Loading...
HomeMy Public PortalAbout5203 MCCLINTOCK AVE_Plumbing__ 76A867A(CE 86178)-1 1/76 APPLICATION FOR PLUMBING PERMIT BUILDING A SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING "' J NUMBER FIXTURE OR ITEM ® FEE ADDRESS 5 C3 ?JC (� WATER.CLOSET LOCALITY ` BATH TUB NEAREST CROSS ST. SHOWER OWNER 1 '� LAVATORYMAIL ADDRESS 4vx SINK 3 CITY I _ TEL.NO.Li 3-92 21 WASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL.NO. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. CLASS GAS SYSTEM OUTLETS DISTRICT NO. GROUP ZONE OCESSED Y SO PER SYSOT M INDUSTRIAL WASTE APPROVAL 0 INSPECTION RECORD C' ol f I1 r1 d Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applica - - APPROVALS y DATE• INSPje't S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING ;(: 'ly`) jii'`=--- 4 City Tel.No. GAS PIPING ., I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT ''•' ) 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 LICENSED AS PLUMBING FIXTURES ' (•�:-�•" REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALI ORNIA OR THAIA AM THE GAS TEST LEGAL OWNER OF,AND INTE O RESIDE IN THE O DES TIAL PROPERTY. / UTILITY CO.NOTIFIED SIGNATURE OFPERMITTEE FINAL ��G - f./' d�-�•C PLAN CHECK VALIDATION K. M.o: CASH PERMIT V4LIDATION CK. M.O. CASH 6 9 7-JUL z0 5 D 1 9.5 0 es WORKERS'COMPENSATION DECLARATION 2o-002APPLICATION FOR PLUMBING PERMIT I her7 hereby, affirm that I have a certificate of consent to self in- 6A666.DPW 4/87 6A667A. 'fl sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certifipa copy tFiereof(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 ,.y •7 j s Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE Gi, LOCALITY T6Vt'i e, Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROMWORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER 4F`Y'Pt ITIPPA (This section need not be completed if the work Involved by MAIL 3 the permit is for one hundred dollars($1.00)or less.) LAVATORY. ADDRESS 5203 (j,rP6 C11 h vc I certify that in the performance of the work for which this per- -611- SINK p mit is issued, I shall not employ any person in any manner so CITY I-eyj I� Cj' 1 TEL. NO. 3SU as to become subject to the Workers'Compensation Laws. DISHWASHER •7"j✓ "�/ C��,�, CONTRACTOR f,V_ Cov►��". Date f Applicant + CLOTHES WASHER ADDRESS 21.E d 1 .y NOTICE TO APPLICANT: If., after making this Certificate of Ex- tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR em P Y I P CITY � YV ° TEL. NO. I sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATEe ? 1 LI'C. ed. WATER HEATER LICENSE NO. J 7 1 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT No. -PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. DATE IL License Number 91' G O Lic. Class c, esFINAL P Q Contractor I"�L'�y Date �-� BY O [— Q/ I am exempt under Sec. W W B.BP.C. for this reason hO C1hl.?�r7 Yt'e q_ !© U)Plan check fee rJ' U) Date: `�j PLUMBING PERMIT ISSUING FEE$ Signaturehtr ? TOTAL FEE ',r SINGLE FAMILY HOME OWNER-BUILDER D CLARIf rATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name F Law for the following reason (Section 7031.5, Business and Professions Code): Addressti''�)°m I, as owner of the property, will do the work and the City Tel. No. 330 35°5ZI structure is not intended or offered for sale(Section 7044, w 1 T EMM Business and Professions Code). _ 50 CONSTRUCTION LENDING AGENCY oil. �(+ENie. '�� ®_ I hereby affirm that there is a construction lending agency for CHECK the performance of the work for which this permit is issued ir- , (Sec. 3097, Civ. C.). CHANGE Lender's Name " ; 103_130•01 7:1 11%19 1 Lender's Address � [t a rf- I certify that I have read this application and state that the � t4, ' `�°"�0 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 abo a-me lone property for inspection purposes. ✓ 7— 12--W SEE REVERSE FOR EXPLANATORY LANGUAGE • Si nature of Permittee Date WORKERS'COMPENSATION DECLARATION 1. APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667APw a/87 sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certifie&copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.P Company ❑ Certified copy is hereby furnished. BUILDING i L Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 52 0 C le✓1 v '` department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY � �fy Date Applicant / WATER CLOSET(TOILET) V NEAREST `.•' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. V`eeV' COMPENSATION INSURANCE SHOWEROWNER w"'. C'�•��M C� (This section need not be completed if the work involved by 2, MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS rjc�,ro► I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date 5-2-0 'f' Applicant 404 V CLOTHES WASHER D NOTICE TO APPLICANT: If, after making this Certificat of Ex- ADDRESS 7 y O 'yL; �f vn e- � 19 emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR i� sation provisions of the Labor Code,you must forthwith comp- CITY r/9 t7 %rrd.1,1/� / TEL. NO.�1 _ S2 dGG P Y P- LAWN SPRINKLER SYSTEM l.� ly with such provisions or this permit shall be deemed revok- STATEG LIC. ed. WATER HEATER LICENSE NO. �, 36 -J CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL !` �� VALIDATION C 59 5 3 6 3 p� DATE I License Number Lic;Class 0 p FINAL 0: ContractorCdY1 ZP ��SM`�f�ate 7 /j BY O I am exempt under Sec. a� W B.&P.C. for this reason no e m(,,ldy ee CL check fee S_av�p� � Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMI Y HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address 3 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 AGENCYi— I hereby affirm that there is a construction lending agency for T ✓ ,"f the performance of the work for which this permit is issued _1"I%l•.t :iv•:+_ (Sec. 3097, Civ. C.). Lender's Name (( } �:�LL�J �.•J(J� LFlt.1:IJl•'a 1 Lender's Address I certify that I have read this application and state that the Pool 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 above ent' ned,p-perty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE a Si ature of Permittee Date