HomeMy Public PortalAbout6059 OAK AVE_Plumbing__ 76A667-CE#817 10-67 7—C,-,p
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �'
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN PR NT OR TYPE) CEASES ST .
NUMBER FIXTURE OR ITEM EACH FEE ;A
WATER CLOSET 1.50 OWNER
BATH TUB 1.50 =ags 061,
SHOWER 1.50 CITY ..' TEL.No
LAVATORY 1.50 CONTRACTOR Iry
SINK .1.50 ADDRESS 4 47 p&j,-;PT"
DISHWASHER 1.50 CITY lw4,
: TEL. NO,g -O
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. G CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT O. GRO /C ZONE PROC SED BY
LAWN SPRINKLER SYSTEM 2.00CL
O
WATER HEATER 1.50 �a INDUSTRIAL V
WASTE APPROVAL C
GAS SYSTEM OUTLETS 1.50 IN PECTION RD v
OUTLETS OVER
5 PER SYSTEM .30
Z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE $ 1 2 100
TOTAL FEE tO APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
AL ,
CIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN.THE ABOVE DE RI D RESIDENTIAL PROPERTY. FINAL ��
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL R.
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
i. 04995 1 5 D 3.50N
` WORKER'S COMPENSATION DECLARATION 7APWe1e9 APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance,or a certified
copy thereof(Sec.3800 Lab.C.)
�� COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No.�� Company S 7'i--M
❑ Certified copy is hereby furnished. BUILDING
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified q A
Certified copy Is filed with the county building inspection
department. NUMBER FIXTURE OR ITEM ® FEE
LOCALITY
Date Applican12 ZC- - WATER CLOSETf
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
COMPENSATION INSURANCE BATH TUB
ASSESSOR
(This section need not be completed.if the work Involved by the SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars•($100)or less.) LAVATORY OWNER 6e.6-(4
I certify that in the performance of the work for which this permit MAIL
is issued, I shall not employ any person in any manner so as to SINK ADDRESS
become subject to the Workers'Compensation Laws.
DISWASHER CITY TEL.NO.
Date Applicant CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS
provisions of the Labor Code,you must forthwith comply with such lit de,F—C
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION WATER HEATER CITYJAI vC� TEL.NO. a
I hereby affirm that I am licensed under provisions of Chapter 9E LIC. 0
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. o q`9 CLAEP,— Z� 0
Professions Code,and my license is in full force and effect. ' DISTRICT NO. PROCESSED^BY
OUTLETS OVER t i 1 cc
, �L �lO 5 PER SYSTEM S10� r %Tom/_ o
License Number [S/ Lic.Class
+:vLIJ 'TlaLV
FINAL ��` _�,J LIDATIQf4 LLI
DATE y
Contractor Date
❑ I am exempt under Sec. BY AL F1;
HvlJ
B.&P.C.for this reason
Date: Plan check fee , C"HAN GH .110
PLUMBING PERMIT ISSUING FEE$ Lf�
Sinnatura p
El TOTAL FEE �� d� I�l_i!I;—t iil�i 112/1311004
SINGLE FAMILY Plan check applicant 21 i49 Y AM![j:05,
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Address
Code):
E] 1,
Tel.No.
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). '
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.)
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
_ & 1,>
Rinn�h,�ea of Dn�rniMtsn r1AtA