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HomeMy Public PortalAbout5628 MCCULLOCH AVE_Plumbing__ 117 12/59 p` APPLICATION FOR PLUM[ INC PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUIL�NCAND ,SAFETYMSION FA I JO A. MBI COUNTY NGINEER WILLIAM A.JENSEN,SUPT OF BUILDING FOR APPLICANT TO FILL IN .NUMBER FIXTURE OR ITEM WATER CLOSET BATE TUB .NO. SHOWER LllluI LAVATORY C.ONTBACT08 Sm ADDRESS 3 7 DISHWASHER CITY CO CTOR'S I STATE LAUNDRY TUB REGISTRATION NO. � COUNTY ❑ CLOTHES WASHER DISTRICT0. GROUP- ZONE P CES$ED BY WATER HEATER e;jj�CffJJ GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD a Orli V x . . w..-.fr_.a -•� F.��' to �� t��.�N G $1.00 PER ITEM I OR FD[TURE $ APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING / rc.41J GAS PIPING ♦ s�LIwS--�--as I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT r AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY.LOS AN6ELE8. COUNTY AND-STATE OF C,pS TEST CALIFORNIA OR THAT I AM THE OWHE OF THE ABOVE DESCRIBED RESIDENTI44ROPERT UTILITY CO.NOTIFIED SIGNATURE OF PERMITTE FINAL � • r / - $a, -NALIDATION ROBERT A.WOOD, (cx. M.0. C45H SUPERVISING MECHANICAL ENG-R. U,1.0 :AoV I C' 5 0 1 1 .0 C r 76A667-CE61712/59 MEMPLE CITE" APPLICATION FOR P�UMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER r B�TIL�DII�iCrLAND�,SA�FETY_ IVISION sulLDnvG �-sl�Z ��G CU(�lr req O N A. AMBI OUNTY NGINEER ADDRESS WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. IDA NUMBER FIXTURE OR ITEM jj OWNER WATER CLOSET hh .... BATH TUB AADDDRESS - 9.... It I as SHOWER CITY �((� CdATEL.NO. CONTRACTOR ;� !Q--V— sum -Vr LAVATORY sum ADDRESS DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHERDISTRICT NO. GROUP Z NE PROCESSED BY WATER HEATER �"1 I ' G#S SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD o ' V F � V W a i y W $1.00 PER ITEM OR FISTIIRE $ O APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT . $1 2100 UNDER SLAB WORK TOTAL FEE ;s ®� ROUGH PLUMBING GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION- AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL PWflR OF THEVE DESCRIBED. RESESIDEHi PROPER Y , UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEaai4 E FINAL X �pv VALIDATIOW----\ROBERT A.WOOD, CK. N.0. / CAM /SUPERVISING MECHANICAL ENG'R � '�a2092 ".34 AUS 30 5 0 3.07 W 4rm that COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMI ther�ll E#irm that I Have a certificate of consent to self in- 76A666 DPW 4/87 76A667A sure,or a certificate of Workers'Compensation Insurance,ora CE 817(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 county building inspection ADDRESSZ department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �I� Date Applicant WATER CLOSET(TOILET) NEARESTjJ ���r CERTIFICATE OF EXEMPTION FROM WORKERS' I BATH TUB OSS ST. CR COMPENSATION INSURANCE ' : SHOWER OWNER (This section need not be-completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this pIer- mitSINK.is issued, I shall not employ any person in ny manner so KI.W N Ac CITY TEL. NO. as to become subject to the Workers'Co Laws. DISHWASHER CONTRALTO Dat © Applicant a CLOTHES WASHER ADDRESS/,3 F NOTICE TO APPLICANT: If, after mak' g this Certificate Ex SWIMMING POOL RECEPTOR emption,you should become subje to the Workers'Compen- CITY` �� T �10. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM y a . ly with such provisions or this permit shall be deemed revo.k- STATE 'Z ' CLAS ed. WATER HEATER LICENSE N LICENSED CONTRACTORS DECLARATION DISTRICT--N O. , PROCES D BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 0 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL D V LIDATION a DATE C License Number Lic. Class V FINA Contractor Date BY �0 8 2 7J I am exempt under Sec.. # o 0 0 0 0 �j O V p Ia - 2250 LU B.BP.C. for this reasonto Plan check fee ® o 0 o 2 2 5 0 v Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE I p,0 4 8 8 SINGLE FAMILY 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 ❑ 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. tate laws regulating Plumbing, and hereby authorize re t 1ve of this County to enter upon the above-m one o or inspection purposes. 1 9 _3/, SEE REVERSE FOR EXPLANATORY LANGUAGE Sig Lure of Permittee —/—cL Dale