The URL can be used to link to this page

Home My Public Portal About6454 OAK AVE_Plumbing__ • �-- 76A6G'1- CES17 5/70ir APPLICATION FOR PLUMBING PE IT v' COUNTY OF LOS ANGELES DEPARTMENT .OF COUNTY ENGINEER. BUILDING AND SAFETY DIVISION BUILDING 0A1 S JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W:JCNKINS. SUPY T T: OF BUILDING LOCAL Q � FOR APPLICANT. TO FILL IN PR NT OR TYPE NEARSSTT. 1 v NUMBER FIXTURE OR ITEM EACH* FEE v �. �O WATER CLOSET 1. 0 OWNER MAII. BATH TUB 140 ADDRESS S SHOWER 1 0. CITY Q -e 6-1 TEL.NO. LAVATORY 1150 CONTRACTOR SINK 150 ADDRESS 361. DISHWASHER 150 CITY 4 TEL.NO. ,. CLOTHES WASHER 150 STATE LIC LICENSENO. CLASS SWIMMING POOL RECEPTOR 1 50 DISTRNCT NO. 6R ZONE P S BY LAWN SPRINKLER SYSTEM 2100 WATER HEATER 1.50 J INDUSTRIAL WASTE APPROVAL GAS SYSTEM, OUTLETS 1 50 INSPECTION RECORD OUTLETS OVER 5 PER SYSTEM .30 g N z Plan check fee 25% of above.-See reverse. PLUMBING PERMIT ISSUING FEE.$ 00 TOTAL FEE APPROVALS DATE INSPE 'S SIGNATURE Plancheck applicant UNDER SLAB WORK Name ROUGH.PLUMBING /XZA Address GAS PIPING' City. ' Tel. NoGAS VENT . . HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE'THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY .PLUMBING FIXTURES WITH. ALL COUNTY 'ORDINANCES AND STATE LAWS REGULATING ,GAS TEST PLUMBING. _ , .1 HEREBY CERTIFI/ THAT I AM PROPERLY REGISTERED' AND/OR UTILITY CO.NOTIFIED . . LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF 'CALIFORNIA OR THAT 1 AM THE 1AGAL OWNER.OF.AND INTEND TO - RESIDE IN.THE ABOVE D RISEI ESIDE PROiERTY. FINAL -SIGNATURE •JACK R. ALLEN SUP OF PERMITTEE RVISIN•G.M.ECIi 19COAL PERMIT VALIDATION CK. CASH PLAN CHECK tA, IDATION CK. M.O. CASH LAGo 4 0 0 4;!1 JM-18 13 D 1 1.7 5.,-, � 7GA667-CE#617 5-61- APPLICATIO F R PLUMBING RMIT• COUNTY OF LOS ANGELFaS zp 3DEPARTMENT OF COUNTY MGM= _ B off NnAGLAI E CMTY IMION rBAiDDSE ° -41 WILLIAM A. JENSEN, SUPT OF BUILDING TYFOR APPLICANT TOFILL IN T.NUMBER FIXTURE OR ITEMWATER CLOSE!RATH TQB888 CITY TSL.NO. SHOWER LAVATORY CONTRACTOR General Installati Snm ADDRESS 6558 West Blvd. . DISHWASHER c= Los Angeles TSL.No. PL g-2541 LAUNDRY TOR CBSGISTBAATIONTE �NO. GoURTY' CLOTHES WASHER DIST' GROUP ZO�iS PR BED BY - WATER BEATER npDOB y.,,,�D "� u GAS SYST864 WASTE.APPROVAL r°`^r y1• lor ,WSPEIMON RECORD :l D' r� a 161.00 PER HTffi4 OR FIXTORE.' N �'� 'APPROVALS DATE INSPECTOR'S.SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK TOTAL FEE ROUGH.PLUMBING WN I HEREBY ACKNOWLEDGE THAT*1 HAVE READ THIS APPLICATIONAND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH. ALL QOUNTY ORDINANCES AND STATE LAW8 REGULATING HEATERPLUMBING.1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR IXTURESLICENSED AS REQUIRED'BY LOS,ANGELES COUNTY AND STATE OFCALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE.DESCRIBED RESIDENTIAL PROPERTY. .NOTIFIEDSIGNATUREO PERMITTE VALIDATION. ROBERT A(I WOOD L� t M.O. ' CASH SUPERVISINGIMECHANICAL ENG'R ' '• Lid 1 3 0 5 FEB 25 5 0 3.5 c;N ,. w pp�� p I WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a. certificate of consent to self 20-0026 DPW 6/137 s insure, or a certificate of Workers'Compensation Insurance, 7GA667A or a certifie copy thereof(Sec. 3800, Lab. C.) �+ COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No.. O2 mpany �p-VLIC �tflJUdrGd�C G�Q17�/�i Yi�YI Certified copy is hereby furnished. BUjLDING iled with the county building inspec- ❑ FOR.APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy 1s f { tion de prtmppent. (-,_ c �[�.� NUMBER FIXTURE OR ITEM @, FEE Te-Date" 0 —/3 Appligant L VAWT)L&F�gl of 'I NEPREST e Cr WATER CLOSET CROSS ST. U BATH TUB CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE , SHOWER S OWNER 4o. '(This section need not be completed if the work Involved by M/� Ave-,,the permit Is for one hundred.dollars($100).or less.) LAVATORY- ADbRESS 6 &-e, t I certify that in the performance of the work for which this 1 , permit is issued, 1 shall not employ any person in any manner I SINK CITY TEL NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER ' fJ CONTRACTOR L V &4 ' 1A r-4+ �7f+ Date Applicant CLOTHES WASHER ADDRESS i NOTICE TO APPLICANT: If, after making this Certificate of-- G D k+� Exemption, you should'becom.e subject to the Workers' SWIMMING POOL RECEPTOR P Y I CITY �- 1"A, TEL. NO.� Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM ( with comply with such provisions or this permit shall be . STATE + ` LIC. /� deemed revoked. WATER HEATER LICENSE NO. V 1 CLASS e—s LICENSED CONTRACTORS DECLARATION : I' DISTRICT NO.. ROCESSED BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM , OUTLETS .rd� (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �/• and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FIIKIAL DATE t VALIDATION C License Number Lic. ClassC7 ��S I } r FI(dAL Contractor'LV+I;4d''�It't'UU' t4JTkDate 10-161-5s `. BY ❑ - I-am exempt under Sec. V 8.8P.C. for this reason • I Plan check fee �r Date: -•� PLUMBING PERMIT ISSUING FEE$ oC b I Signature TOTAL FEE �S SINGLE FAMILY Plan check applicant I HOMEOWNER-BUILDER DECLARATION Name LUf v TriL eE C 0 rA I hereby affirm that I am exempt from the Contractor's LicenseYI-�°a Law for the following reason (Section 7031.5, Business and Address .S'C. Q��j pJ� hec �7t+ Professions Code): City Q Tel. No.(�( y 3`03 ❑ I, as owner of the property;will do the work and the I I I EMIS structure is not intended or offered for sale (SectionTOTAL • 4 1 a �—� + 7044, Business and Professions Code). i CONSTRUCTION LENDING AGENCY _HECK 41.E5 5 I hergb affirm that there is c construction lendingagency for the performance of the work for which this perit is issued I CHANGE °�If (Sec. 3097, Civ. Ci). Lender's Name Lender's Address 1 AM10:50 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-menti a ned'property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date I.