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Home My Public Portal About5019 MCCLINTOCK AVE_Plumbing__ 64 7 76A607-CE817 10-60 APPLICATION FOR PLUMBING PERMIT- � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGII:BMD I UR SAFETY DIVISIsIIILDIIIIG N A. MBIE, COTYADDRESSSoWILLIAM A. JENSEN, SUPT OF BUILDILOCALITY FOR APPLICANT TO FILL IIsi NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL e BATH TOR ADDRESS CITY TEL.NO. SHOWER LAVATORY CONTRACTO r SME ADDRESS' DISHWASHER CITY VaLtaAFL.NO. CONTRACTOR' El LAUNDRY TOB REGISTRATION NO. COUNTTYY ❑ CLOTHES WASHER DISTRICT NO. GROUP ZONEqOqESSRD BY WATER HEATER _ 77 ,41 r 7 ;rl 1 GAS SYSTEM INDUSTRIAL WASTE APPROVAL y, INSPECTION RECORD O t• - V a OO o. S $1.00 PER ITEM OR FD[TURB APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT ! 2 00 UNDER SLAB WORK TOTAL FEE ' , LJ 2 ROUGH PLUMBING l ; f 1 HEREBY ACKNOWLEDGE THAT i HAVB RBAD TN18 APPLICATION GAS PIPING _ - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT �'�� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HEREBY-CERTIFY THAT 1 AM PROPERLY REGISTER `r.,, _ PLUMBING. HOT WATER HEATER i14�i4 I ED AND�OR PLUMBING FIXTURES j LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE. DESCRIBED RESIDENTIAL P O ERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERM!TTE XFINAL ALIDATION ROBERT A.WOOD CK. 1;.0. CASH -SUPERVISING MECHANICAL ENG'R' 4 B 3jui!- 6 5 C 3.50 u 7GA667 (CE-817)- 5/73 �~ r APPLICATIO O PL MBIN PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: FQ�A ADDRESf e HARVEY T. BRANDT, COUNTY ENGINEER r n FOR APPLICANT TO FILL IN (PRINT OR TYPE) , NUMBER FIXTURE OR ITEM @ FEE _ OWNER WATER CLOSET 1.75 MAIL BATH TUB 1,75 ADDRESS SHOWER 1,75 CITY TEL. NO LAVATORY 1,75 ONTRACTOR SINK 1,75 DDRESS 10 J DISHWASHER 1,75 CITY TEL. NO. CLOTHES WASHER 1,75 STATE LIC SWIMMING POOL RECEPTOR 1,75 jLICENSE NO. CLASS DISTRICT NO. GROUP jZqNE PR CESSED BY LAWN SPRINKLER SYSTEM 1,75 WATER HEATER 1,75 �•,. INDUSTRIAL CJ WASTE APPROVAL C GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD , v OUTLETS OVER T C CD 5 PER SYSTEM 30 p U W a N A/ Ora Plan Check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSEDAS 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 RESIDEN TIAL ROPERTY. FINAL SIGNATURE OF PERMITTEE 111 2s: • PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 1 b,7&NOV 7 5 D 4.7 5 ,&L" ,eb CE 617I7;B A%PPLIcCATION FORPLUMBING PERMIT -SB BUILDING AND SAFETY DIVISION 1 Department of County Engineer ME -County of Los Angeles BUILDING ®� JOHN A.LAMBIE,COUNTY ENGINEER ADDRESS b CASSATT D.GRIFFIN,SUF?T OF BUILDING t LOCALITY ibtll 9 4 9PRAPPLICANT TO ELL IN CROSS ST. " OWNER ; Q F o n DISTRICTN. GROUP I ZONE READY FOR INSPECTION MAIL 0 ✓ I t ADDRESS INDUSTRIAL I + CITY TEL.NO. WASTE APPROVAL PLUMBER ,1 ,'�� INSPECTION RECORD rl` vg/ h ADDRESS CITY TEL.NO. 1 s LICENSE NO. � U 12 z,2 NUMBER TYPE OF FIXTURE OR ITEM FEE ,y' WATER CLOSET (TOILET) @ $t.00 BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 �- KITCHENSINK @ $1.00 DISHWASHER @ $1.00 6 LAUNDRY TUB OR TRAY @ $1.00 j CLOTHES WASHER @ $1.00 r WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTOR'S SIGNATURE yip i UNDER SLAB WORK f / f PERMIT $ 1 00 ROUGH PLUMBING �- t ! /i CG.r_ I GAS PIPING TOTAL FEE 4 le ® GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES "E } Cf�"i P'•:' .j PLUMBING'. / I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - GAS TEST 6 _ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF G CALIFORNIA OR. THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED t'�F -��d l�Jf•I . �,_ �-,*i.k••—i DESCRIBED RESIDENTIAIAPROPERTY r. SIGNATURE �s OF PERMITTEE /0 FINAL 2v-?F, y,+j .�- Z� �,•, p/ ROBERTA.WOOD. IOHN A.LAMBIE,COUNTY ENGINEERVALIDATION SUPERVISING MECHANICAL ENG'R Cif. M.0. CASH j&2 5 3 .5 S; SEP 2 3 3 6.00 _ r ' 0 r • LJ lys WORKERS'COMPENSATION DECLARATION { 6 DPW 4/87 APPLICATION FOR PLUMBING PERMIT si�Fii' 76A66 eby, affirm that I have a certificate of consent to self in- 76A667A sure,or g,certifi�ate of Workers'Compensation Insurance,ora % CE 817(REV.8/86) certifie9 cWy thereof(Sec. 3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. t FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING r Certified copy is filed with the county building inspection ADDRESS)10 — Cn department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date / Applicant WATER CLOSET(TOILET) NEAREST CERTI.ICATE OF EXEMPTIO FROM WORKERS' BATH TUB CROSS 57. n COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if the work involved by MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS 10 I certify that in the performance of the work.for which this per- SINK CITY TEL.NO. mit is issued, I shall not employ any person in any manner so as.to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR. Date Applicant CLOTHES WASHER ADDRESS ' NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR lLaL � emption,you should become subject to the Workers'Compen- CITY TEL.NCL? sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM �✓ ly with such provisions or this permit shall be deemed revok- STA.ELIC.; a;v C ed. WATER HEATER LICENSE NO. 2_4 r ;T1 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO �� PR ESSED I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL • VAL ATION fact. _ ^� —'� IL License Number �J / Lic. Class K20 _e- G OV FIN Q Contractor Date Y BY O 0 1 am Vempt under Sec. 84 8 2 A # 0000,05 B.&P.C. for this reason Plan check fee ► cc Date: PLUMBING PERMIT ISSUING FEE$ I o o 2 a 5 O Signature 0 TOTAL FEE 0 0 2 8 5 Q V SINGLE FAMILY Pian check applicant HOME OWNER-BUILDER DECLARATION 12, 02 -87 2O2 -87 1 hereby affirm that Lam exempt from the Contractor's License Name 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. 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 Stat la regulating Plumbing, and hereby authorize represen i s of this Count t on the above-mentione rty for' n purp ses. 0, SEE REVERSE FOR EXPLANATORY LANGUAGE Signa r rmittee Date