HomeMy Public PortalAbout5728 MUSCATEL AVE_Plumbing__ KUMBING OF COUNTY ENGINEER
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DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING -1 !/
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS / I A(,
FOR APPLICANT TO FILL IN LOCALITY
ADILDINGDRESS ' �� �/ /✓j�Sc,¢ y e L_ NEAREST /01CROBS ST, s
N ^ N `_ DISTRI N0. r
ZONE PERMIT NO.
LOCALITY - (T /S � t//
NEAREST m T/
CROSS ST. .� �- !i"(! ECE VED BY Ready for Ini eon DA E ISSUED
OWNER A41 e,HAeL O, s/?e if A y IND STRIAE
ADDRESS9. 01
MAIL c� Q WASTE APPROVAL
�/
CITY TEL.No. INSPECTION RECORD
PLUMBER-
ADDRESS
CITY TEL.NO.
State Contractor's
License No. Class
L.A.County Contractor's
Registration No. Q
Z
PERMIT FEES 6
NUMBER TYPE OF FIXTURE OR ITEM FEE D:
WATER CLOSET(TOILET) OD 0.80 $
BATH TUB 0.80
SHOWER 0.80
LAVATORY(WASH BASIN) OD 0.80
KITCHEN SINK 0 0.80
LAUNDRY TUB OR TRAY Oa 0.80
SLOP SINK OD 0.80
FLOORSINK OD 0.80
FLOOR DRAIN 0.80
DISHWASHER OD 0.80
DRINKING FOUNTAIN a 0.80
URINAL 01 0.80
GAS SYSTEM...-L_.—OUTLETS OD IAO D
WATER HEATER 1.00.
MISCELLANEOUS APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDERSLAB WORK
PERMIT $ 1 DO ROUGH PLUMBING
TOTAL FEE C96 GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT
/117 17
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING- PLUMBING FIXTURES
I HEREBY CERTIFY THAT 0 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST,'
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERM ITTEE_._.._..—._..__.._.
76A667 DRS 17 6/ad -
WORKERS'COMPENSATIONDECLARATION , •APPL�CATION FG FOR. PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A v
insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) !!
or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES � BUILDING AND SAFETY;
Policy No-3,5104 CompahyS7B 7-c-�"'_w—pi - _ I'
Certified copy is hereby furnished. t't
I: FOR APPLICANT TO FILL IN.,(PRINT OR.TYPE) -BUILDING
❑ Certified copy is filed with the county.building inspec-: ADDRESS
tion d part �nt. i NUMBER. FIXTURE OR ITEM Q.
Date 3 "A ligant LE-/hi U L"�_;9 WATER.CLOSET FEE L�AUTY )V. Gv&ieI e �!j,
NEAREST
PP CROSSSST.
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB I
COMPENSATION INSURANCE /I i /
SHOWER OWNE Q J• JO h .
,(This.seetion,need not be completed if the work Involved by I � . . _ - � • MAIL R• �,
the.permit is for;one'hundred dollars.'($100).or less.) LAVATORY ADDRESS 8�✓ ,
I certify that in,the performance of the'work for which this. ! v
peemit is issued;I.shall not employ any person in any manner �. SINK CITY ?A,a���� TEL NO. 7
so as to become subject to the Workers'Compensation Laws. DISHWASHERr�
CONTRACTOR 1' 6w
Date Applicant �' CLOTHES WASHER ADDRESS �,, �y–
NOTICE TO APPLICANT- If, after.making this Certificate.of i' U. d �'/'�C'0 i. 0
SWIMMING POOL RECEPTOR
Exemption, you.'should.become subject;to the Workers' ,
CITY L..NO.
C.ompens plan provisions of the Labor Code,you must forth- ! S� .�
LAWN SPRINKLER SYSTEM
with comply with such provisions. or this,permit shall be I! STATE' ) D 'LIC. ;
deemed revoked. WATER HEATER OV LICENSE NO. 6 a� CLASS CL
LICENSED CONTRACTORS DECLARATION I DISTRICT , ESSED
I hereby affirm that.l am licensed under provisions of Chapter 9 GAS SYSTEM s OUTLETS, I
(commencing with,Section 7000)of Division 3 of the Business OUTLETS OVER I' .
and Professions Code;and my,license is in full force and effect. I, 5,PER.SYSTEM FINAL VA16WATION
DATE :�? r
License Number L'ic. Class !
r
FINAL ' 99
Contractor Date BY !i 0
LU
1 am.exempt under Sec. 0.
B.BP..C. for this.reason Z
Plan check fee Z
Date: v �
PLUMBING-PERMIT ISSUING FEE$ '
Signature 19 6.3.9 A
` TOTAL FEE /`y I
Plan:check applicant 1 6.5 0
C o;o•
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION. Name "o so o,1 &5 05
I hereby pffirm that I am exempt from the-Contractor's License i, Address 5 1 9.r 8
Law'for'the following reason (Section.7031.5,. Business and
Professions Code): ( . City Tel. No.. i
❑. I, as owner of the property, will do the.work and the
structure is not intended or.offered for sale (Section
7044, Business and Professions Code); I
CONSTRUCTION LENDING AGENCY
I hereby-affirm that there is a construction lending agency.for i
the performance of the work for which this permit is issued !
(Sec. 3097, Civ: C.;). l
Lender's Name I'
i
Lender's Address I
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 I i
abbv ment' ned property for inspection purposes.
p7 SEE REVERSE FOR EXPLANATORY LANGUAGE
LA
3 1
idnature of Permittee vote I I