POOLRECEPTOR emption,you should become subject To the Workers'Compen- , sation rovisioris of the Labor Code,you mu'st forthwith comp- CITY TEL NO p y P- LAWN SPRINKLER SYSTEMS ly with-such provisions or this permit shall be deemed revok- STATE LIC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION ' GAS SYSTEM' OUTLETSDISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter L / 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my-license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect HOSE BIB DATE L•-z a License Number Lic Class O FINAL V Contractor Date BY O El /I am exempt,under Sec / (0� 0 W B 8P C for this reason Plan check fee ® a h Date PLUMBING PERMIT ISSUING FEE$ Signature a TOTAL FEE g - SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant =T 1 T I�; ;•_ I hereby affirm that I am exempt from the Contractor's License Name a +- Law for the following reason (Section 7031 5, Business and t y({{'s •+ 2� 80 Professions Code) , Addressta �- XI, as owner of the property, will.do the work and the City Tel No s structure is not intended or offered for sale(Section 7044, (!Ef ti9`3i= Business and Professions Code) CONSTRUCTION LENDING AGENCY . y7:'`" I hereby affirm that there is a construction lending agency,for '" r a the performance of-the work for which this permit is issuedi�,i�li�[t- �' (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 jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for i pection purposes J6Uov SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee U Date WORKERS'COMPENSATION DECLARATION �PPMCATEQN FOR PLU®�UL�1ENG 0ERNT I' I-hereby affirm that I have a certificate'of conse o self 20-0026 DPW 6/87 ir�ure„or a certificate of Workers' Comp e ion I s once, 76A667A or ajr tW=ny 38 , a C ) COUNTY OF cLOS ANGELES DEPT. Of PUBLIC WORKS P. ❑ Certifiekkcopy is hereby furnished ,,��jj FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING la , I�Certif ed copy is filed with th o my builds "spec- � ADDRESS (/ �--J }i eparim n NUMBER FIXTURE OR ITEM @ FEE LpCALI Date pplrcant WATER CLOSET NEAREST ERTIFIC TE OF EXEMPTION FROM WORK6— BATH TUB CROSS ST COMPENSATION INSURANCE OWNER (This section need not be completed if the work Involved by SHOWER the permit Is for one hundred dollars ($100)or less.) LAVATORY MAADDIL RESS 12 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CIT T N so as to become subject to the Workers Compensation Laws DISHWASHER r Date Applicant CLOTHES WASHER ADD RE NOTICE TO APPLICANT If, after making this Certificate of 1 d 67 Exemption, you should become subject to the Workers' CF SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TE LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be ISTATE2175A,& deemed revoked WATER HEATER LICENSE NOC LICENSED CONTRACTORS DECLARATION 4 f • DISTRICT NO ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 f GAS SYSTEM T -!5— (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Co nd m license is in full fnond effect 5 PER SYSTEM ' f ?' FINAL - f VALIDATION o.� �w DATE( f?, License Nu ber ✓ Lic Clas - f E r U ' FINA �'/ _ ,_./ � Contractor Date BY , ra �” O ❑ U I am exempt under Se } 5_ B 8P C for this reason 44% f Plan check fee ��" Z Date PLUMBING PERMIT ISSUING FEE$ 0j''D Signature TOTAL'FEEAb jv Plan check applicant SINGLE FAMILY e HOME OWNER-BUILDER*DECLARATION Name _ I hereby affirm that I am exempt from the Contractor's License (L' Address Law for the following reason (Section 7031 5, Business and z �z 1 �( *,•._ 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 Ei, s60 axe 7044, Business and Professions Code) - m CONSTRUCTION LENDING AGENCY E U:7-'E. ' cr% I hereby affirm that there is a construction lending agency for ; a the performance of the work for which this permit is issued (Sec 3097, Civ C ) Lender's Name _ _('•_ s �1-ACV tJr Lender's Address � � ,� I certify that I have read this application and state that the above informa n i correct I agree to comply with all County ordinances a d Sta jaws regulating Plumbing, and hereby authorizer res n 'ves of this County to enter upon the above-me lone r ty for inspection pu poses SEE REVERSE FOR EXPLANATORY LANGUAGE z- ql�xalg Signature of Permittee Date 1 -WDRKERS'COMPENSATION DECLARATION APPUCATPON FOR PLUMS MIG, HRMY I hereby affirm that I have a cert?ficate of eonsent to self 20-0026 DPW 6/87 G imure,.or is certificate of Workers' Compensation Insurance, 76A667A lul _ or b certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No Company ❑ Certified copy is hereby furnished 't ,A/� / FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS BUILDING ,}OZ / �m,4 Certified copy is filed with the county building inspec- tion department NUMBER FIXTURE OR ITEM Q FEE ALI/1 �G j LOCALITY TEA4PL Datil Applicant 3 WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ?, BATH TUB D� CROSS ST v4I•f�� COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work Involved by / ' MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY 6a ADDRESS O�1F/M G19b &Lv I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner ! SINK CITY G►1T•1 TEL NO '7 ��? so as to become subject to the Workers Compensation Laws DISHWASHER — . G J may. CONTRACTOR �V Date Applicant CLOTHES WASHER 7 ADDRESS /v NOTICE TO APPLICANT- If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL NO Compensation provisions of the Labor Code, you must forth- / LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be 21STATE LIC deemed revoked WATER HEATER LICENSE NO SS LICENSED CONTRACTORS DECLARATION J21Sy21 O ROCESSED Y I hereby affirm that I am licensed under provisions of Chooter 9 GAS SYSTEM OUTLETS `L.�J (commenting with Section 7000) of Division 3 of the Business AS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL/l,_ }�/ ASID TIOPd 6:1 License Number Lic Class DATE / U, FINAL 4 Contractor Date BY v�j ❑ I am exempt under Sec W B 8P C. for this reason Plan,check fee z Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE O SINGLE FAMILY Plan check applicant j A� HOME OWNER-BUILDER DECLARATION Name m )I RSACCT.y I hereby affirm that I am exempt from the Contractor's License ��Z :?�� 1:,%3l�fl Law for the following reason (Section 7031 5, Business and Address 33 . Professions Code) City /11 P1 z;-G1 Tel N. 225110 1 ITEMS ❑ I, as owner of the property, will do the work and the .�—, structure is not intended or offered for sale (Section TOTAL I I AL �.,.' 3 - CIO 7044, Business and Professions Code) D ; CONSTRUCTION LENDING AGENCY �.NEtii 13"13.Oil I hereby affirm that there is a construction lending agency for CHANGE the performance of the work for which this permit is issued (Sec •3097, Civ C ) Lender's Name 19000-101 V/2-`'911 Lender's Address 2542 1 AM 8:34 1 certify that I have read this application and state that the D above information is correct I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize epr s ntahves of this County to enter upon the above- ntio a op ert or inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of Permittee ate