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HomeMy Public PortalAbout6436 LOMA AVE_Plumbing__ 76A667A(CE 8178)- 11/76 �I( APPLICATION FOR PLUMBING PERMIT BUILDING AN AFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS 110 V WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. SHOWER OWNEf,4 MAIL ,r LO L 1'- LAVATORY ADDRESS SINK CITY �/�✓ TEL.NO- DISHWASHER 7•3Dl!� DISHWASHER CONTRACTOR6),641 /A) CLOTHES WASHER m ADDRESS f` C'(>)�'-- SWIMMING POOL RECEPTOR ,/t� n � S� LV C�/ LAWN SPRINKLER SYSTEM CITY TEL.NO. STATE WATER HEATER LICENSE NO. CLASS �' 7 GAS SYSTEM OUTLETS t „-_ r DISI.RLCT NO. GROUP ZONE CE,SED Y OUTLETS OVER J Of 1-7- 5 PER SYSTEM INDUSTRIAL 96 WASTE APPROVAL INSPECTION RECORD b Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE v6— Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPER GISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COU Y AND TE F CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF.AND INTEN O RE N T ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE q C)F PERMITT FINAL PLAN Cv� ATION CK. M.O. CASH PERMIT VALIDATION a CK. M.O. CASH // 4 tlL 7 5 1 0e5 0 e,ti 7GAW7CM17-Il-5Z APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDINGJOHN A. AND SAFETY DIVISION BUILDING JOHN A. LAMHIE, County.Engineor CA33ATT D. GRIFFIN, Sup t of Building LOCALITY FOR APPLICANTTO FILL IN Ca SSTT. NUMBER FIXTURE OR ITEM I WATER CLOSET OWNER P BATH TUB ADDRESS SHOWER CITY �/�� �1 � TEL./N�O. , ?� LAVATORY CONTRACTOR SINK ADDRESS ,y DISHWASHER CITY TEL. NO-0 X_3L/ /J p LAUNDRY TUB CONTRACTOR'S t , l STATE REGISTRATION NO. / / 3 / COUNTY CLOTHES WASHER DISTRI O' GRO P ZONE READY FOR INSPECTION WATER HEATER I GAS SYSTEM INDUSTRIA. WASTE APPROVAL INSPECTION RECORD lea'/A /4i/,*d-c 44P 9rRA�', APPROVALS OR OFDITUIIT $ G DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK /L - � /Y�I!i:✓� ^p PERMIT $ 00 ROUGH PLUMBING TOTAL FEEI t GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATERWITH ALL y�,,,qq PLUMBING. COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES '30'0 &-�*46ff 1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST - /�L i5� (/rte ^r , LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE FPERM FINAL �Q-� N '� •r /�/nr/ ROBERT A WOOD. ©F (V ALIDATION SUPERVISING MECHANICAL ENG'R CK. N O. CASH LAC063 6 1 NOV 5 5 A 6.0 0 t 76A667 (CE-817) - 5/73 APPLICATION OR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO: ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. . NUMBER FIXTURE OR ITEM FEE OWNER WATER CLOSET 1.f5 MAIL . BATH TUB T. 5 ADDRESS � t r SHOWER 1.75 CITY TEL. NO^V7 LAVATORY 0 1.75 CONTRACTOR ` C' SINK 1• 5 ADDRESSr -� J t . DISHWASHER 1 75 CITY TEL NO CLOTHES WASHER 1175 STATE LIC "7 LICENSE N0. G7�j/ CLASS '-3 SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. G!�QUP N PR CESSED BY LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1 F INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD V OUTLETS OVER .30 tr 5 PER SYSTEM - O E— U W CL. Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LO GELES COUrNTY f.,ND STATE OF CALIFORNIA OR THAT I AM yHE GALyOWN OFA A��D)�TENDTRESIDE IN THE ABOVE DESC�7I BED ES'D NTI L-PROP •� FINAL /_/. SIGNATURE / OF PERMITTEE PERMIT VALIDATION/ cKK�.0. CASH PLAN CHECK VALIDATION ( J CK. M.0. CASH �' •7 "..// ✓ 9 5 1 APR G 5 D � � , 4.7 5 ION WOthat I have a certificate of consent to 76A666DPW9/69 APPLICATION_ FOR PLUMBING PERMIT IJ 76A667A 1 hereby affirm that I have a certificate of consent to self insure, or-a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec. 3800 Lab.C.) Policy No. 112946897 Company CNA Ins. Co. COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 10 Certified copy is filed with the county building inspection ADDRESS 6436 N. Loma department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Data 11-10-92 �Applicant Owen Bros . PlbWATER CLOSET Temple City NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. BATH TUB COMPENSATION INSURANCEASSESSOR ry / (This section need not be completed if the work involved by the SHOWER MAP BOOK v PAGE� PARCEL o16 permit is for one hundred dollars($100)or less.) OWNER J.V. Construction I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as toMAIL SINK ADDRESS 701 S. First Ave. #176become subject to the Workers'Compensation Laws. DISWASHER CITY Arcadia TEL.N0445-7292 Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Owen Bros. Plumbing, Inc. Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 4265 N. Baldwin Ave. provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATELIC.E1 Monte 443-0078 0 (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. 231 741 CLASS C36-20-16 0 Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY a: 5 PER SYSTEM ;�- �O �� Q License Number 231 741 Lic.Class C36-20-16 U FINAL VALIDATION W DATE Q.�+ a Contractor Owen Bros. P1bQ. Date 11-10-92 ! ! Cn ❑ I am exempt under Sec. FINAL Z BAP.C.for this reason Plan check fee , Date: Signature PLUMBING PERMIT ISSUING FEE$ J41 c ❑ TOTAL FEE O ACCT. Plan check applicant SINGLE FAMILY 3307 (6-;x.40, HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address ` Code): City Tel. No. TOTAL 64,33 - 40 ❑ I,as owner of the property,will do the work and the structure CHECK 6,.4 i is not intended or offered for sale (Section 7044, Business and Professions Code). ' CHANGE e �. CI`. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the t F�s t •I perfbrmance of the work for which this permit is issued (Sec. 3097, I.�t,00-13100l Civ. 6409 1 A�,t 1U i i• Lender's Name Lender's Address 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 repr sentatives of this County to enter upon the above-mentioned =ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 11-10-92 ig ture of Permittee Date