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HomeMy Public PortalAbout5736 LOMA AVE_Plumbing__ 76A667 (CE-817)-4/72 //^` APPLICATIONF R PLUMBI G PERMIT {� COUNTY OF LOS ANGELES U DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO: ADDRESS 5736 North Loma HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY emple City FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. Y' NUMBER FIXTURE OR ITEM @ FEE* - ' WATER CLOSET 1.75 OWNERConrad Bailey MAIL BATH TUB 1,75 ADDRESS 5736 N: Loma SHOWER 1,75 CITY Temple C1tyTEL. NO.- 285-6073 LAVATORY 1,75 CONTRACTOR Bryant Heat. & Air Cond. Inc SINK 1.75 ADDRESS 1350 E. Las Tunas Drive DISHWASHER 1.75 CITY San Gabriel TEL. NO-. 286-1141 CLOTHES WASHER 1'75 STATE LICENSE NO. 221751 CI ASS C20 SWIMMING POOL RECEPTOR 1,75 DISTRICT NO GROUP NE F CESSED BY LAWN SPRINKLER SYSTEM 1.75 6' 0 WATER HEATER 1.75 INDUSTRIAL ly WASTE APPROVAL 1 GAS SYSTEM OUTLETS 1.75 1 .75 i• INSPECTION RECORD OUTLETS OVER 30 i O 5 PER SYSTEM W N Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE S 3 00 TOTAL FEE 4 5 APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATEW_,7EGULATING .PLUMBING. yy��// GAS TEST HEREBY CERTIFY THAT I A4/PROP6R LYS REG131ERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRE BYJLOS ANGELESICO TY AND STATE OF / CALIFORNIA OR THATJI AM TH�E/!LEGAL�D^�LE•R�t.FAND INTEN TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PER Y. FINAL °� � °� S16NATU RE / OF PERMITTEE ` PERMIT VALIDATION CK. ' M.O. CASH PLAN°CHECK /ALdDATION C/ M.O. CASH _ r v . r3 5.4. 6'rmJUL 2215.: �+.`7 1a7 76A667-CES17 3-59 APPLICATION FOR PLUMBING PERMIT � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS CASSATT D. GRIFFIN, Sup't of Building LOCALITY + FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER C TEL. NO' LAVATORY CONTRACTOR - SINS ADDRESS LJ7,2 141 zezw� �--� DISHWASHER CITY TEL NO. �j-�!/ CONTRAC 'S J� 2 9d? STATE LAUNDRY TUB REGISTR ION NO. // ff COUNTY ❑ CLOTHES WASHER DIST'RRIICTNO. GROUP I ZONE, P OCESSEDBY WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD 2 -T _� IV, @ $I.00 PER ITEM FII 1 OR FIXTURE $ 1 APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ' AND STATE THAT THEABOVEIS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER - 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 APRM THE LEGAL OWNER OF THE ABOVE DESCRIBED_ RESIDENTIA ERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTE FINAL ®P. VAIJDATIO ROBERT A. WOOD, cK. M.0. CASK SUPERVISING MECHANICAL ENG'R 8 5 4 15 c 7 5 A .0 C? �. WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT JJJ777 I,hereltaffirm that.I have a certificate of consent to self 20-0026 DPW 6/87 in`sure,�or a certificate of Workers' Compensation Insurance, 76A667A qr a certi'ipped copy thereof (Sec. 3800, Lab. C. , COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS, Policy No/! _ Company ���/c /�{i/A/6 ❑. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR.TYPE) BUILDING _ LO 1-W Certified copy is filed with the county building inspec- ADDRESS .� 7 �` tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY 2 '1f WATER CLOSET Date / Applicant ^-U$S� 5Qi4�s 0 NEAREST J CERTIFICATE OF EXEMPTION FROM WORKERS' '-�q BATHTUB 0: CROSS ST. COMPENSATION INSURANCE t OWNER, ��YJ SHOWER. (This section need not be completed IF the work involved by' MAIL the permit is for one hundred dollors ($100)or less.) LAVATORY ADDRESS er- I certify that in the performance of the work for which this s permit is issued, I shall not employ any person in any manner SINK CITY' TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER � P �J CONTRACTOR +►V'7�J�'�r 5 DC��1 v3 Date Applicant CLOTHES WASHER ADDRESS / NOTICE TO APPLICANT: If, after'making this Certificate of r14tY(�/�L•�c�v r7 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY pn.+ TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM 2 X/(0 r.2 301 with "comply with such provisions or,this permit shall be STATE LIC. As, deemed revoked. ' WATER HEATER LICENSE NO. 4�1 CLASS Y✓ LICENSED CONTRACTORS DECLARATION . DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �jt ��` (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER lJJ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION .5�3/ l0 D DATE Q ®. License Number Lic. Class_! U. FINAL Contractor USrj�'(I S �QtUs Date BY OF-, ❑ 1 am exempt under Sec. �� W B.&P.C. for this reason DOD. N1 Plan check fee Z Date: PLUMBING PERMIT ISSUING FEE$, Signature TOTAL FEE Plan check applicant SINGLE FAMILY .: HOME OWNER-BUILDER DECLARATION Name g VSSE((' limv5 r•t I hereby affirmthat I am exempt from the Contractor's License 1 Law for.the following reason (Section 703 1.5, Business and Address t T41Y&C Coco ID o k ' 1[� Professions Code): City pFj 1^t©�//q� C j) Tel. No)/ o�.J 1 ❑ 1, as owner of the property, will'do the work and the structure is not intended or offered for sale (Section i.. 7044, Business a'nd Professions Code). ® I='i fit =s�= CI CONSTRUCTION LENDING AGENCY %.- L f'; I hereby affirm that there is a construction lending agency for the performance of the work for which this'permit is issued L (Sec. 3097, Civ. C.). r; Lender's Name 's if;•i<ii_E—I)�;.I i �r.��'s:=rr. Lender's Address € �: -fl 7s 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 laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date