HomeMy Public PortalAbout6000 OAK AVE_Plumbing__ 78A667 CE#817 10 67
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGIId M aon.DlNa
BUIEDING AND SAFETY DIVISION ADD
O O
JOHN A LAMBIE COUNTY ENGINEER
ST
COLEMAN W JENKINS SUP T OF BUILDING LOCALRY N
FOR APPLICANT TO FILL IN PR NT O TYPE AREST
IM
CROW
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 1 SO MAIL -
BATH TUB 1 50 ADDRE88
SHOWER 1 50 CRY TEL NO
LAVATORY 1 50 CNK ONTRA
SI1 50 ADDRESS
CR `
DISHWASHER 150 Y TEL N
CLOTHES WASHER 1 50 STATE LIT
L CENSECLASS _
SWIMMING POOL RECEPTOR 1 50 DISTRICT N GROUP ZONE OC ED BY
LAWN SPRINKLER SYSTEM 200 3�� O ��
O
WATER HEATER 1 50 RIDIISTBLIL O
WASTE APPROVAL C
GAS SYSTEM OUTLETS 1 50 NfSPECTION RECORD
OUTLETS OVER Lu
5 PER SYSTEM 30 0-
y
_ Z
Plan check fee 25%of above See reverse
PLUMBING PERMIT ISSUING FEE 8 2 00
TOTAL FEE APPROVALS DATE INSPECTOR B SIGNATURE.
Plan check applicant UNDER SLAB WORK -
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel No HOT WATER HEATER
1 HERERY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES -WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AB REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM B LEGAL OWNER OF AND INTEND TO
RESIDE IN THE ABOVE DE BE RESIDENTIAL PROPERTYY FINAL
SIGNATURE JACK R ALLEN SUPERVISING MECHANICA
OF PERMITTEE JE I
PERMIT VALIDATION C K M 0(::-:t
PLAN CHECK VALIDATION CK MCI CASH
Ukra-3 6 o "-AL24 5 D 3.50- 9
WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self in 7D 4�� '7 I
sure or a+cwgficafe of Workers Compenlotion Insurance or a CE 817(REV 8/86) U
ctfrtifted fbpy thereof(Sec 388 Lab C) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
Policy No Company
C] Certified copy is hereby furnished
Certified co is filed with the coup building ins FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUDDING' e G n
copy county g pechon ADDRESS lee
department NUMBER FIXTURE OR ITEM ® FEE LOCALITY
w
WATER CLOSET(TOILET) CO)
Date Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS
BATH TUB CROSS ST 6/
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed If the work Involved by il 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 CITY TEL NO e
mit is issued 1 shall not employ any person in any manner so `✓Ys 9/
as to become subject to the Workers Compensation Laws DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER 00
NOTICE APP CAN If after making this Certificate of Ex I ADDRESS
SWIMMING POOL RECEPTOR
emption you should become subject to the Workers Compere CITY 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 STATE LIC
ed WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION �ISTRIj.[I�q PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS UT5!(
9(commenting with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL '/VALIDATION d
foci DATE O
License Number Lic Class V
100
FINAL Q
Contractor Date BY F
C] I am exempt under Sec 2
B&P C for this reason Plan check fee ►
Date PLUMBING PERMIT ISSUING FEE;
Signature TOTAL FEE
SINGLE FAMILY plan check applicant
5
HOME OWNER BUILDER DECLARATION pp w�►�►T
I hereby affirm that I am exempt from the Contractor s License Name AMA
i
Law for the following reason (Section 7031 5 Business and ".50Professions Code) Address 3W
E] 1 as owner of the property will do the work and the C�IY Tel No i ♦TM
structure is not intended or offered for sale(Section 7044 64-50
Business and Professions Code)
CONSTRUCTION LENDING AGENCY , C CK ""5D
I hereby affirm that there is a construction lending agency for CHW s00
the performance of the work for which this permit is issued
(Sea 3097 Civ C )
Lender s Name 1 W24/89
Lender s Address 6M 1 AN 9:53
1 certify that I have read this application and state that the 00above information is correct I agree to comply with all County
ordinances and State jaws regulating Plumbing and hereby
authorize representatives of this County to enter upon the
obovg mentioned property for inspection urpo s
.Trj fSEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date