HomeMy Public PortalAbout5417 LOMA AVE_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY L �'
WILLIAM J. FOX, County Engineer
PERMIT NEI
FOR APPLICANT TO FILL IN DISTRI. NO. GROUP ZONE /s .
PLUMBER /ZA(e/ _T,` LJM i"Y %A%G RECEIVED REFIRST INSPECTION FOR ATE 199UE��
ADDRESS
M p
BUILDING
CITY ` I rAj FAffff TEL No. 44 (p •ADDRESS O
COUNTY EXPIRES _3 tJ� LOCALITY ���4'� j rz
LICENSE NO.
NEAREST
PERMIT FEES CROSS ST. U L-
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER A /T ti � e!HA t3
MAIL
WATER CLOSET(TOILET) @ 13.50 $ d ADDRESS
BATH TUB @ 0.50 00 CITY TEL. No.
--f-' SHOWER 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
APPLICATION AND STATE THAT THE IS CORRECT
LAVATORY (WASH BASIN) a 0.50 Q AND AGREE TO COMPLY WITH ALL C UNOTY ORDINANCES
KITCHEN SINK Q 0.50 0 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0.50 O ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL IT DED ��44BOVE.
GAS SYSTEM OUTLETS 0.50
WATER HEATER O.SO 06
SIGNATURE PERMITTEE771.
SLOP SINK O.SO `. -_
INSPECTION RECORD
FLOOR SINK 0.50
019FLOOR DRAIN ($ 0.50 �o �., S�- 4,✓.t�
DISHWASHER @ 0.50
DRINKING FOUNTAIN 0.50
URINAL 0.50 -I
Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS L7
lY
0
APPROVALS
DATE INSPECTOR'S�NAME
ROUGH PLUMBING
rr �
GAS PIPING :�� �
GAS VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER c�
PERMIT 1.00 GAS TEST
UTILITY CO. NOTIFIED—
TOTAL
OTIFIED TOTAL FEE
FINAL
76A667 DBS.#17 6-52
VORKERS'COMPENSATION DECLARATION , APPLICATION FOR- PLUMBING PERMIT,,
I hereby, offirm.that I haven certificate of consent to self in 76q 67A PW 4/87 �I
sure or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)- �IILJIII
certi-'.iedlcopy thereof (Sec. 3800, Lab. C.).
COUNTY OF LOS ANGELES DEPT. OF, PUBLIC WORKS
Policyl<lo� ' Company.
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ` 1-7
- `L p #�
Certified copy is filed with the county building inspection ADDRESS
NUMBER FIXTURE OR ITEM
department. @ FEE
LOCALITY/``'y� r Le
Date Applicant r WATER CLOSET(TOILET) V 0V NEAREST C'
r CERTIFICATE OF EXEMPTION FROM WORKERS' - BATH TUB 60
" CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved by MAIL
the permit is.for one hundred dollai•s'($100)or less.) LAVATORY ADDRESS
I certify that in the`performance of the work for which this per= SINK
mit is issued, I shall not employ any person in any manner so / CITY TEL. NO.
as to become subject to the Workers'Compe
Laws. DISHWASHER / , f
}� CONTRACTOR w Ue
Date r2 B •Applicants /"� CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after mciVing this Certificate of Ex-
SWIMMING POOL RECEPTOR
emption,.you should become subject to the Workers'Compen- CITY TEL. NO.
sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM
ly vvith'such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATERHEATER LICENSE NO: CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO.. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
o fur
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL LIDATION
feet. DATE O
License Number Lic. Class V
FINAL cc
Contractor Date BY Y/ O
0 I am exempt under Sec: U
W
B'.BP.C. for this reason ,
t�
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$ 10
Signature
" TOTAL FEE
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
-- _'
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and
) Tms
Professions Code): Address , .�07 40.�
I, as owner of the property; will do the work-and the City Tel:',No.
structure is not intended or offered for sale(Section 7044, 1 B
Business and Professions Code). -
46 -
CONSTRUCTION LENDING AGENCY t ® Tt, ��yy� ��
I hereby affirm that there is a construction lending agency for .CHE t' 46.50
the performance'of the work for which this permit is issued �. E eI3
(Sec. 3097, Civ. C.).
Lender's Name VOM-0001 9/25/85 .
.
Lender's Address q 5876 1 AM 10:16
1 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 repres ntatives of this County- to enter upon the
above- enti'ne perty for inspection purposes.
•- (J l� 900 025 SEE REVERSE FOR EXPLANATORY LANGUAGE
S' azure of, ermi ee / Date