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Home My Public Portal About6420 LOMA AVE_Plumbing__ 76A667rd CE 817(REV 6/78) _ i APPLICATION FOR PLUM B LNG. PE RM IT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADILDING DRESS NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET LOCALITY G f I NEAREST l /� BATHTUB CROSSST SHOWER, OWNER �� Z LAVATORY MAIL �L / ADDRESS 6 7�O' (�N--1 SINK CITY 7-_ TEL NO ;67016 DISHWASHER CONTRACTOR CLOTHES WASHER '' ADDRESS SWIMMING POOL RECEPTOR 'CITY TEL NO LAWN SPRINKLER SYSTEM STATE 'LIC WATER HEATER LICENSE NO CLASS GAS SYSTEM 2 OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING f � - �� GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST Plan Check fee UTILITY CO NOTIFI PLUMBING PERMIT ISSUING FEE$ —7 — FEE — FEE / FINAL 1 Plan check applicant PLAN CHECK VALIDATION TO Name Address ,� g • City Tel No r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE 1 5 !1 LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABO Q fl A ESCRI BED RESIDENTIAL to Y PROPERTY # QQ � o � S SIGNATURE OF PE RM ITTEE 2 0 0 1 0 0 DISTRICT NO PROCESSED BY 0 0 0 1 0 INDUSTRIAL �" L 1201 -7 WASTE APPROVAL 76AC67-CEJ 1617 9/63 a APPLICATION FOR PLl MBIG PERM T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A JENSEN, SUPT OF BUILDING LOCALITY a FOR APPLICANT TO FILL IN NEARESSCROSS T. J NUMBER FIXTURE OR ITEM EACH FEE / OWNER0 S WAVER CLOSET 31.2S, MAIL BATH TUB 1.25 ADDRESS Czy SHOWER 1.25 6' CITY TEL. NO. LAVATORY 1.25 CONTRACTOR SINK 1,25 ADDRESS 7 DISHWASHER 1.25 CITY TEL. NO. if 0 LAUNDRY TUB 1.25 CONTRACTOR'S STATE REGISTRATION NO. ,a COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT�NO GROUP ZONE PROCESSED BY WATER HEATER 1.501. ' &,:? _rINDUSFy ( _ I APGAS SYSTEM OUTLETS WASTE APPROVAL a' O OUTLETS OVER 5 PER SYSTEM .30 V Q � INSPECTION RECORD /� o t Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK r, ROUGH PLUMBING TOTAL FEE 2 � -r GAS PIPING 1 HEREBY ACKNOWLCDGE THAT I HAVE READ THIS APPLICATION f 1� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WIIUMBING COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER 1 HE CERTIFY THAT I AM PROPERLY REGISTERED AND�OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TESTS CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE J I 1 FINAL /-Ou/Ccw LIDATION ROBERT A WOOD yCK M O CASH SUPERVISING MECHANICAL ENG'R t.% ,t)1.7 8, JiJ�2 4 5 D 7.2 5~ C r e 6 .. .• Sr �.. .�- .. ..- .. 7GA667 -CE#817 12-64 - APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS, SUPT OF BUILDING LOCALITY 1p FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE t OWNER WATER CLOSET $1.25 :HOWER 1.25 ATH TUB 1.25 MAILADDREU MAIL CITY YL4TEL. NO. LAVATORY 1.25 CONTRACTOR �+ SINK 1.25 ADDRES a L DISHWASHER 1.25 CITY' TEL. NO.,I&4 LAUNDRY TUB 1.25 CONTRACTOR'S S ATE REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 DISTRI.CT NO GROUP WNE PARCESSED BY WATER HEATER 1.50 J _ J�� GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL OUTLETS OYER 5 PER SYSTEM .30 INSPECTION RECORD E� t 9L N APPROVALS DATE INSPEc-�C R S SIGNA PERMIT $ 2 00 UNDER SLAB WORK A %; ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GA S•VENT Y AND STATE THAT THE ABOVE IS CORRECT AND 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 TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE BOVE DESCRI ED RESIDENTIAL P P rY• UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL VALIDATIQN`___\ROBERT A WOOD " CK M oCSH /SUPERVISING MECHANICAL ENG'R LIDO 7 8 5 6 DEC 7 5 D 8.75- WORKERS'COMPENSATION DECLARATION20-0026 -, APPLICATION -FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667A PW 490 • sur»,or d ce(fificate of Workers'Compensation Insurance,or a n certified copy thereof (Sec 3800, La C y �"d ) full Policy No Ivby� Com anPee-1,0A kLE COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Pa^ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS tS42io LSD M A A vE NUMBER FIXTURE OR ITEM LOCALITY department J @ FEE �E M"of-� �r �' 7 Date r• Appljcont fir- sA` r'A��'H� WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST Ld N a-D /"I• COMPENSATION INSURANCE SHOWER OWNER So lam/A7Fy q / �i-/� (This section need not be completed if the work involved by 4L the permit,is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS 6 TZO 1-40/"7,44 A E 1 certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK _ CITY '7F/17 E' ell TEL NO Z J36_l0/ p as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR K �' M��NA�✓/ Q Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of Ex- ADDRESS 1`Z 5 l- 4A.-./7 GGA dZA gl emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR (a Q G A t�1/�► sation provisions'of the Labor,Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS CITY TEL NO ly with such provisions or this permit shall be deemed revok= STATELIC ed - WATER HEATER LICENSE NO G� 7� �9 CLASS � 2� LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I'hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS Com/ 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ::: W and Professions Code, and my license is in full force and ef- - 5 PER SYSTEM FINAL VALIDATION feet • O HOSE BIB � DATE Gj- ..•� S ' License Number Lic//Class O d I J FI AL �, Af%f'T a U Ba Contractor K G n'►EGHAr to is O ❑ I am exempt under Sec B 8P C for this reason Plan Check fee ® LU N Date PLUMBING PERMIT ISSUING FEE$ 0 Signature I ; TOTAL FEE 1i SINGLE FAMILY Plan check applicant: 1 TTGhiC HOME OWNER-BUILDER DECLARATION , I hereby affirm that I am exempt from the Contractor's License Name A V Irt-f&r a Law for the following reason (Section 7031 5, Business and _ a Professions Code) Address 12-s E 5„A,.r7,A GLA,e,q !;'T AM 9:23 ❑ 1, as owner of the property, will do the work and the City &4:?-e-A f A .Tel No structure is not intended or offered for sale(Section 7044, Business and Professions Code) oil.CONSTRUCTION LENDING AGENCY I hereby affirm that there is a constructidn 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 I have read this appJication and state that the above information is correct I agree to comply with all County j ordinances and State jaws regulating Plumbing, and hereby' outhoriz pr sentatives of this County to enter upon the above- e i ed pro rty for inspection puW / /, SEE REVERSE FOR EXPLANATORY LANGUAGE Signa of Permit ee bate