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HomeMy Public PortalAbout6126 OAK AVE_Plumbing__ D.B.S.-17 25M SETS 12-45 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES , PLUMBING Wm.J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH __ FIXTURES COMPLETE HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED r" FIRST INSPECTION GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB �? E NAME ADDRESS ADDRESS _ / .�.% G�Z/ LOCALITYNEAREST % !Q d CITY tttryyY TEL.No. _ CROSS ST. COUNTY CERT.No. EXPIRES ¢ I NAME nQ W LOCATION OF SEPTIC TANK, OR CESSPOOL ZMAIL !ti' 3 ADDRESS 1 NORTH O < CITY P7"9 2f.-F TEL.No. I AM THE LEGAf- POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPER .Y DESCRI ED ABOVE. 3 MOfwr4lm CORRECTIONS SOUTH a DESCRIPTION OF WORK ATH TUB FURNACE (� H ROWER DISHWASHER C d LAVATORY REFRIGERATOR t KITCHEN SINK WATER SOFTENER I LOOR SINK r ` AND TRAP LOP SINK ( FLOOR DRAIN ASH TRAY URINAL APPROVALS ATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S MAKE WATER HEATER DENTAL LAVATORY ROUGH PLUNGING ETER GA8 SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES / S v SEPTIC TANK CESSPOOI SEPTIC TANK ` SEWER UTILITY CO.NOTIFIED TOTAL FEE FINAL 76A667-CE*817 4-64 4?:;��-- w :�r v r APPLICATION FOR PLU�MBIN PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ���, �/ C} JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS.. WILLIAM A.JENSEN,Sup•T OF BUILDING LOCALITY �y 1 FOR APPLICANT TO FILL IN CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER s WATER CLOSET 51.25 MAIL BATH TUR 1.25 ADDRESS r SHOWER 1.25 CITY TEL. NO. ` . LAVATORY 1.25 CONTRACTOR SINS 1,25 ADDRESS DISHWASHER 1.25 CTTY TEL.NO. LAUNDRY TUB 1,25 CONTRACTOR'S STATE ❑ REGISTRATION N COUNTY ❑ CLOTHES WASHER 1•25 DIST ICT NO. GROUP ZONE PR EBBED BY WATER HEATER 1.50 -G GAS SYSTEM OUTLETS 1.50 INDUSTRIAL O WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD, ,1 A U .y •� H APPROVALS DJ4TE INSPECTORs slGu E PERMIT $ 2 00 UNDER SLAB WORK ,�, ROUGH PLUMBING TOTAL FEE liGAS PIPING f I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING .HOT WATER HEATER .fly A/ PLUMBING. , 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DEBCRIBED RESI NTIAL PROPERTY. UT'I'LITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL LIDATION ROBERT A. WOOD. v v CK M.O. CASH SUPERVISING MECHANICAL ENG'R 1x2473 JUN 9 5 D 1 1.2 5 + WORKER'S COMPENSATION ate of consent to 7�BBADPW 9l89 APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self Insure, ora certificate of Worker's Compehsatlon 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 ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) PDDR Certified copy is filed with the county building Inspection + department. NUMBER FIXTURE OR REM @ FEE LOCALITY- -i----- �.., Date Applicant WATER CLOSET C CERTIFICATE OF EXEMPTION FROM WORKERS' CROREST SS 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($100)or less.) OWNER `. I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS &/,. fJ"C. become subject to the Workers'Compensation Laws. DISWASHER CITr� /1� TEL.NO. Date Applicant CLOTHES WASHERvv NOTICE TO APPLICANT: If, after making this Certificate of CONTRAC OR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code,you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER a (commencing with Section 7000)of Division 3 of the Business and STATE LIC. Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETSU[� LICENSE NO. CLASS 0 OUTLETS OVER DISTRICT NO. PROCESSED BY It 5 PER SYSTEM ,{•�n License Number Lic.Class o/• f% ; O FINAL DATE O+ V v�bA'�ION til Contractor Date /"©.� t�J65 IL ❑ I am exempt under Sec. FI AL j ITEMS Z B.&P.C.for this reason TOTAL Plan check fee Date: � Signature �i"��.(s�t 40.65PLUMBING PERMIT ISSUING FEE$ CHANGE .00 TOTAL FEE � �j Plan check applicant Ij�l•a-13001 f./ 6/93 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Lawe � for the following reason(Section 7031.5, Business and Professions Address 0-580 1 AM 7 Code): City Tel.No. �p 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 repro entatives of this County to enter upon the above-mentioned pro a fo�lgntur i sti n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE �41rmittee Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT n I hereby,affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.8/86) u or a certified copy thereof Vec.%36W, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM ® FEE�1/� LOCALITY Date Applicant WATER CLOSET 620 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. C. �Q+✓' COMPENSATION INSURANCE SHOWERyt OWNER / (This section need not be completed If the work Involved by CJ MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS iol!3 Al I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY _r TEL.NO. � 3Q so os to bome subject to the Wor rs'Compensation Laws. DISHWASHER I. f� CONTRACT Date JZ 7 -plicant CLOTHES WASHER ADDRESS NOTIC TO APPLICANT:- If, after making this Certificate of Ono Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT N PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE .