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HomeMy Public PortalAbout4904 MCCLINTOCK AVE_Plumbing__ I%w.D.E.S.-17 X5M SETS 18-45 AE=I APPLICATION FOR PERMIT TCOUT OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES. �V WM.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT_ NO. GROUP I ZONE PERMIT NO. ROUGH FIXTURES COMPLETE 'I i / . I r HEATS CESSPOOL -I SEPTIC TANK REC61V6�B READY FOR ppT6 ISSUBD �(� FIRST INSPECTION _ � r• GAS NIBCELLANEOUS / (¢� S `I c� �. APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB ff ' NAME f ADDRESSYyjS ■ ADDRESS \ _ LOCALITY L CITY , TEL.No. C OBS or.NEAREST COUNTY NAME ) CERT.No. • EXPIRES LOCATION OF SEPTIC TANS, OR CESSPOOL ' 0 ADDRESS NORTH II�y^ CITY .,�C... 1 TEL.No. i AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. own" ( � CORRECTIONS NetP ef Baa 6 - gj .(e BOOTH DESCRIPTION.OF WORK �'33�•^BATH TUB FURNACE ROWER DISHWASHER -LAVATORY REFRIGERATOR -KITCHEN SINK WATER SOFTENER ` 'LOOK SINK SAND TRAP / Ing-t-) zz LOP SINK wLOOR DRAIN ASH TRAY -URINAL APPROVALS S WATER CLOSET DRINKING FOUNTAIN \ L' DATE tNSP 's NAYR WATER HEATER ^ENTALLAVATORY ROUGH PLUMBIN\ �_ �✓� ETER. OU S CODA FOUNTAIN GAS PIPING I GAS VENT CESSPOOL , TOTAL NUMBER OF FIXTURES SEPTIC TANK I CESSPOOL LSEPTICTANK SEWER r I TOTAL FEE d UTILITY CO.NOTIFIED + 1&*-2 FINAL F IRKER9'COMPEKSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 'l +r , firm 76A66 that I have a certificate of consent to self in- 6 DPW q/87 6A667q sure,or agertjtjcate of Workers'Compensation Insurance,ora CE 817(REV.8/86) certified copy thereof(Sec. 3800, Lab. C.) +� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy bo. Company Gerfified copy is hereby furnished. BUILDING 0011 ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS 014 n e, department. NUMBER FIXTURE OR ITEM @ FEE 7 LOCALITY Date Applicant WATER CLOSET(TOILET) ©� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' l BATH TUB 19 00 CROSS ST. COMPENSATION INSURANCE SHOWER /2610 OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORYADDRESS Q [!� I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY ` (gyp • TEL. NO. as to b e subject to the Workers'Compehsatio Laws. DISHWASHER \ 8•` 'CONTRACTOR DateApplicant a- CLOTHES WASHER NOTICE fO APP ICANT: If, after making this Certificate of Ex- ADDRESS emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR sation provisions of the Labor Code;you must forthwith comp- CITY TEL. NO. p y P" LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �- 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VA ATION >" Li ct. DATE ��3"� IL 0 O License Number Lic. Class V FIN g� Contractor. Date BY O • t– V I am exempt under Sec. 1E I W f� B.$P.C. for this reason ► N Plan check fee � Date' PLUMBING PERMIT ISSUING FEE$ SignatureTOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant ;1049,5 A I hereby affirm that I am exempt from the Contractor's License Name I&& # 0 0 0 0 0 5 Law for the following reason (Section 7031.5, Business and Professions Code): Address 0 0 5 a 5.0 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, o o ° 5 8,5 0 5 Business and Professions Code). Poo. Q $ 2 2 8 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 abovVnentioned jMoperty for inspection pur oses. Z?j SEE REVERSE FOR EXPLANATORY LANGUAGE gnature of Permittee Date 75AG67-CEMS17 5/69 - - bity- Of Tgnplo MY ; 15038 APPLICATION FOR PLUMBING PERMIT. COUNTY OF LOS ANGELES -DEPARTMENT OF COUNMENGINEER BUILDING ANSAFETY• DIVISION FADDRESS G JOHN A.LAM IE. COUNTY EN'.GINEER' WILLIAM A.JENSEN, SUPT OF'BUILDING TYFOR APPLICANT TO FILLIN T ST. NUMBER FIXTURE OR'ITEM EACH FEE' •r vo WATER CLOSET .'25s. OWNER -` .r �&7iiwC1 i.G .. ' ,MAIL HATH TUB -1.25' SHOWER + 1.251. CTtY TEL NO. LAVATORY 1.25 CONTRACTOR a�naral- SINS 4 "ry ADDRESS:..:' I. DISHWASHER , 1.25 CITYLos AngaleaTEL.NG. $. LAUNDRY TUB 1.•25 .( CONTRACTOR'S STATE. pt REGISTRATIOW NO. f COUNTY CLOTHES WASHER 1.25 ` DISTRICT NO. GROUP ZONE PROCESSED BY WATER HEATER 1.50 '` c- 150 INDUSTRIAL GAS SYSTEM . OUTLETS WASTE APPROVAL 0 OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD w Reader fok Inspeotian Now �. , n. - - W F r APPROVAL'S 'DATE" INSPECTOR'S SIGNATURE •PERMIT $ 2 ,00 UNDER SLAB WORK r� ROUGH PLUMBING TOTAL FEE 310 GAS PIPING 1 HEREBY ACKNOWLEDGE: THAT 1 HAVE READ THIS APPLICC MION GAS VENT AND'STATE THAT THE ABOVE IS: CORRECT AND AGREE TO COMPLY _ WITH ALL COUNTY ORDINANCES AND STATE -LAWS REGULATING PLUMBING. HOT WATER HEATER ' - I HEREBY CERTIFY THAT 1 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 ABOVE DESCRIBED REBID55fl,B OP UTILITY CO.'.NOTIFIED ` SIGNATURE fv�' ' OF PERMITTEE FINAL -V)MATION ROBERT A.WOOD. CK. M.O. CASH SUPERVISING MECHANICAL ENG'R ,