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HomeMy Public PortalAbout6243 OAK AVE_Plumbing__ 76A667-CEN-817 9/69 �SLC- Cr-%Y APPUCATION FOR. PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUR DING y �4 JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN. NEAREST ROSS ST . D NUMBER FII,TURE OR ITEM EACH FEE OWNER • WATER CLOSET $1.25' DATH TUB 1.25 ADDS "� SHOWER 1.25 CITY TEL. NO.4.06 7 of LAVATORY 1;25 CONTRAC OR- SINK- 1.25 ADDRESS Al �. DISHWASHER 1.25 CITY TEL.NO. �3 y LAUNDRY TUB 1.25 CONTRACTO 'S- STATE ❑ ' REGISTRATION NO. Ay/ COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ONE OCESSED Y WATER HEATER 1.50 . OR, GAS SYSTEM ` OUTLETS 1.50 S INDUSTRIAL 9L WASTEAPPROVAL O OUTLETS OVER 5 PER SYSTEM .90 V INSPECTION RECORD O. Lu N Z APPROVALS DATE INSPECTOR'S SIGNATURE , PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING _ TOTAL FEE - —9O. ••' ' - bSl// 3. GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I 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 PLUMBING. HOT WATER HEATER _ -1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 1 A LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF "GAS TEST (p, }`yajI CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO. RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY 60.NOTIFIED I SIGNATURE. " OF PERMITTEE - -" FINAL LIDAT_ION ROBERT A. WOOD r CK. M.0. CASH SUPERVISING MECHANICAL ENG'R ��O 6 7 7 6 Go DEC 14 . 5 D 350— 76AC 7-CE817-�-5; L//I 1 ti,-" 41, Fw APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER / BUILDING AND SAFETY DIVISION BUILDING ADDRESS IOHN A. LAMBIE. COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY /rte'111 _�-' r / FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM r— - 1 OWNER �' /- �_ 7/ {-' / WATER CLOSET �/ BATH TUB ADDRESS f J (�a/r /`� vcm 71 SHOWER CITY /'/y J j y/TEL.NO. 1'" t 7 ( r &1 ,5 LAVATORY CONTRACTOR SINK ADDRESS DISHWASHER CITY TEL.NO. LAUNDRY TUB CONTRACTOR'S STATE ❑ REGISTRATION NO. COUNTY ElCLOTHES WASHER DISTRICT NO, GROVP ZONE READY FOR INSPECTION WATER HEATER / ;t _ GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD i APPROVALS @Q $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE OR FIXTURE $ UNDER SLAB WORK ROUGH PLUMBING PERMIT S 1 00 GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. SIGNATURE OF PERM ITTEE FINAL ROBERT A. WOOD. ©s VALIDATION SUPERVISING MECHANICAL ENG'R CK. w P. CASH t 78A887.4FE817A) - B/76 ' �!! . ^5�i�f�'/`s(,%/ //K"�✓' _ '" APPLICATION FOR PLUMBING PE[R/JMIJTI! COUNTY OF LOS ANGELES J/7 � DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM @ FEE WATER CLbSET OWNER MAIL BATH TUB ADDRESS { , SHOWER CITY TEL. NO LAVATORY CONTRACTO SINK ADDRESS DISHWASHER CITY C7_ TEL. N0. CLOTHES WASHER STATE NO. LIC SWIMMING POOL RECEPTOR CLASS LICENSE LAWN SPRINKLER SYSTEM DIST I T NO. GRO P ZROCE ED B rj�' T WATER HEATER INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS INSPECTION RECORD cc OUTLETS OVER 5 PER SYSTEM Au W 12- 1A N z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I. HEREBY.ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT A I THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE b RI ED Rp1,VENTIAL PROPI.RTY. �i . a FINAL Y ';6,� IVa(tili,In–n —/ - SIGNATURE f OF PERMITTEE .. PERMIT VALIDATIO CK. M.O. CASH PLAN CHECK VA (DATIONC M.O. CASH 0 .5.4:0-REP 3 5 D 7.5 0 a ..,I:,WORKERS'COMPENSATION DECLARATION I 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. Company ❑ Certified copy is hereby furnished.❑ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS (O Ile- tion copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET Date Appl igant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. (� COMPENSATION INSURANCE OWNER (This section need not be completed if the work Involved by SHOWER the permit is for one hundred dollars($100)or less.) MAIL LAVATORY ADDRESS I certify that in the performance of the work for which this ` permit is issued, I shall not employ any person in any manner SINK CITY M `b Cil TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER ��I bbb 6—JOT 11 CC CONTRACTOR- Pi Re �, .1 P69 NOTICEDate TO APPLICANT: If, making�dCertificate uo� CLOTHES WASHER ADDRESS S �rW Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR A 1 Compensation provisions of the Labor Code, you must forth- CITY /µ TEL.NO�' 3 LAWN SPRINKLER SYSTEM 2 � with comply with such provisions or this permit shall be / deemed revoked. WATER HEATER a LICENSE NO. Z y / CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL �QQ n'` DATE VALID ION 0 License Number`�al� Lic. Class `� v /��� at _ FINAL,&, O Contractor Date BY E � ❑ I am exempt under Sec. �S( / us N B.BP.C. for this reason Plan check fee Signature Date: PLUMBING PERMIT ISSUING FEE$ �10 -�'p ' 00 TOTAL FEE 46 1 u SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License ss Addre Law for the following reason (Section 7031.5, Business and ;22867A 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 ® 0 - 16,50 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY o 0 o 1 6505 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 0 5 0 6=8 5 (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 10, ordinances and State laws regulating Plumbing, and hereby authorize represent Lives of this County to enter upon the above-menti ned o t f r inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE i r Signature of Permitte Date I