HomeMy Public PortalAbout6463 LOMA AVE_Plumbing__ 76A607-CE817 10-60
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING�{ ;
JOHN A. LAMBIE, COUNTY ENGINEER. ADDRESS
IV
WILLIAM A. JENSEN, SUPT OF. BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
-NUMBER FIXTURE OR ITEM - OWNER
WATER CLOSET NAIL'
BATH TUB ADDRESS
CITY TEL. NO: .
SHOWER _ 7
CONTRACTOR.- -I
LAVATORY
SINK -
ADDRESS s
DISHWASHER CITY 77p,NTRACTORrr
LAUNDRY TUB REGISTRATIION NO. le I CO STA
-
CLOTHES WASHER'- DISTRICT 1110. GR Z PROCESS BY.
WATER HEATER [f/j
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL r
_ SPECTION RECORD D'
7
/ 11-Z71(
Ov
V
ITEM
OR FIXTURE
APPROVALS ...DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 200
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ.THIS APPLICATION ( �� ,•
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT r //
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,L.IOT WATER HEATER 1
PLUMBING. _
1 -HEREBY CERTIFY THAT I AM PROPERLY. REGISTERED AND/OR PLUMBING FIXTURES II r i����
LICENSED AS REQUIRED BY LOS ANGELES COUNTY,AND,STATE OF
LEGAL OWR OF 7 £ ABOVE GAS TEST _ /I7 ���! ��1/✓1/�/.
CALIFORNIA OR THAT I AM THE • /y
DESCRIBED RESIDENTIAL.PROPERTY. UTILITY CO. NOTIFIED �fn�.ff
SIGNATURE . •'....• f.a., /!/7
'OF PERMITTE -
FINAL
ALIDATION - - ROBERT`A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
,, 5 o;d`� x;12. 5., 3.:5:ON
I hereby affirm that I have a. certificate of consent_to self cE.en (z-s°) A P P L I f'i 1;'.�'®1�1 _FORPLUM �7 r G 1`(IVL IT
WORKERS'COMPENSATION DECLARATION zswsszw
insure or a:certificate of Workers'Comp sation Insurance,or
a certified copy.thereof(Sec.3800,Lab ) T
COLIN TY.OF.LOS ANGELES BUI YMVG AND SAFETY
'..Policy No. Company
O Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE). BU DI
g inspection A IR
Certified
.is filed with the county bu di E ~
-d par,f NUMBER FIXTURE OR ITEM 0 FE LOCALITY
WATER CLOSET- ,
Date Applicant t NEAREST-
BATH TUB
EAREST-
BATH7UB ' CROSS ST. -
CERTIFICATE OF EXEMPTION FROM WORK S', I
COMPENSATION INSURANCE SHOWER OWNER
LAVATORY
MAIL ^^>>
(This section need,not be completed if the work involved ADDRESS Lam/ . �.
by the permit is for; one hundred dollars ($100) or less.) s I N KCL
O
CITY TEL.NO�
I certify that in the performance,of the work for which this. DISHWASHER U
CONTRACT
'Permit is issued, I shall not employ any person in any manner
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER 0
ADDRESS
Date Applicant 'SWIMMING POOL RECEPTOR vU
'NOTICE TO APPLICANT:4f, after making this Certificate of CITY TEL. NOl� � a
Exem tion, LAWN SPRINKLER SYSTEM
p you should become subject to the Workers' STATEfi LIC. JJ Z
Compensation'provisions of the Labor Code, you must forth- LICENSE NO. 2 2 C/ CLASS.
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. P CESSED BY
LICENSED CONTRACTORS DECLARATION
OUTLETS OVER
I hereby'affirm-that'I am licensed under provisions of Chapter 5,PER SYSTEM
9 (commencing with Section 7000) of,Division 3 of the Busi- FINALVALIDATION'-
ness and Professions Code, and my license is in full force and DATE
-� ZS"� �-
effect.
FINAL
License Numb r- Lic.Class BY
Contractor Date
lamrexe pt rom heylicensing requirements as I am a Plan check fee ,
licensed architect or a registered professional engineer - PLUMBING PERMIT ISSUING.FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic,or Reg.No, Date Plan check_applicant
HOME OWNER-BUILDER DECLARATION Name
Address
I hereby affirm that' I am exempt from the Contractor's A
License Law for the following reason (Section.7031.5, Busi- City Tei,No. � �5 4,6 A.
ness and Professions,Code):
I,'as owner,of the property., am exclusively contracting #'0 fo 0 0-0 5
with licensed contractors to construct the. project
(Section 7044,Business'andProfessions Code).. co ° 1 2 5 0
CONSTRUCTION LENDING AGENCY O'O'° 2 5 O v
'I hereby,affirm that there is a construction lending agency t'
for the performance of the work for which this permit is 0'6 2'4'—`8 2
issued(Sec. 3097,Civ.C.).
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 SEE-REVERSE FOR EXPLANATORY LANGUAGE
authorize representatives f this County to enter upon the
above-mentioned proper f "inspection purp ses.
Sign re of Permittee Date