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HomeMy Public PortalAbout5010 MCCLINTOCK AVE_Plumbing__ YDEPARTMENT OF BUILDING AND SAFETY APPLICATION FOR PERBUT COUNTY OF LOS ANGELESPLUMBING WM.J. FOX.CHIEF ENGINEER ` NATURE OF INSTALLATION DlffrRICT DISTRICTNO. GROUP O PERMIT NO. ROUGH FiXTUREB COMPLE'ra 1 *5 Isr,2A a $7 HEATER CESSPOOL SEPTIC RECEIV •HY ' READY FOR DATE 1� TANK � " FIRST INSPECTION t F AS• MISCELLA EOU � cJ APPLICANT FILL �°I�N�y HEAVILY OUTLINED h PORTION ONLY JOB �D W NAME. A-Ajg�,)r -D P. �7 M1 l.-1- DDRESS {,. �'/� C t`-'�'-,y��"-Us.� � ADDRESS. - 4 / . pp��. //l LOCALITY lJ C_ NEAREST CITY (' TEL.No. OV(I` NIC CROSS ST.CCU j CERT..NO: EXPIRES �' NAME F t� �"J. 1/ .] I! 7'a LOCATION OF SEPTIC TANS, OR CESSPOOL Z MAILSf / t � � �} 3 ADDRESS". I/, a•J / !/ _mss NORTH O ,tel CITY A->c el a Ai F tESTEL.NO..YV MC 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. - rt.uMasR 1 AM THE LEGAL OWNER OF THE P OPERTY EBCRIBED ABOVE. � / � v3/d A 3 OWNER CORRECTIONS Air 160 SOUTH J DESCRIPTION OF WORK Z. BATH TUB FURNACE "r HOS DISHWASHER Q LAVATORY REFRIGERATOR ITCHEN SINK WATER SOFTENER FLOOR SINK AND TRAP GLOP SINK z7 COR DRAIN WASH TRAY URINAL' APPRO*ALS WATER CLOSET DRINKING FOUNTAIN _ DATE INSPZ=OO''R'S NAME —WATER HEATER DENTALLAVATORY ROUGH PLUMBING METER-3 SAS ouSODA FOUNTAIN GAS PIPING i n. GAS VENT I • CESSPOOL TOTAL NUMBER OF FIXTURES d� SEPTIC TANK I CESBPOCI EPTICTANK o z SEWER I TOTAL FEE r�'—� UTILITY CO.NOTIFIED FINAL O.B.B.17 BBM BETE 1-48 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBINGWM.J.FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT No. 6 OUPfOP aR�M QNO. ROUGH FIXTURES _I COMPLETE -� r '44� �— vs Y ll HEATER CESSPOOL SEPTICTANK RAE ED READYTOR ' TE 18B ED r 1�fj FIRST INSPECTION � A9• MISCELLANEOUS tB•T-(T xd� AP/P�LICAN/T FILL IN HEAVILY OUTLINED PORTION ONLYJOB ,y NAME // / / `'�j� �{��'� . ADDRESS �•/��— �(/l/ ' m ADDRES �_ 'tf`)•�.�{sZ•1" 1 LOCAL y. l bX i L y P7 NEAREST IL CITY q EL.No. CROSS 8T. COUNTY CERT.No. EXPIRES m NAME e/l^�I{ si L✓fi\hJ� . �i/'�t.(( 1. LOCATION OF SEPTIC T OR CESSPOOL 3 MAIL `'f v NORTH O CITY TEL.No. IAM THE LEGAL POSSESSOR OF THE ABOVE LOB ANGELES COUNTY CERTIFICAIrg,OF QUALIF 4;VION. �' � PLYIitBEs - I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. 3 - own= CORRECTIONS SOUTH .J DESCRIPTION OF WORK z ATH TUB FURNACE n a ROWER DISHWASHER p LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR BINK 9ANDTRAP SLOP BINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INBPECTOR'S HANE WATER HEATER DENTALLAVATORY ROUGH PLUMBING- I Ef ES AAS SODA OUTL FOPYTAIN� ,y GAS PIPING C' GAB VENT I CESSPOOL I I TOTAL NUMBER OF FIXTURES SEPTIC TANK I I _CESSPOOL SEPTIC TANK SEWER I / UTILITY CO.NOTIFIED I I� TOTAL FEE' FINAL : WORKERS;COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 0.1 hereby,affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure; or a certificate of Workers'Compensation Insurance, 76A667A r a certi{ied copy thereof(Sec 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS oficy Nb. Company ❑ Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS b �' CL Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY 10 s WATER CLOSET ,& Date Appli4ant � CROSS ST. l= NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE SI{OWER OWNER ^ (This section need not be completed if the work involved by the permit Is for one hundred dollars 100 or less. MAIL P (S ) ) ! LAVATORY '� ADDRESS I certify that in the performance of the work for which this permit is issued,I shall not employ any er an in any manner SINK r' CITY9 0-161 TEL.NO. so as to becme su lett to the Worke Cpm neat' Laws. DISHWASHER CONTRACTOR Date ����Applican j CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certifi a of ADDRESS , Exem tionyou should become subject to the Workers' SWIMMING POOL RECEPTOR Exemption, y I CITYTEL.NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM ' with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRJZ NO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM —2,—OUTLETSGy, (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE C License Number Lic. Class C FINAL:c r / lY Contractor Date BY l C ❑ I am exempt under Sec. - B.BP.C. for this reason I I L Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ r/b Signature TOTAL FEE r' SINGLE FAMILY Plan check applicant -' HOME OWNER-BUILDER DECLARATION Name �� �(§�� /�/� I hereby affirm that I am exempt from the Contractor's License p ACCT. Law for the following reason (Section 7031.5, Business and Address X50\® e, CI,\ p Ar1d 3307 ��■� P assions Code): City .gam C;-t•\ Tel. No. 7 �[E l` 1 ITIS I, as owner of the property, will do the work and the , structure is not intended or offered for sale (Section TOTAL 52.51131 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY GASH 552'511 1 hereby affirm that there is a construction lending agency for CHANGE .00 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name 00MI -=I 8/29/89 Lender's Address 5370 1 AN 9:11 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 outhoriz representatives of this County to ent r upon the above- tion pro�forection purp es. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ^' r - ! 76A666 DPW 4/87 n I herek�y, affirmthatI have a certificate of consent to self in- 76A667A -IUI sdre,.ot•a certtfAte of Workers'Compensation Insurance,or a CE 817(REV.8/86) cerfiQied copy.thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company 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. FIXTURE OR ITEM @ FEE LOCALITY I�JI WATER CLOSET(TOILET) X1.4 Date Applicant Fm NEARESTAt CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB • L CROSS ST. nip 14 11 COMPENSATION INSURANCE SHOWER V V OWNER (This section need not be completed if the work involved by AL MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY © ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK CITY TEL. NO. ,e ,S/GtL as to become s bje to the Workers'Co aws. DISHWASHER s 7 CONTRACTOR Date V ApplicantCLOTHES WASHER ADDRESS NOTICE TO APPL CANT: If, after making this Certificate o x- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. 'J sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DI TR)CT NO. 1ESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS ((' 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER V and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION >_ fect. DATE ` a. License Number Lic. Class l V FINAL.[:, y cc Contractor Date BY O U I am exempt under Sec. CL B.&P.C. for this reason ► �r�` _�2—�/ U) Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ + '� Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION pP 1 hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and (}t CT TO Pro ssions Code): Address 307 3-4.51._ t�,� t P:�. I, as owner of the property, will do the work and the City Tel. No. I ITEMS ructure is not intended or offered for sale(Section 7044, S usiness and Professions Code). ► TOTAL 3-4.m 50. CONSTRUCTION LENDING AGENCY CASH yi .50 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANGE .111, , (Sec. 3097, Civ. C.). Lender's Name '_ _- Lender's Address 024 1 AM ;:■�-' 6:■ 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 repr entativ s of this County to enter upon the above-menti d pro rt for inspe ion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Oe ignature of Permittee Date