HomeMy Public PortalAbout9815 LONGDEN AVE_Plumbing__ e4PFL.I-CATION FOR P.LI�'IVI,B IN
-G 'Fitk1Vl IT
COUNTY,OF LOS ANGELES BUILDING AND SAFETY' " •' '. ' S, '
FOR APPLICANT TO FILL-IN(PRINT OR TYPE). '. ' BUILDING 1
ADDRESS
NUMBER FIXTURE.OR ITEM ® FEE' ,
: e
...WATER CLOSET • , ., ,, �:; •'.. .• LOQkL ITY
NEAREST t
BATH TUB. :CROSS ST: S
SHOWER y, OWNER
LAVATORY MAIL �--
ADDRESS'.• �j - �/C/
SINK•
CITYTELAO:
DISHWASHER CONTRACTOR•
CLOTHES_WASHER PADDRESS •
,/ �-"
SWIMMING POOL RECEPTOR -`
TEL.NO
LAWN SPRINKLER SYSTEM
STATE., LIC: /
WATER HEATER LICENSE NO. /may CLASS '
GAS SYSTEM:•' OUTLETS APPROVALS DATE, INSPEctoR s SIGNATURE
-OUTLETS OVER '~ UNDER SLAB.IN.ORK ,
S.PER.SYSTEM ROUGH PLUMBING
GAS PIPING'
GAS VENT
HOT WATER HEATER
PLUMBING•FIXTURES '
GASTEST_
Plan ckieck-fee
UTILITY'CO.,N IFIED'
PLUMBING PERMIT ISSUING:FEE$
TOTAL FEE FINAL'
1PLAN.CHECK VALIDATION
Plan Check:applicant „ 1
Name
Address r
City - TeI;.No.
. I HEREBY ACKNOWLEDGE THAT 1•HAVE READ THIS APPLICATION AND'STATE
THAT THE ABOVE IS CORRECT AND AGREETO:COMPLY WITH'ALL COUNTY ORDINANCES':.
AND STATE LAWS REGULATING PLUMBING. '- 'PERMIT.VALIDATION-' c ,
I HEREBY CERTIFY-THAT I•AM PROPERLY REGISTERED AND%OR.LICENSED AS-' 1 - - 1 -2 O 6 61 H A
REQUIRED BY LOS ANGELES COUNTY AND STATE.OF CALIFORNIA OR THAT I.'AM THE
LEGAL OWNER OF;AND I:;a
ABOVE D CRIBED RESIDENTIAL # O',O .O O O'5'
PROPERTY. '
poQ11a0�Q
SIGNATURE OF PERMITT •: '• • '
oo=Q1,000,�` '
DISTRICT NO: -• PROCESSED'BY'
p a Q 6—7.8 .
INDUSTRIAL
WASTE APPROVAL.
IIDEPAIILTMEN7' OF COUrfrY ENGENEEIi -- PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNW OF LOS .ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS , ham✓
FOR APPLICANT TO FILL IN LOCALITY ,
BUILDING NEAREST
ADILDING+ /L+./ CROSS ST.
�-- L �' As 74 � DISTRICT NO. GROUP ZONE PERMIT
/NO.
--�
LOCALITY l.�it y j/�• �4 X-X
NEAREST
CROSS ST. �rpj jy�� ,,�Fy.i^� RE I sm/BY Ready for Inspection DATE ISS
VEO
OWNER /J6
MAILw, INDUSTRIAL r
ADDRESS �� /� �/$E..a WASTE APPROVAL
CITY /,�_, ff.-e.f y''.rTEL.NO. INSPECTION RECORD
PLUMBER
ADDRESSed�'!0�
CITY S 1 -sns./ TEL.NO.
' ❑STATE
LICENSE NO. ❑COUNTY / F f/F'S7t.If. )
PERMIT FEES a
NUMBER TYPE OF FIXTURE OR ITEM FEE
/
WATER CLOSET(TOILET) 0 0.80 a
BATH TUB @ 0.80 / 1 -2 '1 Y /'TAYl�/ F� - lkf/� C
SHOWER @ 0.80 n -- 1VQ7 ,-,qDY�
LAVATORY(WASH BASIN) 0 0.80 I
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80 Q e
SLOP SINK @ 0.80 /� /
FLOORSINK @ 0.80 /d.7 - &/U �ylf/C' l�f Yk A47-
FLOOR DRAIN @ 0.80 19Tf! TaR F/rT/lye
DISHWASHER @ 0.80 / / 4,711 PI/ 5
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
D
GAS SYSTEM..._.P..OUTLETS 0 1.00 AL" m _m 6n . z v. •�. s , sd
i WATER HEATER @ 1.00 _ e
MISCELLANEOUS 1...ZLDndl ru
n Z`''� APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK / y
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE /V / GAS PIPING I'7 -7 7 % (%611:1
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GASVENT f ~
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RES DENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE v �y'ses�OF PERMITTEE..._.._.._.Z.._.._ _....._ -_.._.._..__.__.._.._�___-•-- FINAL /i77A/l // ,u z �/
76A66T DBS 1T 1/53
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hby, affirm that I have a certificate of consent to self in- 2D 0026 DPW q/87
sure, r a certificate of Workers'Compensation Insurance,ora E 81 7.(
p CE 817(REV.8/86)
certified copy thereof(Sec. 3800, Lab. C.) 'fl
'I' COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Pdlicy No. Company
❑ Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE)
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ADDRESS
department. ti @ FEE LOCALITY
1� 0. )A p ,��,� z.� WATER CLOSET(TOILET)
Date • )Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER 'OWNER t,
(This'seetion need not be completed if the work invoived'•by MAIL (� -� i �' _
the permit is for one hundred dollars($100)or less.) LAVATORY O �• ADDRESS 1 '1 M- '1�,+
I certify that in the performance of the work for which this.per- SINKCITY '' TEL. NO.Z-6C"'�t09
mit is issued, I shall not employ any person in any manner so
as to become subject to the-Workers'Compensation Laws. ' DISHWASHER
_ CONTRACTOR
Date- Applicant t CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: if, after making this Certificate of Ex-
emption,you shouldbecome subject to the Workers'Compen- SWIMMING POOL RECEPTOR ^_ .
2:27
• sation.provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM CITY TEL.NO.
ly with such provisions or this permit shall.be deemed revok- STATE • '� �(�y LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO... ROCESSED BY
I hereby off irm'that I am licensed under Oovisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business (J
OUTLETS OVER Jj
and Professions
Professions Code, and my license is inJull.force and ef- 5 PER SYSTEM FINAL VALIDATION a
lPDATE _
License Number �� p4iLk Lic. Class Jt �� V
0,I'Y`r•� BY
-►tri 6 FINAL
Contractor �S Date O
• I am exempt under Sec: LU
6.8P:C. for this reasonpop- cc
Plan check fee
Date' . PLUMBING PERMIT ISSUING FEE$
Signature- � �� /
• TOTAL FEE /� �F-
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan,check applicant. c
5
1 hereby affirm that I am exempt from the Contractor'sLicense Name � La
Low for the following reason (Section 7031.5, Business and I AC .Ta
Professions Code): Address ' 5`L\L �ni.� .�ti y v 307 1jJo
❑ I, as owner of the property, will.do the work'and the City Tel. No.
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). ,
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 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
ae�mentio d pro -Pty f�Inspection purposes.� _ _ j.L C�Ji SEE REVERSE FOR EXPLANATORY LANGUAGE,
Si`g'F(ature of Permittee "� Date