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Home My Public Portal About6267 LOMA AVE_Plumbing__ X 76 A 867-CE#817.4-67 APPLICATION FQIR PLUNfI G PERMIT LJ COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER;BUILDING AND SAFETY DIVISION J774�2 JOHN A. LAMBIE, COUNTY ENGINEER - COLEMAN W. JENKINS. SUPT OF BUILDING- LOCALITY �f FOR APPLICANT TO FILL IN NEAREST CROSS ST. el Iva NUMBER FIXTURE OR ITEM EACH FEE OWNEF WATER CLOSET $1.2 MAIL BATH TUB 1. ADDRESS CITY TEL. NO. SHOWER 1.2 ' LAVATORY 1.25 CONTRA SINK 1.25 ;ADDRESS oqs J DISHWASHER 1.25 CITY y LAUNDRY TUB 1.25 STATE LIC LICENSE NO. Q (! CLASS CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PR CESS BY WATER HEATER I.50 _j- GAS GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a' WASTE APPROVAL O U OUTLETS OVER 5 PER'SYSTEM .30 INSPECTION RECORD O cn APPROVALS DATE INSPECTOR'S SIGNATURE LRENPERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING BY ACKNOWLEDGE THAT I'HAVE READ THIS APPLICATION TE THAT,THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT LL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUM EBY CERTIFYf THAT I 'AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST NIA OR THAT 1 AM THE LEGAL OWNER OF,AND IN D TO N, THE ABOVE DESCRIBED RESIDE I PROPERTY UTILITY CO NOTIFIED URERMI FINAL f0 ALIDATION JACK R. ALLEN CK. M o. CASH SUPERVISING MECHANICAL ENG'R. LfU04 1 4 1 APR 4 5 D r WORKER'S COMPENSATION DECLARATION DP,wsies APPLICATION FOR PLUMBING PERMIT' 76A667 I hereby affirm that I',have a certificate of consent to self insure, 76A667A /'1 or a certificate ofAVorker's Compensation Insurance, or a&rti(ied '' ;,•- w copy thereof(Sec. 3800 Lab C.) - - COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS? DEPT. OF PUBLIC WORKS'DIV.. 'P❑olicy No Company Certified copy is hereby furnished, ❑ _ FOR APPLICANT TO FILL IN(PRINT OR-TYPE) BUILDING. _ Certified copy is'fded with the county.budG ding inspection ADDRESS - a . department NUMBER FIXTURE OR ITEM @ FEE LOCALITY --7 _ - Date Applicant WATER CLOSET NEAREST •CERTIFICATE OF,EXEMPTION,FROM WORKERS'' BATH TUB CROSS ST y D COMPENSATION INSURANCE I ASSESSOR �, �• r SHOWER MAP BOOK • -`y�' �` J PAGE PARCEL (This sectlori need not be completed if the work involved by the - permit is for one hundred dollars($100)or less.) OWNER �• LAVATORY- - I certify that in the performance of the work for which this permit is issued, I shall,not employ any person in any-manner so as toMAIL SINK - _ -_ j/ become subject to the Workers'-Compensation Laws. ADDRESS •' - � , • DISWASHER CITY � P1L.NO Date 49-67-20 Applicant CLOTHES WASHER ' NOTICE TO APPLICANT If, after making Oils ti;_ of CONTRACTOR Exemption,you,should become subject to the Workers!,Compensation SWIMMING POOL RECEPTOR- provisions of the Labor Code,•you must.forthwith.comply with such ADDRESS provisions or this permit shall be deemed revoked. i LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS,DECLARATION CITY TEL.NO I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC 12 '(commencing with'Section 7000) of Division 3 of the Business and. LICENSE NO CLASS - f O Professions Code, and my license is in full force and effect. '_1 - GAS SYSTEM OUTLETS cc OUTLETS OVER Dh$TRI ROCS BY O 5 PER SYSTEM vpJ� U License Number �Lic.Class V FINAL ALIDATION , LU _ ATE a Contractor to• ' — fn ❑- - - - FINAL r Z I am exempt under c. BY B&P.C..for this reason Date, Plan.check fee ® ; -- ` j PLUMBING PERMIT ISSUING FEE$ 10 Signature , TOTAL FEE EJ - i c Plan check applicant SINGLE FAMILY fJ� s ' HOME OWNER-BUILDER DECLARATION Name:' t` ACCC E sa I hereby affirm that I am exempt from the Contractor's License Law '5 for the following reason (Section 7031.5, Business and Professions Address _ _ n _ I 3_3307 20.•' Code) ❑ City ` 1 Tel. No - 1 iTEM I,as owner'of the property,will do the work and the structure TOTAL � is'not intended or offered for sale (Section 7044, Busmess _ 20 m _ 0 and Professions Code) j , f,LJ �` -0.513 ft ,CONSTRUCTION LENDING AGENCY A6lr bit I hereby affirm that there is'a construction lending agency for the - > �E performance of the work for which this permit is issued (Sec. 3097, Civ C.)" 111100-0001 S/1 E X17 Lender's Name 2443 }}�' �/}�y( � T1J - I� 1 11 t .t b�� Lender's Address T i 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 ORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 76A666 DPW 4/87 w` I '.Q_rPt•di inat I hove a certificate of consent to self in- 76A667A L,I�1II Sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) - - certified copy thereof(Sec. 3800, Lab. C.) <_J 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 ❑ Certified copy is filed with the county building inspection ADDRESS NUMBER FIXTURE OR ITEM LOCALITY ' de�prartment. @ FEE //(( Applicant WATER CLOSET(TOILET) V0 NEAREST Date CE TIFICATE OF EXEMPTION FROM WORKERS' BATH TUB I CROSS Si. COMPENSATION INSURANCE SHOWER OWNER A/'` �' / �+ (This section need not be completed if the work involved by MAIL L� the permit,is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 1 certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY f l� TEL. NO. � as to becom su 'ect to the Workers' Co p sat' n DISHWASHER Y/ CONTRACTOR Date / - Applicant CLOTHES WASHER ADDRESS NOTICE TO A PLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR v emption, you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS y� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER C/ and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. • DATE 10 3&� License Number Lic. Class / O BY FINAL1,5a/V`�� M Contractor Date 0, CY ❑ I am exempt under Sec. B.BP.C. for this reason ► Plancheckfee x Date: PLUMBING PERMIT ISSUING FEE$ D Signature TOTAL FEE SINGLE FAMILY ;2 0 0 6 2 A HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name "0 0 0 o 0 5 Law for the following reason (Section 7031:5, Business and Professions Code): Address ( o,0 2 x 5 0 I, as owner of the.property, will do the work and the City Tel. No. o o o 2 8,5 0 56 structure is not intended or offered for.sale(Section 7044, Business and Professions Code). , 07,01 =88 CONSTRUCTION LENDING AGENCY . I 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 I certify that'l 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 re resentatives of this County to enter upon the above- . ooneWpr for inspection pu po ss.^� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date