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Home My Public Portal About5622 LOMA AVE_Plumbing__ '76A667-CE817 12/59 T M_PLE- CITY .APPLICA►TION FOR. PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /' { f / JOHN•A. LAMBIE, COUNTY ENGINEER ADDRESS .5(fit 2� A , Loitz/i WILLIAM A. JENSEN.'SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST EARSCROSS ST. G 4i NUMBER FIXTURE OR ITEM � WATER CLOSET OWNER MAIL ADDRESS BATH TUB CITY TEL. NO. SHOWER LAVATORY CONTRACTOR lc SINK ADDRESS a::-,, DISHWASHER CITY / C� TEL. NO. CONTRACTOR'S / STATE LAUNDRY TUB REGISTRATION NO. a/e� COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUPI ZONE I P OCESSED BY WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL 1:1o c, INSPECTION RECORD y a O U a O F+ w - � a w z @ $1.00 PER ITEM OR FIXTURE $. APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 210C) UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ' THIS APPLICATIONLFINAL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGHEATER PLUMBING. -IHEREBY CERTIFY THAT 1 AM' PROPERLY REGISTERED AND/ORIXTURESLICENSED ASREQUIRED BY LOS ANGELES COUNTY AND STATE OF ZCALIFORNIA OR THAT 1 AM TH L L N F THE ABOVEDESCRIBED RESIDENTIAL PROP NOTIFIED SIGNATURE OF PERMITTE ®a VALIDATION ROBERT A. WOOD. cs. M.O. CASH SUPERVISING MECHANICAL ENG'R LAS DEC 4 2 4 ore 5 5 Q 4-.00 '•76A667 CE817 6=60 < SCi�• l , k"-� V �� %�T +�ri� /P` b� APPLICATION FOR PLUMBING-PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN..A. LAMBIE. COUNTY ENGINEERADDRESS ' �- WILLIAM A.JENSEN, SUPT OF BuiLDING• > LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. . NUMBER FIXTURE OR ITEM OWNER .WATER CLOSET MAIL ADDRESS L BATH TUB r CITY TEL. NO. SHOWER CONTRACTOR LAVATORY SINS ADDRESS DISHWASHER CITY TEL. NO. CON CTOR- L STATE LAUNDRY TUB REGISTRATION NO. X713, COUNTY ❑ CLOTHES WASHER DISTRICT NO. GR�OIJP ZONE PR9CESSED BY WATER HEATER. OT GINDUSTRIAL AS SYSTEM WASTE APPROVAL INSPECTION RECORD k a t0) P. 6F,�1411141VfA16 A610L ",fW OR FIXTURE APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $- Z 00 UNDER SLAB WORK. - - TOTAL FEE ,�-a ROUGH PLUMBING 'p t'/ U GAS PIPING.Lt':S#•SAY f:s'��r• 1p<+ - �fi' .. 1 .HEREBY ;ACKNOWLEDGE THAT 1 HAVE READ THIS-APPLICATION GAS VENT - .AND .STATE THAT THE ABOVE ISCORRECTAND AGREE TO'COMPLY WITH ALL_COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. - 1 HEREBY.CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES - LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TESTCALIFORNIA OR THAT I ~ AM THE DESCRIBED RESIDENTIAL PROPERTY.�EGAL OWNE OF. THE ABOVE UTILITYCO..NOTIFIED SIGNATURE OF PERMITTE /�� /�• t `� ? FINAL ®p VALIDATIO ROBERT,A.-WOOD; c5.... M.0. CASH SUPERVISING MECHANICAL'ENG'R o 9 8.5 1 DEC 'l 5 0 3 .0 0 ,• r "" 7,6A667• AP•P-L,ICAT�I-ON, FOR PLUMBING PE-. .I.T.. _ DB5-17 12.64 + ''DIVISION OF .BUILDING.AND'SAFETY Department of.County Engineer Co>.inty of Los Angeles, 6 -ENGINEER BUILDING r WM. J. FOX. COUriTY - ADDRESS CASSATT"D.'GRIFFIN,"SUP'T OF.BUILDING - - . -- L-OCALITY FOR'APPLIC NT TO.FILL IN NEAREST . ROSS.ST.* , OWNER DISTRICT NO: GROUP 7-ONE READY FOR"INSPECTION " MAIL _ - - .. ' ..•r2=1- ADDRESS .� Jv - r^ INDUSTRIAL "C(TY -TEL. NO. -• •WASTE APPROVAL••- PLUMBER INSPECTION RECORD - - - ADDRESS - •� IL ,.. .. CITY -•TEL'.']NO. LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM .FEE ' WATER CLOS ET'(TOILET) _ .V BATH TUB SHOWER - .. LAVATORY(.WASH BASIN) - �. - KITCHENSINK - . DISHWASHER "LAUNDRY TUB OR'TRAY CLOTHES WASHER' TOTAL:NO. r. @- 0.800 APPROVALS _ DATE INSPECTOR'S.SIGNATURE GAS SYSTEM '.�OUTLETS'. @' 1.00 UNDER SLAB-WORK WATER HEATER, @' I;r00 (. /j j' 'J ,ROUGH PLUMBING ( -w..I,f1`+. ' � ,. . �� PERMIT �; 1 00 .. ^,..