HomeMy Public PortalAbout6522 OAK AVE_Plumbing__ 76A667:JOE;#817 5=G1' ��r✓J
APPLICATION FOR. PLUMBING PERMIT
COUNTY OF LOS ANGE M
DEPARTNMT OF.COUNTY ,EN "IIN
BUIL E IG AND SAFETY DrMON B11WI NG
JOHN A. _AMBLE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
,.LocALnY �o fe CFi
FOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM OWNER
-• WATER CLOSET NAM
BATH Tos ADDRESS
CTPY TSL.NO.
SHOWER )
CONTRALTOS ,�, • �T� � f`
LAVATORY
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ADDRESS 0 O
DISHWASHER CITY 14gfQov ;A Tm NO. iF4 fd"OS
RIITATZ
COAONRY TOREGISTRATION /;k— .2-0 S
CLOTHES'WASHER DISTRI NO. GROUP ZONE P CES BY
WATER HEATER 1d 112 A
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SYST>3dI WASTE_ APPROVALad
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M=CTION RECORD
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OR�F>ST0H8 $ / APPROVALS DATE INSPECTOR'S SIGNATURd
PERMIT S. 2 00 UNDER SLAB WORK
TOTAL FEE 3 .- ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT•I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL QOUNTY ORDINANCES AND STATE LAWS. REGULATINGi
PLUMBING. HOTWATER HEATER
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES �• �I/I _.
LICENSED AS REQUIRED BY LOS•ANGELES' COUNTY AND STATE OF GAS TEST �w .�_ I��/i16�J1k1✓
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER THE ABOVE
DESCRIBED RESIDENTIAL: PER p 'UTILITY CO..NOTIFIED I
SIGNATURE
OF
PERMIT.-.---FINAL
ALMATION ROBERT A. WOOD
CK. M.o. CASH SUPERVISING MECHANICAL ENG'R
_'�2 4.4 4 % 11-1710 5 D 3.50 ��
COUNTY OF Los ANGELES APPLICATION FOR PERMIT
Dof County Engineer
DIVISION
SION OFF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
ISTRIIC NO. GR UP E
OR APPLICANT TO FILL IN
PLUMBERR IVED BY ek
READY FOR DATE ISSUED
FIRST INHPECTION /
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ADDRESS
JF BUILDING
CITY TEL-mz ADDRESS 110P0d z /YU/P(J� S�
COUNTY LOCALITY Cr L
LICENSE NO. � EXPIRE
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWN'(j)1 t
MAIL
Z WATER CLOSET(TOILET) @ 0.50 111 9967 ADDRESS
BATH TUB 0.50Sn CITY TELNa.
SHOWER 0.50 b 1 HER Y ACKNO OE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) 0.50 ®'Q AP PI ICA T ON AND ST E THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK 0.50 O AND HTATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY C�4 0.50 J�8- ANGELES COON LICENSE. O 12��
GAB BYBTEM OUTLETS @ 0.50 g� OF THE RESIDE I PROPER
SIGNATURE Or
WATER HEATER 0 0 5v.50 PERMITTE KE
SLOP BINK 0 13.50 INSPECTION RECORD
FLOOR BINK ® 0.50
FLOOR DRAIN 13.513 h�
DISHWASHER 0.50
DRINKING FOUNTAIN 0.50 ['
URINAL 0.50 v� �IS'1� / 3ElrDLi/ ro a
HOUSE SEWER @ 0.50 _ _ ® _Z
MISCELLANEOUS xGF�� J m
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APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
?�
GAS PIPING
GAS VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 SEWER
PERMIT 1.1313 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE
TO
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(lam FINAL
76A667 DBS.#17 6-58
WORKERS'COMPENSATION DECLARATION + 78A887A I APPLICATION POR PLUMBING P E R M I T
I hereby affirm that I have a Cli817 of consent to self c617(&60)
insure,or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C.)
I COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING �� �
❑ r
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE ADDRESS
department. LOCALIT1j C/
Date Applicant WATER CLOSET NEAREST — )
/�
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST
COMPENSATION INSURANCE SHOWER r OWNER"
MAI L
(This section need not be completed if the work involved LAVATORY ADDRESS (p
by the permit is for one hundred dollars ($100) or less.)
SINK C Y TEL.N 0
I certify that fn the perf ante of the wo k for which this DISHWASHER
permit is issued, I shall n•t e ploy any pers n i ny m ner CONTRAC R
so as to become subjetr
ct o t e Workers'Co p ti aws. CLOTHES WASHER
ADDRESS O
Date Applica SWIMMING POOL RECEPTOR U
NOTICE TO APPLICANT: , a er making this Certificate of CITY TEL.NO. W
Exemption, you should come subject to the Workers' LAWN SPRINKLER SYSTEM CL
STATE LIC.
Compensation provisions the Labor Code, you must forth- LICENSE NO. CLASS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER !COY
:1
I hereby affirm that I am licensed under provisions of Chapter 15 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE f _ Z Z
effect.
FIN L
License Number Lic.Class FI i.u- v'i1
Contractor Date
I am exempt from the licensing requirements as I am a Plan check fee �7
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ v
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic,or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's
Address a5 7�>
License Law for the following reason (Section 7031.5, Busi- City Tel.No. 0 0 0 0 0
ness and Professions Code):
1, as owner of the property, am exclusively contracting ^ o'o 2 n,^ G
with licensed contractors to construct the project
(Section 7044,Business and Professions Code). 1
CONSTRUCTION LENDING AGENCY 1' j 0/I,--'
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
1 certify that I have read this application and state that the
above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
thorize repres ntatives of this County to enter upon the
a ove-mentione pro ty forinspection purposes.
i
Signature Of Permittee Date