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Home My Public Portal About5004 PAL MAL AVE_Plumbing__ 76AG67A,ICE?61713) -Gy77 r.APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION l /�}�J FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRIIN DD d_ //� y NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET LOCALITY BATH TUB NEAREST CROSS ST. SHOWER OWNER j LAVATORY MAILbre ADDRESS SINK CITY TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL.NO. LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. CLASS GAS SYSTEM OUTLETS DISTRICT NO. G U ZONE PRO S ED BY J �7 55 PER SYSTEM oo x-3 .� V INDUSTRIAL WASTE APPROVAL n INSPECTION RECORD CD LLJ Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS-VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ' AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT.I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF:AND I END TO RESIDE IN THE'ABOVE DESCRIBED RESIDENTIAL PROPERTY. , UTILITY CO.NOTIFIED SIGNATURE OF PERM ITTEE 4 L. FINAL PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cr. CASH 784CRAL 19 5 0 0.0QA 7GA66.7A(CEFS 1713)---11}/76 _ - O� •� Ile . "APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR-TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS WATER.CLOSET LOCALITY NEAREST BATH TUB CROSS ST. SHOWER OWNER Z. LAVATORY MAIL ADDRESSLF r SINK CITYr." TEL.NO. �g— DISH WASHER CONTRACTOR CLOTHES WASHER ADDRESS 73 SWIMMING POOL RECEPTOR CITY `VIM (fir TEL.NO. 6 7— LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. S CLASS GAS SYSTEM OUTLETS v DISTRICT NO. GROUP ZONE P. WD BY OUTLETS OVER CJ 5 PER SYSTEM INDUSTRIAL. WASTE APPROVAL INSRECTION RECORD 96 z Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK LDA s ROUGH PLUMBING Tel.No. GAS PIPING IEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT. ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER,H EATER E LAWS REGULATING PLUMBING. EREBY CERTIFYT IAMPROPERLY REGISTERED AND/OR LICENSED AS _ PLUMBING FIXTURESD BY LOS ANGEL OUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE GAS TEST .fir . WWNER:OF,AND T DTORESI IN THE ABOVE DESCRIBED RESIDENTIAL. Y. UTILITY CO.NOTIFIED URERMITTEE FINAL PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION,L41 CK. M.O. CASH 8 s ►�Ci 27 5 v 75 0 ,4-,?J ®s 76AS67-CE817-SSS APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTNIENNT OF COUNTY ENGINE BURDING AND SAFETY DIVISIO"Lij D S dg!— AA TrOHN A. T-9 IL CwmtF es CASSATT'D.GRD?FIIv.Snp t o!Evil 9OCA= L = d t FOR APPLICANT TO FILL IN NEXREST CROSS NUMBER FIXTURE OR ITEM ® d L G C WATER CLOSET OWNER NAM _ BATH TOB ADDRESS A SHOWER CITY TEL.NO. 6L/ LAVATORY CONTRACTOR film ADDRESS DISHWASHER CITY TEL NO. . LAUNDRY TUB CONTRACTOR'S STATE ❑ REGISTRATION NO. COUNTY CLOTHES WASHER DISTRICT NO. GROUPNE P CESSE .BY WATER HEATER GAS SYSTEM INDUSTRIAL r WASTE APPROVAL INSPECTION RECORD APPROVALS $ OO PER ITEM ORFDLTIIB S I — DATE IN_SPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 2 00 ROUGH PLUMBING / - TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES. AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA ORTHAT I A THE LEGAL OWNER OF ABOVE UTILITY CO.NOTIFIED DESCRIBED RES TIAL P ERTY. SIGNATURE OF PERMITTE FINAL ROBERT A.WOOD. OF VALIDATION SUPERVISING MECHANICAL ENG'R CIC. X.0. CASH LG3348e� VAR 12 5 A 3.00 � '. i 7GA667A CE 8171FI 81 ®S ' APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY . FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ��. NUMBER. FIXTURE OR ITEM ® FEE ADDRESS, WATER CLOSET' LOCALITY r4kI ole NEAREST �1 BATHTUB CROSS ST. SHOWER OWNER r..� LAVATORY MAIL ADDRESS SO - ' SINK CITY TEL.NO. ZIZI DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY�7 gTEL.NO. LAWN SPRINKLER SYSTEM STATE �t �'/C ASS WATER HEATER' LICENSE NO.-4 (o� f GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK. 5 PER SYSTEM ROUGH PLUMBING- GAS PIPING GAS VENT @3 JHWATER HEATER. BING FIXTURES yy TEST. d xCPZPlan check fee TYCo.:NOTIFIeDPLUMBING PERMIT ISSUING FEE.$ 7 TOTAL FEE LPlon check applicantLAN CHECK VALIDATION Name ' Address City Tel.No. ' I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION ;9679.2A I HEREBY CERTIFY THAT IAM PRO LY REGIS DAN REQUIREDQQOR LICENSED AS LEGAL OWNER OF,ANDY LOS TO CO TO SID ST HO BOVI DENIRI�ED.HRESID MTIAL O O o O o 5 PROPERTY: Q O O SIGNATURE OF PERM O O c O C.L V DISTR O.0 PRO. ED BY O q 2 0'_7 9 INDUSTRIAL WASTE APPROVAL WORKERS'COMPENSATION DECLARATION rswesrA I hereby affirji that .I have ir certificate of consent to self Cr et7(.R-eo) A:P P L I C AT I O.N .FOR PLUMBING PERMIT insu,e,JAW a ceftificate'o"I Worket's'Compensation Insurance,.or,. a certified copy thereof(Sec.3800,Lab.c.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy,No. Company „+ ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 1165004,411w," � /� ADDRESS r ❑ departm copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE ,, departmen"t. � LOCALITY WATER CLOSET NEAREST Date Applicant r BATH TUB CROSS ST. J CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER t - MAI L LAVATORY (This section need not be .completed if the work involved ADDRESS by the permit is for.one hundred dollars ($100) or less.) SINK I O CITY TEL.NO.. 0 I certify that in the performance of'thqpwork fgrxvhich his' DISHWASHER cc permit is iss ed, shall not emplo perso CONTRACTOR 0 so as to Woubject to't s'C CLOTHES WASHERI AD..DRESS. epelican SWIMMING POO.L,RECEPTOR W NOTIC TO'APPLI.CANT:•If, after making t rtift e f CITY TEL.NO. to Exemption, you should become subject to the Worke, ' LAWN SPRINKLER SYSTEM STATE , LIC. z Compensation provisions of the Labor Code,you must fort LICENSE NO. CLASS with comply with such provisions or this permit shall be WATER HEATER , deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. P CESSED BY LICENSED°CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM. 9 (commencing with Section 70.00)of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code,and my license is in full force and DATE effect.. - ' License Number FINAL, Lic.Class FBY I 'Contractor Date ❑ I am exempt from the licensing requirements as I am a Plan Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity .(Section 7051, Bus- iness and Professions Code). , TOTAL FEE Lic,or Reg.No. Date LAddress applicant HOME OWNER-BUILDER DECLARATION i '6 9 2 8 A I hereby affirm that I am exempt from the Contractor's o o o o o,5 License Law'for the following reason (Section.7031.5,, Bust= Tel.No. ness and Professions Code): }; 2 o - 1 250 Lr1J5 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project ' o;o o l 2 5 0 5 (Section 7044•,Business and Professions Code). 1(11 8-82 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, SEE REVERSE FOR EXPLANATORY LANGUAGE ordinance and St laws regulati umbi , and hereby z ion iMy s o y to ter upon he ab ntpur sea. nature WrhfltWe_ ate .� r