• � .• - - • I GAS PIPING - - - -TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE-THAT 1. HAVE READ,THIS APPLICATION HOT WATER HEATER- AND STATE THAT THE ABOVE".IS CORRECT. AND AGREE TO COMPLY • ' • '-i.�' p- Ij� WITH ALL COUNTY_ ORDINANCES. AND- STATE LAWS- REGWLATING PLUMBING FIXTURES PLUMBING. - - - I- HEREBYCERTIFYTHAT: 1 AM PROPERLX .REGISTERED AND/OR GAS TEST, LICENSED AS_REQUIRED BY LOS ANGELES"COUNTY'AND STATE OF UTILITY CO. NOTIFIED _ CALIFORNIA OR THAT �1. AM THE LEGAL'.OWNER .OF THE ABOVE ' DESCRIBED RESIDENTIAL PROPERTY.- SIGNATURE ROPERTY:SIGNATURE - -OF PERMITTEE - WILLIAM J. FOX, COUNTY ENGINEER ♦ VALIDATION 2'8"43 0: :APR20 3 3.6 0 BY DEPUTY l , WORKERS'COMPENSATIONDECLARATION CEce 61 w APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a' certificate of consent to self s» (z-so) , insure, or a certificate of Workers'Comp' ation Insurance,or a certified copy thereof(Sec. 3800,Lab ) COUNTY OF LOS ANGELES BUI G NDS E Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL'IN (PRINT OR TYPE) BUILDING ��^� •r iO Certified•co is filed with the c nt b d NUMBER FIXTURE OR ITEM • FEE ADDRESS (�yl py y g inspection LOCALITY" I. =rt a t. WATER CLOSET Date Applicant NEAREST ' BATH TUB CROSS ST. ' CERTIFICATE OF.EXE PTION FROM WO ERS' COMPENSATION INSURANCE, . SHOWER OWNER MAIL (This section need not be'completed if the work involved LAVATORY AD DRESS .¢, a. by the 'permit is for one hundred dollars ($100) or less.) SINKCITY TEL.NOr'S®fel O ' I certify that in the performance of the work for which this DISHWASHER permit is issued,I shall not employ any person in any manner CONTRACTOR 0 So as to become subject to the Workers' Compensation Laws. CLOTHES WASHER H ADDRESS /� U Date Applicant W 1 SWIMMING POOL RECEPTOR 0- NOTICE TO APPLICANT:-If, after makingthis Certificate of CITY TEL. NO. Exemption, you should become subject to the Workers'. _ - LAWN SPRINKLER SYSTEMz STATE LIC. _ Compensation provisions of the Labor Code, you must forth- `l LICENSE No. r CLASS with'comply,with'•such provisions or this permit shall be WATER HEATER L/ deemed revoked. DISTRICT NO. PAJOCESSED BY GAS SYSTEM OUTLETS r LICENSED CONTRACTORS DECLARATION OUTLETS OVER d hereby affirm that I am licensed-under provisions of Chapter 5 PER SYSTEM u (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION ess and Professions Codd4rt4.my license is in full force and DATE ffect:. ''cense Num r Lia Class BY FINAL �G_. �ontracto) Date 7 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer �J acting in my professional capacity (Section 7051, Bus- PLUMBING PERMIT ISSUING FEE$ 's-27 0 S- iness and Professions Code). TOTAL FEE , c:or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name hereby affirm that I am exempt from the Contractor's /address icense Law for the following reason (Section.7031.5 Busi- City Tel.No. 'ss and Professions Code): )� I, as owner of'the property, am exclusively.contracting with licensed contractors to construct the project. e7 6 9 (Section 7044, Business and Professions.Code).• op #'oo'o o o.5 CONSTRUCTION LENDING AGENCY �hereby affirm that there is a construction lending agency 2 °'O 1' 2-50 rthe performance of the work for which this permit isued(Sec. 3097,Civ:C.). 1 = •• nder's Name - � � � 1250� 'Ender's Address 0 4,2''6-8;2 " certify that.I have read this application and state that the rove information is coriect.I agree to comply with all County tdinances and State laws regulating Plumbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE, thorize representatives this County to enter.upon the ove-mentioned proper f inspection purposes. p turfeo of fermittee Date