HomeMy Public PortalAbout5660 MCCULLOCH AVE_Plumbing__ 'D.B77YSMSETS 12-43APPLICATION FOR PE . . .. ,
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COUNTY
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WM.J. FOX.CHIEF ENGINEER LU
NG
NATURE OF INSTALLATION.. : DgsTR9 pw0: 0ROUP ZO z ----PERMIT O.O
ROUGH FIXTURES COMPLETE / `
READY FOR '
HEATER CESSPOOL SEPTIC TANK R=1131 y!FY 'DATB 1881JED
�. � ,7► 1 FIRST INSPECTION e P �-
AAS-. INIBCELL:ANEOUB- i��G !
APPLIICAl FIIY.g. IN HEAVILY OUTLINED PORTION ONLY
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a NAME Al�f(as i 6�Y ... AAA_k✓ I ADDRESS r.
LOCALITY
d CITY. Gk � -J ' CROSNEAREST
d .f�'� .No. �'i CROSS B7'. I--
COU
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COUNY NAMBCERTND. EXPIRES •.eis( iv!
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LOCATION i OF.,SEPMC TANK, OR CESSPOOL;, z MAIL ADDRESS.
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NORTH' _ r O _
CITdr -M TEL.No.
1 AM THE LEGAL POSSESSOR OF' THE ASO.VE LOS
j ANGELES.COUNTY CERTIFICATE OF Q, jCI-.IAFACAT}Ih)ON.
P ` PLYCAB6R
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
. "• .OWNER
ago USEUM 'w,
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SOUTH, t to
DESCRIPTION OF WORK _z
BATH TUB -FURNACE.
Q'
-HOW ER -DISHWASHER G
AVATORY -REFRIGERATOR^
KITCHEN SINK -WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK QLOOR DRAIN
WASH TRAY URINAL
• APPIIB®VALS -
WATER CLOSET DRINKING FOUNTAIN'
DATB UlRSPBCT�O`R'B NAMB
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING '~if �/�-�'-1���-��+✓
METES GAS SDA FOUNTAIN I
OUTL, GAS PIPING
GAS VENT
TOTAL NUMBER OF FIXTURES CCQ
CESSPOOL I
/:S SEPTIC TANK _
CESSPOOL SEPTICTANK SEWER -n
S UTILITY CO.NOTIFIED m
TOTAL FEE � �{
FINAL
D.B.B.17 25M arm 1.48 1 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND.SAFETY '
COUNTY OF LOS ANGELES
WM.J.FOX.CHIEF ENGINEER PLUMBING
NATURE OF INSTALLATION DiffREET NO. GROU ZONE
Q _—PERMIT NO.
ROUGH _,. FIXTURES COMPLETE (7
HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
GAS- B9IBCELLANEO is=-v6--�8
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
E NAME ADDRESSi'//GSI EG° f c:nil.%✓��i�_{•�``���
ADDRESS LOCALITY ( . 4 !�
D
NEAREST
IL CITY TEL.No., ROSS ST. �t/
COUNTY
CERT.No. EXPIRES
LOCATION OF SEPTIC TANK OR CESSPOOL NAME / J`,_ iL/� �,• "t► � ./17%i jo/'I-
z
z MAILNORTHADDRESS ^CITY i,.�/'rb':.? /�At?" TEL.NoIAM THE LEGALaPOSSESSOR OF THE ABOVANGELES COUNTY CERTIRICATB OF QUA�.IF ATION,r f LYMB61tI AM THE'LEGAL OWN�OFTHE PROPERTY DES
ABOVE. `�
owmg.k i1
CORRECTIONS
Pi A P., ro C 0"I) ..? .a.
