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Home My Public Portal About5646 MCCULLOCH AVE_Plumbing__ 786 _ APPLICATION FOR PLUMBINGPERMIT '0186-17 8-BS 7. DIVISION OF BUILDING AND SAFETY 1 Depaatment of County Engineer County of Los Angeles PBUILDING `,.` �T WM.J. FOX. COUNTY ENGINEER ADDRESS v'i'O N®MCC`U.11OCk CASSATT.D.GRIFFIN,SUI OF BUILDING LOCALITY Temple Cit FOR APPLICANT TO FILL IN NEAREST I CROSS ST. OWNER -DISTRICT O. GROyj� I Z�JVE/I READY FOR INSPECTION MAIL ADDRES INDUSTRIAL CITY TEL.NO. WASTE APPROVAL PLUMBER. T� S '] InC o INSPECTION RECORD �F ADDRESS 2019 lY,,HoVt Pe•O.408 CITY El Montero z TEL.NO: GT �+15J9 LICENSE NO. 14+ G v NUMBER. TYPE OF FIXTURE OR ITEM FEE 1 WATER CLOSET (TOILET) s 11,00 BATH TUB I.00 . SHOWER 1 LAVATORY (.WASH BASIN) 1 KITCHEN SINK W d1S osal DISHWASHER 1 LAUNDRY TUB OR TRAY 11 00 CLOTHES WASHER TOTAL NO. ® .0.80 APPROVALS GAS SYSTEM OUTLETS 1.00 110,001.00 INSPECTOR'S SIGNATURE. r 1 WATER HEATER 1.00 1 00 UNDER SLAB WORK I�yi p` ' , ROUGH PLUMBING d ly `,� PERMIT S I 1 00 GAS-PIPING TOTAL FEE 800 GAS VENT g / z 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND -AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES •' A PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY. REGISTERED'AND/OR GAS TEST r �. LICENSED AS REQUIRED BY LOS ANGELES COUNTY. AND STATE,OF CALIFORNIA OR THAT I AM THE LEGAL WNEIt OF THE ABOVE UTILITY CO.NOTIFIED ' f1141�„y � DESCRI.BED.RESIDE&VAL PROPER SIGNATURE y OF P.ERMI `FINAL . WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD.CHIEF PLBG.INSPECTOR 3 7.7�."MOV 1- 3 , 8.00 � 7GA6S7A(QE817A) - 8/75 / •L . f APPLICATION FOR PLUMBING PERMIT ' COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS HARVEY.T. BRANDT, COUNTY ENGINEER LOCALITY e FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST. , OWNER � WATER CLOSET MAIL BATH TUB ADDRES SHOWER CITY T 2 TEL. NO. LAVATORY CONTRACTOR .1P io1 ? a C SINK ADDRESS �� `� DISHWASHER CITY TEL. NO. CLOTHES WASHER STATE LIC LICENSE NO CLASS�L SWIMMING POOL RECEPTOR 7S CT NO. P ZONE OC D BY LAWN SPRINKLER SYSTEM WATER HEATER INDUSTRIAL WASTE APPROVAL :7 GAS SYSTEM OUTLETS INSPECTION RECORD d OUTLETS OVER 5 PER SYSTEM u cd O a b W IL y z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER 1 HEREBY.ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 'PLUMBING FIXTURES l� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST7-17-26 �! w-•.,,�� I HEREBY CERTIFY THAT I AM PROPERLY REGIST ED AND/OR UTILITY CO. NOTIFIED LICEN SED, AS REIIUIRED BY LOS ANGELES COUNTY STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF p INTEND TO RESIDE IN THE'ABOVE OESC ED RE`DE IAL PR TY FINAL SIGNATU RE OF PERMITTE PERMIT VALIDATION (CK-,, M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH • 6.2-.6,clo-AUG 12 :5 0 7.5 0,A98 WORKERCOMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- x-0026 DPW 4/90 sure,or a certificate of Workers'Compensation Insurance,ora 76A667A [� certified copy thereof(Sec. 3800, Lab. C.) _luI Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Cv C ❑ Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Ddte Applicant WATER CLOSET(TOILET) , NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' / BATH TUB CROSS ST. L/V 9 Al' COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for orie hundred dollars($100)or less.) / LAVATORY ADDRESS I certify that in the performance of the work for which this per- / SINK mit is issued, I shall.not employ any person in any manner so CITY S w=;,' TEL.NO. as to become subject to the Workers'Compensation Laws.. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS a�'� �OC/ �/� NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL.NO. �- sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS �7 ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. 3 y�6 CLASS C 3 CO LICENSED CONTRACTORS DECLARATION DISTRICT NO. CLASS SEb BY I hereby affirm that I jam licensed under provisions of Chapter GAS-SYSTEM OUTLETSD p C 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL / VALIDATION fect. HOSE BIB DATE r License Number Lic. Class a Ap'Oonliow, FINAL Contractor Date / ` BY V d . I am exempt under Sec. b F_ V B.&P.C. for this reason Plan check fee W oil. Date; PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION PP 5/+./�. 1 hereby affirm that I am exempt from the Contractor's License Name A44ToS Law for the following.reason.(Section 7031.5, Business and Professions Code): Address 3303+^'� V6/� /9 i.iY A I, as owner of the property, will do the work and the City Tel. No. 1 ITEMS is not intended or offered for sale(Section 7044, Business and Professions Code). TOTAL 466_913 CONSTRUCTION LENDING AGENCY ► CHECK 66.90 1 hereby affirm that there is a construction lending agency for eQ� the performance of the work for which this permit is issued CHANGE (Sec. 3097, Civ. C.). Lender's Name 0000-0001 7/25/95 Lenders Address 1541 1 AM 818 I certify that I have read this application and state that the above information is correct.Jagree to comply with all County ► ordinanc s and State laws egulating Plumbing, and hereby a t or. re es Ftative of this County to enter upon the v men on y for ins tion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE , ignature fi Pirrp ittee Date ;