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Home My Public Portal About4954 MCCLINTOCK AVE_Plumbing__ 76,�667-CU,745/ f• APPLICATION FOR 1 PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT .OF COUNTY ENGINEER 7BUILDINGBUILDING AND SAFETY DIVISION ClintockJOHN A. L_AMBIE. COUNTY ENGINEERCASSATT.D. GRIFFIN, SUP'T OF BUILDING e le citFOR APPLICANT TO FILL IN NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL �1 BATH TUB ADDRESS SHOWER CITY TEL.NO. LAVATORY CONTRACTOR JI SINg ADDRESS13354 S Central. DISHWASHER CITY Ch I no TEL.NO. Na R-4791 LAUNDRY TUB CONTRACTOR'S STATE Ll REGISTRATION NO. 4 C- COUNTY ❑ .• CLOTHES WASHER DISTRICT NO. GROUP ONE READY FOR INSPECTION ,]. WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL // INS�PPECTION RECORD gaa eAA !!?Of . APPROVALS. @ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE C� OR FIXTURE $ 9 00 UNDER SLAB WORK ROUGH PLUMBING +S A PERMIT $ 00 GAS PIPING _ TOTAL FEE 11100 GAS VENT 1 HEREBY ACKNOWLEDGE. THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST ,— LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE. UTILITY CO. NO DESCRIBED RESIDENTIAL PROPERTY. B SIGNATURE ! OF PERMITTEE I j FINALiiiiiiiiii Os VALIDATION ROBERT A. MOD, SUPERVISING MECHANICAL ENG'R CK. M.O. CASH LACO 5 6 9'6in= OCT 14 5 A 1 .1.0 0 9 BS-17 f0-BB 7 OBS-1APPLICATION FOR PLUMBING PERMIT D DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County Of 'TAS Angeles BUILDING • JOHN[A..LAMBIE.COUNTY ENGINEER ADDRESS. CASSATT D.GRIFFIN,SUPT OF BUILDING. Oe�c.:2e LOCALITY fP/• FOR APPLICANT TO FILL IN NEAREST CROSS ST. OWNER DIST O. GROUP ZONE ADY FOR INSPECTION MAIL ADDRESS ..�• OW INDUSTRIAL CITY TEL.NO. WASTE APPROVAL PLUMBER GENERAL INSTALLATION CO. INSPECTION RECORD ADDRESS 6558 West Blvd. . CITY LOA. 43 TEL.NO. PLeasaet 3-2541 LICENSE NO. 787 C-36 151839 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ BATH TUB @ .$1.00 SHOWER Q. '$1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY Q $1.00 • CLOTHES WASHER @ $1.00 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 1 WATER- SOFTENER 1 100 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT' . $ I 00 ROUGH.PLUMBING GAS PIPING TOTAL FEE 00 GAS VENT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ. THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING, I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 29? OF THE ABOVE UTILITY CO.NOTIFIED.DESCRIBED RESIDENTIAL SIGNATURE , �- OF PERMITTEE FINAL _2. C, I IOHN A.LAMBIE.COUNTY ENGINEER VALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR cx. m.®. USH A,'o 7 0,3 953 FEB 2:99 5 a 3.SJ WORKERS'COMPENSATION DECLARATION 2026 DPW 4,90 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of conserq to self iq- 76A667A. - sure,ora certificate of Workers'Compensation Insurance,ora certified copy thereof(Sec. 3800, Lab. C.) Policy RIo. - Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. department. NUMBER FIXTURE OR ITEM @ //FEE LOCALITY Dote Applicant WATER CL (TOILET) (O01NEAREST C- Pmt CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER NER (This section need not be completed if the work involved by MAIL q the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY _ TEL.NO. mit is issued, I shall not employ any person in any manner so I !' !� as to become subject to the Workers'Compensation Laws. DISHWASHER f✓V G� NTRACfOR 4 J Date Applicant 16 43,✓U�� CLOTHES WASHER ADDRESS C) NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Com pen- r sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS CITY 1 n .n TEL.NO 11K 3 l ly with such provisions or this permit shall be deemed revok- STATE `V/1LJ� 6 LIC. ed. WATER HEATER LICENSE NO. CLASS 46 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS I/,—n p 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER Q and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINALVALIDATION fect. - JHOSE BIB DATE �Z�y/ }a License Number 4 Lic. Class FINAL 59.50 C V Contractor, !' Date BY " ,� Ix I am exempt under Sec. G _ W B.&P.C. for this reason Plan check fee Date: rA PLUMBING PERMIT ISSUING FEE$ go TOTAU t 59 o 50? Signature TOTAL FEE SINGLE FAMILY GASH .99 Rn HOME OWNER-BUILDER DECLARATION Plan check applicant ° I hereby affirm that I am exempt from the Contractor's License Name CHAh65 Law for the following reason (Section 7031.5, Business and Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. (MM—MMI 1�14�� structure is not intended or offered for sale(Section 7044, 3292 1 AN10-003 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 lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the ab -mentioned operty r inspection purposes. Z SEE-REVERSE FOR EXPLANATORY LANGUAGE �igno re of Pr mittee Dote