SOUTH
J
DESCRIPTION OF WORK z
MATH TUB/ QURNACE O
SHOWER DISHWASHER p
■-VATORYREFRIGERATOR
—/—KITCHEN SINK/ WATER SOFTENER
Yr^^R SINK SANDTRAP
LOP SINK / ^OR DRAIN
EE"WASH TRAY URINAL APPROVALS
WAT CLOSED DRINKING FOUNTAIN DATE I149PECTOR'9 NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I
6TOUTL E RODA FOUNTAIN GAS PIPING I I
GAS VENT
7� CESSPOOL I 1
v TOTAL NUMBER OF FIXTURES d.b SEPTIC TANK I %
CESSPOOL AEPTICTANK SEWER
S O O UTILITY CO..NOTIFIED .I ,_ I �•
TOTAL FEE J�_
FINAL,
,,/� � �7 � 7
CEE 8 81717( /�
(REV.11/78)
APPLICATION FOR PLUMBI`N•G PERMIT ~
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING X
ADDRESS. IL (JL.CrO
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET LOCALITY
BATH TUB
CROSS ST.'-AR-IST--E/-
C
SHOWER OWNER ��
LAVATORY MAIL. / /4 f
ADDRESS CO CO
SINK CIT TEL.NO. - q
DISHWASHER CONTRACTOR
CLOTHES WASHER ADDRESS/
I
SWIMMING POOL RECEPTOR
CITY TEL.NO' �,al
LAWN SPRINKLER SYSTEM STATE LIC.
WATER HEATER rRG
QX �� CLASS Sc�
GAS SYSTEM OUTLETS PROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER AB WORK
5 PER SYSTEM UMBINGrtG
GAS VENT pS
HOT WATER HEATER
PLUMBING FIXTURES
GAS TEST 1A
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE ' FINAL �-
Plan check.applicant PLAN CHECK VALIDAT O
Name
Address
City Tel.No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 9 12.25 A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION # o O'o o o 5
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS '
REQUIREDD BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE 2 0 0 1. �O O
LEGALWNER OF.AND I ND TO RESIDE IN THE OVE DE5CRIPCD RESIDENTIAL
PROPERTY. ` o 00 0 1 .300M
SIGNATURE
OF PERMITTEE 07, 14-80
DISTRICT NO P C SSE
INDUSTRIAL
WASTE APPROVAL
•ti.
WQRKERS'COMPENSATION DECLARATION
., 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT
(herby", affirrfi that I have a certificate of consent to self in- 76A667A
sure,ora certificate of'Workersr Compensation Insurance,ora CE 817(REV.8/86)
certified copy thereof(Sec. 3800, Lab. C.)
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 �
Certified copy is filed with the county building inspection ADDRESS O
department. NUMBER FIXTURE OR ITEM @ FEE
/� LOCALITY
Date Applicant WATER CLOSET(TOILET) (f NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER €0 �� �`
(This section need not be completed if the work involved by MAIL A-Q iMn
it oo
the permit is for one hundred dollars($100)or less.) LAVATORY 05 ADDRE S [/ /O w
Li
I certify that in the performance of the work for which this per-
mit is issued, I shall not employ any person in any manner so SINK CITieA TEL.NOJ " f 72
as to become subject to the Workers'Comp7lon Laws. DISHWASHERCONTRACTDate -W— Applican CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If;after making this,Certificate.of SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Comp CITY TEL. NO.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shallbedeemed revok- STATE LIC..
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO // ESSED Y
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 �J (j o
fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM. FINAL ��� V (DATION
DATE O
License Number Lic. Class V
FINA IIZ
Contractor Date BY O
1 am exempt under Sec. ` W
B.BP.C. for This reason Plan check fee ► z$4 1,3 A z
Date: PLUMBING PERMIT ISSUING FEE$ 6—b # 0 0 0 0,0 5
Signature TOTAL FEE 1 - - 28,50
SINGLE FAMILY 0 0 0 2 8,5 0 C
HOME OWNER-BUILDER DECLARATION Plan check applicant
1 hereby affirm that 1 am exempt from the Contractor's License Name I 1.2 $7
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.).
i
Lender's Name
Lender's Address '
1 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-m n'oned Iroperty for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permitte Date