HomeMy Public PortalAbout5530 MCCULLOCH AVE_Plumbing__ DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES I BUILDING !j�'" � G� i�/�i^
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS ✓ ✓
FOR APPLIC O LP"leenneLOCALITY i Gi
T
BUILDING A J NEARE
ST
I CROSS ST. ��
ADDRESS
DISTRICT NO. GROUP ZONE PERMIT NO.
LOCALITY
NEAREST
CROSS ST. RECEIVED BY%� Ready for Inspection DA E ISSUED
OWNER �.// / 301` v
MAIL ^ I ASTE APPR VAL Z<f r
ADDRESS S ��
CITYTEL.N0. INSPECTION RECORD
PLUMBE
ADDRESS
CITY"If / TEL.NO..
LICENSE NO./ Z>L/ , ? A—L, 7, fit; UG NTY J
PERMIT FEES z
NUMBER TYPE OF FIXTURE OR ITEM FEE I,
WATER CLOSET(TOILET) @ 0.80 $ , ,O O
BATH TUB @ 0.80
SHOWER @ 0.80
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80
SLOPSINK @ 0.80
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM...3....OUTLETS @ 1.00
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING �/- a _4% UIP.I-•:Id ., L 9
TOTAL FEE 05) GAS PIPINGi (/(�F/!ri E�•_. ._r�
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES 'FY THAT I AM PROPERLY REGISTERED ! /
AND/OR LICENSED EBY IAS REQUIRED BY LOS ANGELES COUNTY GAS TEST ;.Jj yy� �
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- y
ER OF THE ABOVE DESCRIBED RESIDENTIA PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE .. ...... ...... .... .. ....... ..._.._......... .FINAI 7%r ti.4,
70A667 DBS 17 1/58
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby, affirm that I have a certificate of consent to self in 76A666 DPW 4/87 _ n
'sure,or a certificate of Workers'Compensation Insurance,ora 768667( ,ul
P CE 81.7(REV.8/86) ,
certified copy:thereof'(Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company !
Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE)
Certified copy is filed with the countyADDRESS building inspection MBER FIXTURE OR ITEM
department, @ FEE LOCALITY
Date 19C- A licant WATER CLOSET(TOILET)
PP NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed-if the work involved by MAIL
the permit Is for one hundred dollars($1.00)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this per-
SINK CITY TEL.NO.
'Mit is issued, I shall not employ ariy person' in a manner so
Nation
me ubject t the Work rs' pe s n Laws. DISHWASHER 'CONTRACTOR
Applic CLOTHES WASHERADDRESS
APPLIC T: If, after making this ertificateofEx- SWIMMING POOL RECEPTOR
ou should become subject to the Workers'Compen.- CITY TEL. IVO.
isions of the-Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions'or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION aORICT NO4 ACCESSED BY
1-hereby affirm that I.am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of'the-Business OUTLETS OVER �3
and Professions Code, and my,license is in full force and ef- 5 PER SYSTEM A FINAL VALIDATION
fect. DATE
License Number Lic. Class O
V
9-44 FINAL I%
Fctor Date BY O
am exempt Under Sec. W
B.&P.C. for this reason Pool check fee
Date: PLUMBING'PERMIT ISSUING FEE$
• Signature
TOTAL FEE
SINGLE FAMILY Plan check.,a licant
HOME OWNER-BUILDER DECLARATION l, PP• 5.
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 3307 17
16.511
2�1'1,-as owner of the property, will do.the work and the City Tel. No.
structure is not intended or offered'for sale(Section 7044,' '_ EMu
Business and Professions Code). TOTAL
'OTAL 196 a 6=0
CONSTRUCTION LENDING AGENCY ►. I/ 5113
I hereby-affirm that there is a construction lending agency for ICHECK °
the performance of the work for which this permit is issued i 6i' °(:11
(Sec. 3097,,Civ.. C.). `HAINGE
Lender's Name 121;_+_01113, 4/ 5/89
Lender's Address °��
• ,
1 certify that'[ have-read this application and state that the s1 S _I 7:19°
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
lo.ve-men,ione �, perty�Iorinsp�ecfin purpo s. _ •
SEE REVERSE FOR EXPLANATORY LANGUAGE
ig ture'of Permittee D. to