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Home My Public Portal About5642 1/2- 5644 MCCULLOCH AVE_Plumbing__ 76AGG7-CENS17 12-54 P 2212 City of 11'emple City ' APPLICATION FOR PLUMBING PERMIT • COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS 5644 X70. McCulloch A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS,SUPIT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS ST. Freer Ivionte NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1,25 ADDRESS Same SHOWER 1.25 CITY TEL. NO. LAVATORY 1,25 CONTRACTOR General Installation Co. SINK 1,25 ADDRESS 6558 West Blvd. 'DISHWASHER 1.25 CITY Los Angeles TEL. NO. PL 3-2541 LAUNDRY TUB 1.25 ETORGISTRAC ION NO. C-36 151839 787COUNTY CLOTHES WASHER 1.25 DISTRICT NO. GR UP P O BY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL d OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD v Ready for Inspection Now 0 rr- e� —V 4— d krrJU&� z Al d Gf1/sir✓ _ � � ..a�-�,� APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 3 50 GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY LRESIDE COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER . Y CERTIFY THAT I AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST A OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO THE ABOVE DESCRIBED RESIDEp1yy1LOPE UTILITY CO.NOTIFIED REL`!!MITTEE FINAL VALIDATION ROBERT A.WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENG'R ,L}C 9 9"�t5 2� FEB 23 5 D 3.50- IT till �� APPLICATION FOR PLUMBING P I�MIT . G COUNTY OF LOS ANGELES 2 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION nnn�ss �� - _�/ �, JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN, SUP'T OF BUILDING yOCALITY FOR APPLICANT TO FILL IN NEAREST ST. NUMBER FIXTURE OR ITEM EACH FEE CROSS CROSS OWNER WATER CLOSET $1.25 d� MAIL BATH TUB 1.25 f::l .D ADDRESS SHOWER 1.25 CITY TEL.NO. LAVATORY 1.25 CONTRACTOR SINS 1,25 D ADDRESS 13933 .So. Crenshaw B1vd DISHWASHER 1.25 CITY Hawthorne TEL. NOS 93691 LAUNDRY TUB 1.25 'f REGIISTRA ON NO. 193b 17 C-3b COUNTY STATE p CLOTHES WASHER 1.25 F717 NE P ESSED BY WATER HEATER 1.50 �'� 1.50 GAS SYSTEMOUTLETS ROVAL O OUTLETS OVER 5 PER SYSTEM .30 1NI5PECTkQN BECOR im v a Z APPROVALS PATME INSPECTOR'S SIGN9TU E PERMIT $ 2100 UNDER SLAB WORK B ROUGH PLUMBING d iIr iD�l 9f TOTAL FEE GAS PIPING 19- I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT J AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY" / WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER l V 1 HEREBY CERTIFY THAT 1 AM P PERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS LES COUNTY AND STATE OF : .GAS TEST CALIFORNIA OR THAT 1 AM THMLOWNERF,AND INTEND TO CwRESIDE IN,THE ABOVE DESCRIBOPE UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL % LIDATION ROBERT A.WOOD ' CK. I M.O. CASH SUPERVISING MECHANICAL ENG'R _j ,6 7'4 519 OCT 2 5 5 D 2 8.Q 0�' .. __ , - I WORKER'S COMPENSATION DECLARATION '20-00276A668Dl'W9,89 APPLICATION FOR PLUMBING PERMIT I h&}eby affirm that I have a certificate of consent to self Insure, �78A887A or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy NG �, COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. o y ❑ Certified copy is hereby furnished. BUILDING � � FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS LAM Certified copy is filed with the county building Inspection department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date 1& --9,3 Applicant WATER CLOSET ' NEAREST BATH TUB CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.COMPENSATION INSURANCE 1ASSESSOR (This section need not be completed If the work Involved by the SHOWER MAR BOOK PAGE PARCEL permit Is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY Is Issued, I shall not employ any person in any manner so as toSINK MAIL become subject to the Workers'Compensation Laws. ADDRESS J .7 DISWASHER cU9;W 45A9717EL.N .l�, Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRCJOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR , C provisions of the Labor Code,you must forthwith comply with such ADDRESS Q � provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY '� �/�' TEL.Naft-,&TV I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER / O (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS STATE NO. l LIC. �j�'C��O 0Professions Code,and my license is In full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY IIm License Number �� o`er Lic.ClasR�-3� / 5 PER SYSTEM �O p ` wry FINAL a /-`f' �f 6tJ Contractor Date DATE VALIDATION��J (n ❑ I am exempt under Sec. -- BY B.&P.C.for this reason Plan check fee , Date: PLUMBING PERMIT ISSUING FEE$ Signature ❑ TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION NameCCT.f I hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address Code): ❑ I,as owner of the property,will do the work and the structure City Tel.No. I ITEMS is not intended or offered for sale(Section 7044, Business TOTAL1 m �'95 and Professions Code). CHECK �f 1:u:1 CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the CHANGE ,1313 performance of the work for which this permit is issued (Sec.3097, Civ.C.) Lender's Name 0000—fIOD I 12/13/93 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 property f r Inspection purpose SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date