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HomeMy Public PortalAbout5405 MCCULLOCH AVE_Plumbing__ Tal�tw NOW r '... � •1 • 1 1 OW VF •r: : ::2:1 i mss. F� 1 11 . WMEM w a- -�■ .1 1. DAA.17 swi sEra 1.48 APPLICATION FOR PZRWT DEPARTMENT OF BUILDING AND. SAFETY COUNTY OF LOS.ANGELES PLUMBING WM.J.FOX.CHIEF ENGINEER NATURE OF INSTALLATION PERMIT o. ROUGH FIXTURES COMPLETE �v HEATER __ CESSPOOL �BEPTIC TANK R 11/ HY READY FOR DATE ISBUED FIRST INSPECTION' — ,N Z2 AS MISCELLAN US APPLICANT FILL IN HEAVILY © INED PORTION ONLY JOB S DDRESB I Q w W n-f'S/y�Aj4j� 4%AJL._.. LOCALITY JArro ,� m ADDR68 �. si,._ � i S Dj .�+ NEAREST IL CITY , TEL.No. , / CROSS ST.COUNTY iJ CERT.No. I EXPIRES -, °7/F NAME (..-7. LOCATION OF SEPTIC TANK, OR ChS OOL• 3 ADDRESS .4-M42/ NORTH O CITY s TEL.No. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OR gUyLIFICATION. �= PLUMasR 1 AM THE LEGAL.OWNER OF THE PROPERTY DESCRIBED ABOVE. own= CORRECTIONS SOUTH J DESCRIPTION OF WORK z. BATH TUB FURNACE Q SHOWER DISHWASHER Q —LAVATORY REFRIGERATOR TrCHEN SINK WATER SOFTENER r ^OR SINK SAND TRAP SLOP BINK FLOOR DRAIN N WASH TRAY URINAL APPROVALS r/ WATER CLOBET DRINKING FOUNTAIN pT: �ws R•o NAMs "WATER HEATER DENTALLAVATORY ROUGH PLUMBING EI EABSODA FOUNTAIN mph PIPING I I OUTL GAS VENT CESSPOOL I TOTAL NUMBER OF FIXTURES SEPTIC.TANK I CEBSPOOt TANK SEWER S UTILITY CO.NOTIFIED TOTAL FEE ' ••TINA �. ��' -- WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667A sure,or a cq,llfcate of Workers'Compensation Insurance,or a n certified copy thereof(Sec. 3800, Lab. C.) hull COUNTY OF LAS 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. NUMBER FIXTURE OR ITEM @ FEE LocAur�Y G Ddte Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. .Si'a COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS 1 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. NQ,S-,::?y k,- as to beco � pubject To the Workers'Comnsa;i DISHWASHER Laws. CONTRACTOR ��? ./• Dat Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR ADDRESS emption,you should become subject to the Workers'Compen- CITY ��f✓3//1Z Z <, sation provisions of the Labnr Code,you must forthwith comp- i TEL. ly with such provisions or this permit shall be deemed revok- LAWN SPRINKLER SYSTEMS STATE LIC 2 ed. WATER HEATER LICENSE NO. ���7 �� CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS - -- OUTLETS /�j 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 'D and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE -Z tier• } License Numbe f Lic. Class ti v °R L CL O FINAL -- Contractor Date BY - -- _ I am exempt under Sec. I I I EN-J 0 I 5V B.BP.C. for this reason $' a y W Plan check fee ► r.:t r ;�=.a- Date: (ii.;. 'r.I° W PLUMBING PERMIT ISSUING FEE$ CHANGE °1 ( ? Signature TOTAL FEE �Cj SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant C)-)(rr_� lr i(. 5/15'/9 1 hereby affirm that I am exempt from the Contractor's License Name c--�i 1'° :: Law for the following reason (Section 7031.5, Business and 52; 1 HAM L°s, 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 poll and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned PLqj3prty f9ri spection purses. �F SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ur of Permittee Date