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Home My Public Portal About4939 MCCLINTOCK AVE_Plumbing__ 7UG67-CE817"a APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ] / BJOHNIAGLAAMB SION BUILDING E.COUNTY ENSTY G NEEER ADDRESSC 1 a-r-io - l< WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEARSTT. NUMBER FIXTURE OR ITEM CROSS fj OWNER , Z5 wo )z-r WATER CLOSE! MAIL BATH TOB ADDRESS CITY TEL NO. SHOWER LAVATORY CONTRACTOR M WE HYING Go. lNe. s>Ns ADDRESS 410. SO. G DISHWASHER crr7r MONTERMILpA . r4l IF CONTRACTOR'S STATE- LAUNDRY TUB I REGISTRATION NO. I' b I COUNTY CLOTHES WASHER DIiSmr-T NO. GR UP ZONE P SED BY , WATER HEATER �!a , GAS SYSTEMUgUSTRLAL WASTE'APPROVAL r /?INSPECTION RECORD O W OS Ba PER rrElM $ I f JL APPROVALS ,DATE INSPECTOR'S SIGNATURE PERMIT $ UNDER SLAB WORK TOTAL FEE / ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 I AM PROPERLY REGISTERED AND/OR PLUMBING.FIXTURES Ar LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GA CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE S TEST DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED 1n16A SIGNATURE. r OF PERMITTE FINAL /,'�l�r�= 'y jam;';��{• DrVALIDATION ROBERT A.WOOD, cc' Y.0. CASH SUPERVISING MECHANICAL ENG'R s 0 .s:3 QE ,13 5 D 3.4 O 76A667�A .. - CE 19I NEV.6/7191 + ` ;,Vs .. APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN IPRINT OR TYPEI BUILDING w ADDRESS McClintock v 7— NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET LOCALITY Temple Cit NEAREST BATH TUB CROSS ST. SHOWER OWNER Shackelfort MAIL LAVATORY ADDRESS Same SINK CITY Temple City TEL.NO L148J+108 DISHWASHER CONTRACTOR ng.-rt. Air Systems CLOTHES WASHER ADDRESS 131+0 Dvnmics Unit J SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM CITY Anaheim TEL.N0524-7630 WATER HEATER ITATE LICENSE NO 3(0�97 CLASS LIC C-20 1 GAS SYSTEM 1 OUTLETS 3.00 APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS TEST Plan check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ 00 TOTAL FEE 10 00 FINAL Plan check applicant PLAN CHECK VALIDATION Name TIP . 54Address City Tel.No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES A%D 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 LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY SIGNATURE OF PERMITTEE DISTRICT NO. PR CESSE BY INDUSTRIAL WASTE APPROVAL .`' WORKERS'COMPENSATION DECLARA`TPpN " ., reaesry' ' I hereby affirm that I have a7 certificate of cdnsent to'self ca: a.(2-so) 'APPLICATION FOR PLUMBING PERMIT insltre, or a certificate of Workers'Compensation Insurance,or a certified'copy thereof(Sec.3800,Lab.C.) r COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING j ADDRESS -'i Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE department. WATER CLOSET LOCALITY Date Applicant NEAREST /; ^ �� BATH TUB � CROSS ST. L� n CERTIFICATE OF EXEMPTION FROM WORKERS' SHOWER OWNER �COMPENSATION INSURANCE LAVATORY MAIL � A ria (This section need not be completed if the work involved ADDRESS I"1�by the permit is for one hundred dollazs ($100) or less.) -14 SINK CITY _I certify that in the performance of the work for which this DISHWASHER CONTRACTOR permit is issued, I shall not employ any person in any manner �so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS 'Date Applicant SWIMMING POOL RECEPTORNOTICE TO APPLICANT: If, after making this Certificate of CITY jExemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO.with comply with such provisions or this permit shall bedeemed revoked. GAS SYSTEM OUTLETS DISTRI NO. LICENSED CONTRACTORS DECLARATION OUTLETS OVER �� I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE effect. FINAL License Number Lic.Class BY REGIF Contractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 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 I hereby affirm that I am exempt from the Contractor's Address `;3451 A License Law for the following reason (Section 7031.5, Busi- City Tel.No. ness and Professions Code): IJ . 0 0 0 0 5 F1 I, as owner of the property, am exclusively contracting 2 0 -124.50 with licensed contractors to construct the project (Section 7044,Business and Professions Code). 0 0 o ?/i 5!`x CONSTRUCTION LENDING AGENCY 3.30-82 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 mply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws reg lumbing, and hereby authorize re ese a ' s of t s ou ty to enter upon the above-m ned p ty fo s ect' n purposes. S*nai re f Per Date