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Home My Public Portal About6135 OAK AVE_Plumbing__ 75AG67-CENB17 4-64 APPLICATION FOR PLUMB G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUWING AND SAFETY DNISION BUILDING � 4e* JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS. WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FUIT'URE OR ITEM EACH FEE •. + OWNER' ' WATER CLOSET 11.25 N'' pDA BATH TUB SHOWER 1.25 CITY i TE .LAVATORY- 1,25 COBiTAACT SINS •1,25 ADDRESS DISHWASHER 1.25 CITY TEL.NO dv'��IJ LAUNDRY TUB 1.25 SGI. Al.;NO. �.. COUNTY CLOTHES WASHER 1.25 DISTRICT NO.• GROUP NE OCESSED BY WATER HEATER 1.50 GAS SYSTEM OUTLETS L50 INDUSTRIAL' d WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM' .00 INSPECTION RECORD V ld H r , :e7a APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING .r TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS,VENT .AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I. I .� •I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATERIIIIO k/ I PLUMBING. ' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED 'AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE D CRIBED RESIDENTIAL PROPERTY.. UTILITY CO.NOTIFIED LOFFERMITTEEM? GNATURE FINAL VALIDAT N OB RT AWOOD CK. M.0. CASH UPERV.ISING MECHANICAL ENG'R Llil,o 5 7 1 V 9 5' 3.50Al GE 817 diog,,9/-78)' APPLICATION FOR PLUMBING PERMIT COUNTY'OF LOS ANGELES BUILDING.AND SAFETY Al FOR APPLICANT TO FILL IN IPRINT OR TYPE) 'BUILDING [/ NUMBER FIXTURE OR ITEM ® FEE ADDRESS LOCALITY WATER CLOSET `� C �� NEAREST BATH TUB CROSS ST. SHOWER, OWNER0 60 e MAIL LAVATORY d�'ADDRESS CL4,y � SINK CITY TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY - TEL.NO. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER qLICENSE NO. CLASS GAS SYSTEM OUTLETS �/ AP ALS DTE INSP CTO SIGNATURE OUTLETS OVER UNDER ORK WNP -5.PER SYSTEM ROUGH PLUMBING ?� 'GAS PIPING I®� GAS VENT HOT WATER HEATER ®p PLUMBING FIXTURES GAS TEST lee Plan Check fee UTILITY CO.NOTIFIED g PLUMBING PERMIT ISSUING FEE$ M Roar 7 7 0 TOTAL FEE 4tv FINAL Plan check applicant PLAN CHECK VALIDATION Name • Address /3 _ City Tel.No,A P-6 33� I HEREB CKNOWLEDGE THA • HAVE READ THIS APPLICATION AND STATEj' -9 'THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. j PERMIT VALIDATION '#�.c o'o o o 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS _ REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT,I'AM THE 2 o o [I ZQ C} LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL - PROPERTY. / SIGNATURE z'+1.__ OF PERMITTEEo U ��•// O ,2 V—.7 DISTRICT NO. ESSED BY d$'.U 8 INDUSTRIAL WASTE APPROVAL WORKERS'COMPENSATION DECLARATION° - APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.10/81) or a certified copy thereof(Sec. 3800�, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Companvo-4 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 (a�." FEE - Z LOCALITY Date Appli4anOAF d WATER CLOSET NEAREST ' CERTIFICATE OF EXEMPTION FROM WO KERS' ,3 BATH TUI( 3-G a v� -k,�j �� CROSS ST. / Q COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS /19 I certify that'in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER, CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code; you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER.HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM _3 OUTLETS , (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION �/� j� License Number.?" -2/7/' Lic. Class 14: 0C SJ3 FINAL O v Contractor /& /✓' ?` Date 3 BY ❑ I am exempt under Sec13... h B.AP.C. for'this reason. n Plan check fee - Date- PLUMBING PERMIT ISSUING FEE$ Poo Signature '� �'0 7 4.3 A TOTAL FEE j� 0,0`o 0 0 � Plan check applicant �]� SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name '6/0'0 7 6 0 I hereby affirm that I am exempt from the Contractor's License 0 o o 7�� 0 4 Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. 0 = 2 5—8 3 ❑ I, as owner of the property, will do the work and the ` structure is not intended or offered for sale (Section pop7044, 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 111110.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 proprty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 5 U Signature of Per Date