HomeMy Public PortalAbout6116 OAK AVE_Plumbing__ ;8887 0-S' APPLICATION FOR PLUMBING PERMIT 1
DMSION OF BUILDING AND SAFETY
Department of County Eagfneer
County Of Los Angeles . BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS p
CASSATT D.GRIFFIN.SUPT OF BUILDING 6
LOCALITY ,
FOR APPLICANTITO FF.L IN A NEAREST
CROSS ST.
OWNER !i� DISTRICT N G OUP :;WF. READY FOR INSPECTION
AIL r
M
ADDRESS /
t� C INDUSTRIAL
CITY TEL. — ,` WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS S' 3pp.�+
CITY /4f�9q' TEL.NO ���
LICENSE NO.
.NUMBER TYPE OF FIXTURE OR ITEM .FEE
WATER CLOSET (TOILET) @ $1.00 $
BATH TUB @ $1.00
` SHOWER $I.00
LAVATORY (WASH BASIN) @ .$1.00 OC)
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
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK.
PERMIT $ 1 00 ROUGH PLUMBING
zi GAS PIPING
TOTAL FEE 1v GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL,1CAT10N 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- .!
I 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 OWVR .OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDEN L-PROPERTY. v
SIGNATURE
OF PERMITTEE ` FINAL: �'s
OHN A.LAMBIE,COUNTY ENGINEER `�ALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
CK.
CASH
t1 7 1 \O
. ti,o� �. 2 j4-Z%0, AUS 14 3 4.0 0. L�
WQ.RIirm that
I have ir, ie ofconI t FE817(z-ael APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have ar,certifi ate of consent to self
insure,or a certificate of Workers'Compensation Insurance,or Tr(f.,
a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 1
ADDRESS
Certified copy is filed with the county building inspection NUMBERI FIXTURE OR ITEM • FEC-
department. / LOCALITY 7,
Date Applicant p WATER CLOSET NEAREST I�C1S l
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
LAVATORY MAIL, }•
(This section need not be completed if the work involved ADDRESS , % c tL
by the permit is for one hundted dollars ($100) or less.) 0
SINK CITY; U_hl TEL.NO
I certify that in the performance of the work for which this DISHWASHER
permit is issued, I shall not em loy ny person i Va y an a CONTRALTO O
so as to e m subject tot ker 'rom s CLOTHES WASHER ADDRESS U
%}} 7
F Dat Applicant , '� W.
LU
SWIMMING POOL RECEPTOR CL
NOTI O APPLICANT: , er m cin IIS t Ica e f CITY TEL.NO. 2
Exemption, you should beco a subject to the Worker LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the abor Code,you must forth- WATER HEATER LICENSE NO. CLASS
with comply with such provisions or this permit shall be
deemed revoked. ) DISTRICT NO. PR CESSIjD B.Y
/ GAS SYSTEM OUTLETS � /
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 15 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL. g ^g VALIDATION
ness and Professions Code, and my license is in full force.and DATE A V
effect.
FINAL
License Number Lic.Class ; BY
Contractor Date
F1 I am exempt from the licensing requirements as I am a Plan check-fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code).
TOTAL FEE
Lie,or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
ness and Professions Code):
I, as owner of the property, am exclusively contracting ._106 8 CA
with licensed contractors to construct the project
(Section 7044,Business and Professions Code). Y �� 0 0 0 0 0
CONSTRUCTION LENDING AGENCY 2 0 0 2 2 Q C
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is
0 0 0 ? i, C
issued(Sec.3097,Civ.C.). -
Lender's Name 0 07
_ 1
Lender's Address
I certify that I have read this application and state that the
bove information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
rdinances and State laws regulating P,jumbing, and hereby
uthori epresentatives f is I ou '.o enter upon the
bo - e .tio.ed ,op r f 4"s ecti �p rposes.
1 � I
S e to ate