HomeMy Public PortalAbout5940 OAK AVE_Plumbing__ "M7-CE817-8-58
APPLICATION FOR PLUMBING PERM 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONfAD
D NG t1
_1OHN A. LAMM, County Eagla.er Is 940 Ni, Oak
IT D.GRIFFIN,Supt of uildiayLTI'Y
2'e: le Cit
FOR APPLICANT TO FILL IN SS ST. jam, Tun s
NUMBER FIXTURE OR ITEM
ER
WATER CLOSET 7.0
BATH TUB SHOWER TEL NO.
6 LAVATORY 6.0 0 CONTRACTOR Ain C1 r e�•J F l uTnh .n Co.
2 sem 2.00 ADDRESS 112 Cuiur�ii�o Elva.
DISHWASHER CITY ICS All c 1 e S TEL NO. CL-6-8846
CONTRACTOR'S V STATE
LAUNDRY TUB REGISTRATION NO. 183245 COUNTY
CLOTHES WASHER DISTRICT NO. GROUP I 40NE P D BY
l WATER DATER1.00
GAS SYSTEM DMIUSTMAL
WASTE APPROVAL C-
Urin-iI ^•nC INSPXC77ON Co
service sink 1.0^
2 z Drinkin , '.00 -, r yy;! -' e,
,� -i
Floor drain 2.0014
-a x .
APPROVALS
i� @ OS NCErURIZIEM $ 25..00 (DATE INSPEC OR'S SIGNATURE
UNDER SLAB WORK +�
PERMIT $ 2100 ROUGH PLUMB.IN /E/ �► r'" y
TOTAL FEE 1 21 00 GAS PIPING ift1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
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 I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENT AL PROP TY.
SIGNATURE FINAL \
OF PERMI
ROBERT A.WOOD.
®R VALIDATION SUPERVISING MECHANICAL ENG'R
CK. Y.0. CASH
1
7
L7
;
J .L7 Y 1,
i
WORKER SCOMPENSATION iDE^�11RATiON 204M DPW 9189 APPLICATION FOR PLUMBING PERMIT ll
I hereby affirm that}'have a certificate of�ednegnt to sglf Insure
or a certificate of Worker s Gompensation Insurfnce or a certified
copy thereof(Sec 3800 Lab C)
Poiw No-LI! 7 7 company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV
❑ Certified copy Is hereby furnished
FOR APPLICANT TO F14L IN(PRINT OR TYPE) BUI�WRING
SS
❑ Certified copy Is filed with the county building Inspection
depaitmentl NUMBER FDfTURE OR ITEM G FEE LOCALITY
Date 0741-tApplicant WATER CLO8ET
40-01 CROSSST
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS BATH
TUB
COMPENSATION INSURANCE MAP BOOK PAGE P ASSESSOR
(This section need not be completed if the work Involved by the SHOWER B
permit is for one hundred dollars($100)or less) LAVATORY OWNER
I certify that In the performance of the work for which this permit 4- 1
Is Issued I shall not employ any person in any manner so as toMAIL
SINK
ADDRESS
become subject to the Workers Compensation Laws
DISWASHER CITY , TEL NO
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT If after making this Certificate of CONTRACTOR
Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code you must forthwith comply with such
provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION WATER HEATER CRY TEL NO d
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business andGpg SYSTEM OUTLETS SLK NSE NO �-�Oi� C (7
Professions Code and my license Is in full force,and effect
OUTLETS OVER DISTRICT NO ENS 8ED BY Q
5 PER SYSTEM f/ Q
License Number •�'�_Lk: Clams 3�_ � O
Contractor�x 1161(a Dant �( TE •� V ATION '711.80M
I ITEMS co
❑ I am exempt ander sec d FINALz
VITAL 211®so
8&P C for this reason
Data I Plan check fee , CHECK 2111 20
Signal re PLUMBING PERMIT ISSUING FEE$ CHANGE .0rI
❑ ar, TOTAL FEE
SINGLE FAMILY Plan check applicant 0000-0001 11/ 9/94
HOME OWNER BUILDER DECLARATION Name1 F M 1 3lf
I hereby affirm that I am exempt from the Contractors License Law 7642
for the following reason(Section 7031 5 Business and Professions Address
Code)
❑ I as owner of thecity Tel No
property will do the work and the 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 3057
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 authorize
representatives of this County to enter upon the above mentioned
property for Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
I 0 A
Ponature Of Petmltlee DOB