HomeMy Public PortalAbout5514 MCCULLOCH AVE_Plumbing_10/31/1985_ 'SA66T
)88.,7,D.gg APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Loa Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN.SUPT OF BUILDING r
LOCALITY
FOR APPLICANT TO FILL IN I NEAREST
CR08S ST.
OWNER DISTRICr GROUP O I READY FOR INSPECTION
MAIL P O 7
ADDRESS
INDUSTRIAL
CITY TEL.NO. WASTE APPROVAL
PLUMBER ` a JNSPECTION RECORD
A.
ADDRESS
i
CITY �s yy TEL.NO. rrb ` D
LICENSE NO. ry Y� / - I
r
TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 5 /100
BATH TUB @ $1.00 D�
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00 / 100
KITCHEN SINK @ $1.00 D
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
O CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00 ®D
GAS SYSTEM @ $1.00 ®®
APPROVALS
DATE INSPECTOR'S SIGNATURE
i
UNDER SLAB WORK �� � �:a �✓rr�/
PERMIT $ 00
ROUGH PLUMBING
1 �
GAS PIPING � '�d �y. 1.< '`•+ +."
TOTAL FEE
GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER " ''� %J L ��'•4 W s,"
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.NOTIFIED Ogg,i
DESCRIBED RESIDENTI PRO TY.
SIGNATURE
OF PERMITTEE - FINAL P2.
IOHN A. LAM, 1 , COUNTY ENGINEER LIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CK. H.0. CASH
Z��I O .
WORKER$'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT '
.sl herebo affirm that I have a certificate of consent to self 76A667A
insure, or a certificate-of Workers'Compensation Inst/ ce, CE 817(REV. 10/81)
or a certified copy thereof(Sec. 3800, Lab. C.)a onCOUNTY OF LOS ANGELES BUILDING AND.SAFETY
I
Policy No. Company
Certified copy is hereby furnished. BUILDING
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS
Certified copy is filed with the county building.inspec-
91 3
tion department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Date A' li.ant WATER CLOSET
Pp 4CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 1/-
COMPENSATION INSURANCE OWNER v
(This section need not be coinpleted If the work involved by SHOWER
the permit is for one hundred dollars($100)or less..) LAVATORY MAIL
ADDRESS
I certify that in.the performance of the work for which this
permit is-issued, I shall not employ any person in any manner SINK CITY NO..
so as to become subject to the.Workers'Compensation Laws. DISHWASHER
[p... CONTRACTOR
Date. +��' pplicant CLOTHESWASHE.R ADDRESS /
NOTICE TO APPLICANT: if, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions.of the Labor Code,you must forthLAWN SPRINKLER SYSTEM- CITY TEL. NO.
with comply with such-provisions or this permit. shall lie STATE LIC.
deemed revoked. t WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION I DISTRICT NO. 97 ED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS +� 5-108
(commencing with.Section 7000)of Division 3othe Business OUTLETS OVER d
and Professions Code,and my license is in full force and effect: 5 PER SYSTEM FINAL
DATE 0—�/�� VALI ATION u
License Number tic. Class �;����j p9
NW r 6 FINi4• O
Contractor Date. r BY V
oI.am exempt under Sec. N
BAP.C. for this reason Z
Plan che.Ck fee
Date. PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name #;2 2.5 Qd 5 Q
I hereby affirm that'I am exempt from the Contractor's License ' Address J
Law for the following reason (Section 7031.5, Business and ( c o 2 5
Professions Code): City Tel. No. '
0 I,'as.owner of the property, will do the work and the -2a500
structure is not intended or offered for sale (Section ,
7044, Business and-Professions Code). 0 7 2 5=8 5
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 laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned properWr
spection purposes.
o` G SEE REVERSE FOR EXPLANATORY LANGUAGE
d
Signalure of Permittee Date