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Home My Public Portal About5640 MCCULLOCH AVE_Plumbing__ 76A667 08817 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ' PLUMBING COIINTY OF LOS ANGELES " WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTR •O RMI O. PLUMBER 1. DATE 1 EIVED BY READY FOR ED �/ FIRST INSPECTION' ADDRESS � `r��r (q I d f/o U I/9 // � / BUILDING TEL Na. � 1/ I I el ADDRESS 9 ( �ci 6 A // /�' /� / �r COUNTY ®, EXPIRES (:J ®�.� Ly LOCALITY / /�� ge/ / LICENSE NO. w PERMIT FEES ' CROSS ST.. n)/ v® a A NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER A AI %1b 1 )�® /IJ WATER CLOSET(TOILET) 0 0.50 S ADDRESS 3,9"Art,/om ie 1 S`'I elA� 6 p BATH TUB ® 0.50 CITY !/-.�~/Til�1��/� ��`/r}5� TEL NO. D r�Q Jt1� SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS 20 LAVATORY (WASH BASIN) 0 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES J KITCHEN SINK I)! 0.50 AND STATE LAWS REGULATING PLUMBING. I I CERTIFY THAT 1 POSE EBB THE ABOVE VALID LOS / LAUNDRY TUB OR TRAY 0 0.50 ANGELES COUNTY LICENSED OR 1 AM THE LEGAL OWNER J OF THE RESIDENTIA PROPERTY DESCRIBED.ABOVE. ✓ GAS SYSTEM-1--OUTLETS @ 0.50 SIGNATURE OF �' WATER HEATER 0 0.50 PERMITTED 6 ..�."-, ' Y � ' SLOP SINK 0 0.50 INSPECTION RECORD FLOOR SINK 411 O.SO FLOOR DRAIN @ 0.50 DISHWASHER ((? 0:50 DRINKING FOUWrAIN 0.50 URINAL lb 0.50 4 HOUSE SEWER 0.50 Z 5 MISCELLANEOUS O APPROVALS DATEQ INBPEOTOR-8 NAME ROUGH PLUMBING. ^r/ P GAS PIPING 4. GAS VENT CESSPOOL 1.00 f CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT 1.00 SEWER PERMIT 1.00 GAB TEST UTILITY CO.NOTIFIED TOTAL FEE � a 1 FINAL J \11ORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 'e 20-0026 DPW 4/90 Jher6by, affirm that I have a certificate of consent to self in- 76A667A sure,%r-a certificate ofporf ors�ompensation Insurance,ora I� certified cop�r thereof(Sec. 3800, Lab. C.) Policy Np�Oy /J5� ?O'pa y 1 r"��' COUNTY OF LOS�+ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. , FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS _JZ';sem ��9�/ t%►'/� c.G department. / NUMBER FIXTURE OR ITEM @ FEE LOCALITY�� Date %5 Applicant"14u, / WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL �J y/ )�/ /� the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS .32--5l1 // • /y/ G:-'1/`� 1 I certify that in the performance of the work for which this per- SINK CITY mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER J ' CONTRACTOR✓ q,l+U Date. Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL.NOL sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS L �i} ly with such provisions or this permit shall be deemed revok- STATE ry LIC. ed. WATER HEATER LICENSE NO. CLASS 157;!f 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 ev and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. �GS�� ` HOSE BIB DATE f a License Number Lic. Class 4 -r $ f'7 63� r%G'l 91 S ,✓ rG ' y �� ', ,� FINAL V Contractor cvG l/G;'�I S )i/ a` 15 � ue% BY / 1" 'J O I am exempt under Sec. UJIV B.$P.C. for this reason Plan check fee IT Ei(sA y Date: PLUMBING PERMIT ISSUING FEE$ TOTAL `—} .610 Signature 7/ / r_';0 TOTAL FEE �'l (C CHECK �•°•-r'') SINGLE FAMILY an aLl() HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name —iL�i1 jI 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 State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- enfioned property for,i spection purposes.�,�JJ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ION WOthatI have a certificate of consent to M667 DPW 9/89 APPLICATION FOR PLUMBING PERMIT I hA1,'eby affirm that I have a certificate of consent to salt Insure, I 76A687A or a certificate of Worker's Comp6Aation %surance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No. ompany "' COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ 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. J NUMBER FIXTURE OR ITEM G FEE r -13-93 [i• LOCALITYmwk Date Applicant WATER CLOSET BATH TUB NEAREST /j_ CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. 4?COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit Is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit is issued, I shall not employ any person In any manner so as toSINK MAIL become-subject to the Workers'Compensation Laws. ADDRESS L7 DISWASHER Cli%%10 f T L NO. Date Applicant CLOTHES WASHER / NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR r/ Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS �7 provisions of the Labor Code,you must forthwith comply with such �T provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY "'— TEL.NO.. sf 'rJ } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC. / i d (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. �� CLASS ,$�C-� V Professions Code,and my license is In full force and effect. !� OUTLETS OVER DISTRICT NO. PROCESSED BY j= License NumberSa` Lia Clasd&C 5 PER SYSTEM r0 O r 1 9 WOW / FINAL DATE U VALIDATION W Contractor4rd _n'(J a ❑ I am exempt under Sec. BY AL,// BAP.C.for this reason ,•� Date: Plan check fee , �• PLUMBING PERMIT ISSUING FEE$ fp Lf b SignatuACCT.s ❑ TOTAL FEE /� �,S SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name 1 ITEMS I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address TOTAL iTL ®35 Code): , ❑ City Tel.No. CHECK 41■15 I,as owner of the property,will do the work and the structure 1+ } is not intended or offered for sale(Section 7044, Business CHANGE. e13 and Professions Code).. , CONSTRUCTION LENDING AGENCY i t I hereby affirm that there is a construction lending agency for the 01100-0001 12/13/T3 performance of the work for which this permit is issued(Sec.3097, 2976 1 AM 9:Kr 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 reprosentiLtives of this,County to enter upon the above-mentioned property o Inspection p pose . SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date