� License Number Lic. Class FIN Contractor Date BY ❑ I am exempt under Sec. 0 U B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address '] 1. Law for-the following reason (Section 7031.5, Business and Professions Code): City Tel. No. # 0 0 0 0 0 5 I, as owner of the property,will do the work and the structure is not intended or offered for sale (Section , o o 2 a 5 O 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY o 0 - 2a5 0 5 l I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 0 S1 2-87 (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 aize representatives of this County to enter upon the at_mentioned property for inspection pur oses 7,e?�• / SEE REVERSE FOR EXPLANATORY LANGUAGE S nature o ermittee ate WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,offirm that I have a certificate of consent to self 76AB67A insure, or a certificate of Workers'Compensation insurance, CE 817(REV.8/86) IIJ� or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. ID Certified APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Date Appligant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER � r (This section need not be completed if the work Involved by MAIL ,n ,p the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 6 / -� I certify that in the performance of the work for which this permit is.issued, I shall not employ any person in any manner SINK CITY 'f TEL.NO. _ .g so as to b come subject to the Worke5l Compensation Laws. DISHWASHER CONTRAC76R Date pplicant CLOTHES WASHER ADDRESS NOT IC TO A PLICANT: If, after r4aking this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL.y0_ Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be / STATE LIC. deemed revoked. WATER HEATER rW Q� LICENSE NO. CLASr— LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED B I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATIOa DATE License Number Lic. Class FINAL Contractor Date BY I= ❑ � I am exempt under Sec. Ell. B.BP.C. for this reason 29 Plan check fee ® m Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE O �7 6$ 1 A 00,00-05 Plan check applicant SINGLE FAMILY Q Q 0 0—0 5 HOME OWNER-BUILDER DECLARATION Name I hereby off irm that I am exempt from the Contractor's License Address �7 6 E1 2 A Law for.the following reason (Section 7031.5, Business and P ssions Code): City Tel. No. ( ° ° 1 6 5 0 GOK— 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). 00 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 jupon the a -)3-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE � r /-?/T? gnature of Permittee Ifate ORKERS'COMPENSATION DECLARATION 40.0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT 4 hereby;,w;ffirrriethSt I have a certificate of consent to self in- 76A667A sure,or a certificate of Workers'Compensation Insurance,,or a CE 817(REV. 8/86) certfied copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / Certified copy is filed with the county building inspectionADDRESS e department. NUMBER FIXTURE OR ITEM @ FEE p1� LOCALITY / Date Applicant WATER CLOSET(TOILET) W NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER �.r / � (This section need not be completed if the work involved by MAIL rC�p�^ 64 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 mit is issued, I shall not employ any person in any manner so CITY T �, TEL. NO. _ 3� as to become subject to the Workers'on!pensation Laws. DISHWASHER �. C CONTRACTOR/ Date--Z.� Applicant • �" CLOTHES WASHER NOTICE TO APPLICANT: If, after maling this Certificate of Ex- ADDRESS empti6n,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR sation provisions of the Labor Code,you must forthwith comp- CITY TEL. NO. P Y P- LAWN SPRINKLER SYSTEM ly with such provisions or this permit-shall be deemed revok- STATE LIC. ed' WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS bECLARATION DISTRICT PRO D'BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �� 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fe d, Professions Code, and my license.is in full force and ef- 5 PER SYSTEM FINAL '/ ✓ VALID TION d DATE License Number Lic. Class V V FINAL Contractor Date BY O 1 am exempt under Sec. W B.BP.C. for this reason Plan check fee Date: pop- . PLUMBING PERMIT ISSUING FEE$ Signature ;10 2 7.8 A TOTAL FEE SINGLE FAMILY # 0 0 0 0 0 5 HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name X 0 - 31L50 Law for the following reason (Section 7031.5,•Business and 03 4 5 05= Professions Code): Address, o 0 I, as'owner•of the property, will do the work and the City Tel. No. 0 7.2,6'—8 8 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.). Lenders 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 autho' e representatives of this County to enter upon the abov I entioned Proerty for inspection purposes.?-Zoc $ SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Permittee Date