HomeMy Public PortalAbout5722 MUSCATEL AVE_Plumbing__ .8581,IO.6S
IB8.17 APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF BUILDING AND SAFETY
Depcwtment of County Engineer
County of Los AngelesBUILDING ..ry
JOHN A.LMBIE. COUNTY ENGINEER ADDRESS / � A/ -A,44XF
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CASSATT D.GRIFFIN,SUPT OF BUILDING e
LOCALITY/VJaC!-A-j rb/Q,.46fvf-
,FO A - C$ TC�,�__I,,iTI�.. o NEAREST
CROSS ST.
OWNER/� / ,DISTRICT NO. GROUP I ZQJVfREADY FOR INSPECTION
MAIL
ADDRES. / -
�J ��"
DUSTRIAL
CITY AAXAfiK TEL.N &O A*4— WA TE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS /
CITY / TEL.NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 $ 0v
BATH TUB @ $1.00
SHOWER @ $1.00 O
LAVATORY (WASH BASIN) @ $1.00 OO
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @'$1.00 00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE X1,
Op GAS VENT
1 HEREBY ACKNOWLEDGE THAT I 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. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM ]'HE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENTIAR
SIGNATURE / f.' `�
OF PERM ITTBFINAL
IOHN A.LAMBIE.COUNTY ENGINEER VALIDATION ROBERT A.WOOD.CHIEF FLOG. INSPECTOR
CK. R.G. CASH
L-To 4 1: 5 8° MAR 153 5.0 0 In
5y
WORKERS'COMPENSATION DECLARATION 2DPW 4/87 APPLICATION FOR PLUMBING PERMIT
n
I heaQba, efPixAfiat I have a certificate of consent to self in- 76A6676A667A `1IL fll
sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86)
certified copy thereof(Sec. 3800, Lab. C.
� Company
G COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No.
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING g"]_7 jo A L �` ,n•ry GG
Certified copy is filed with the cop�ty b 'Iding inspection ADDRESS ✓ ( frv� ,a[�/-'t'/ [�
de tm t. 1 ) NUMBER FIXTURE OR ITEM @ FEE LOCALITY 'T /J 1 e G
yQP r Le —
Date// Applicant WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST L 0,A/&
COMPENSATION INSURANCE SHOWER OWNER i L4 c-c—e rL
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this per- SINK
mit is issued, I shall not employ any person in any manner so CITY
75mI i! TEL NO. T/�
y —2j�j
as to become subject to the Workers'Compensation Laws. DISHWASHER V�
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR ^^,, r,
emption,you should become subject to the Workers'Compen- CITY I't'W '"Tt' TEL NO
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATEj d� LIC.
ed. WATER HEATER LICENSE NO.�C ll L CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETSQ�
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 4
fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VA )� DAA a
#16'fj�j,G DATE —� O
License Number 6vV Lic. Class �}
y�Lf Q FINA U
Contractorll.Crc��//�5�, Date m BY p
I am exempt under Sec. W
CL
B.BP.C. for this reason Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$
Signature TOTAL FEE �
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant ` , 6oK6,
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and Q 4 9.6 A
Professions Code): Address T �� T.
# 000ao5
r] I, as owner of the property, will do the work and the City Tel. No —Zf��l
structure is not intended or offered for sale(Section 7044, � o o � ��8=0:Business and Professions Code). V
CONSTRUCTION LENDING AGENCY ® 0822 -88
1 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
authorizer prese fives of this County to enter upon the
e-me Toned p operty for inspection p rpos s.
f SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date