HomeMy Public PortalAbout5018 PAL MAL AVE_Plumbing__ �-
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APPLICFORPL G PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN-(PRINT OR TYPE) BUILDING. �A /�
ADDRESS L p v A
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET LOCALITI�
NEAREST
BATHTUB CROSS ST.. E.
SHOWER OWNER C�
LAVATORY MAIL
ADDRESS L.QAA A(-
SINK CI TEL.NO.
DISHWASHER CONTRACTOR l__W
d
CLOTHES WASHER ADDRESS -10
SWIMMING POOL RECEPTOR
CITY �� TEL.NO, 5-1 �'
LAWN SPRINKLER SYSTEM STATE LIC. C
WATER HEATER LICENSE NO. CLASS
-GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING
67,�,;) GAS PIPING.
GAS VENT
HOT WATER HEATER p®
PLUMBING'FIXTURES / ,
GAS TEST7`' y� 1 , TECO D1Z1 J-v/J N�TiJ
Plan check fee UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE$ lI C
s/� i�1 FINAL ✓U�
TOTAL FEE vv C%
PLAN CHECK.VALIDATION,
Plan check applicant
Name
Address ! /�
City Tel.No.
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 8'A
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
L
WS REGULATING P MBINGs` PERMIT VALIDATION # O O O o o.5
BY CERTIFY T IAM PROPIERLY REGIS D AND/OR LICENSED ASq•O O 1 QOC
LOS ANG ES COUNTY AND STATE O A FORNIA THAT I AM THE GR OF.A INTEND'TO RESIDE IN TH AB E DE BED RESIDENTIAL
'O O O jO,OCU 0lMIJ�T,JT�_E{ /fX/
-INDUSTRIAL
WASTE APPROVAL
74667 - 08817 5/76
APPLICATION FOR PLUMBING PERMIT
COUNTY OF .LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING �j
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS �/� /-0-� /%,p,/GL
COLEMAN W:JENKINS.. SUPT. OF BUILDING LPC . _ •
7NUMBER
R APPLICANT TO FILL IN PR NT OR TYPE NEAREST
CROSS ST.
FIXTURE OR ITEM EACH FEE
OWNER d o
WATER CLOSET 1. _
BATH TUB0 A DD BESS A- l q& _ C,
SHOWER .50 CITY TEL.N.O. +7/a
LAVATORY 1 p CONTRACTOR'
SINK1. 0 ADDRESS
DISHWASHER 1.5 CITY TEL. NO.
CLOTHES WASHER 1.5 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.5
DISTRICT NO. GROU ZO E P D
LAWN SPRINKLER SYSTEM 2. 0 t -C Q
WATER HEATER 1 0 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS .50 INSPECTION RECORD 8
OUTLETS OVER
5.PER SYSTEM .30 Z.
O
b
n-
V)
z
Plan check fee 25%of above. See reverse.
PLUMBING PERMIT ISSUING FEE.$ 00
TOTAL FEE
APPROVALS DATE _ INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
Cit . GAS VENT
y Tel. No. HOT WATER HEATER
1 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 CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF,AND INTEND TO `
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY: FINAL (/ 2
SIGNATURE CK R. ALLEN
OF PERMITTEE SUPERVISIE ANICAL EGN' 'R.
ERMIT VALIDATION CK. .O. CASH
PLAN CHECK VALIDATION CK. M.0. CASH ti
i.f0 4 438--
FEB 16 5-5 D '8.2-5~ g
• 'VJ'ORKERS CQMPENSArION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT
I hereby, affirm that I have a certificate of consent to self in- 76A667A
sure,or a certificate of Workers'Compensation Insurance,or a
certified copy thereof(Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company
M Certified copy is hereby furnished. BUILDING 'Os ��g
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 15 /S/
E] Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE �-
department. � LOCALITY
Date Applicant WATER CLOSET(TOILET) �Aff NEAREST
!`+'d /�
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.-,940�40 Z4_)ej 7
COMPENSATION INSURANCE SHOWER OWNER (f
(This (section need not be completed If the)ork involved by MAIL O�
the permit is for one hundrod dollars $100 or less. LAVATORY ADDRESS D /f�iC L
i certify that in the performance of the work for which this per- SINK CITY TEL.NO. �� O
mit is issued, I shall not employ any person in any manner so O
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date- Applicant CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY TEL.NO.
sation provisions of the Lahw)r Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSEb BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ::5 �
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fect. HOSE BIB DATE ��.;r-=- 3 �.
License Number Lic. Class
FINAL _-�''� '' ==�
Contractor Date BY
:;fls:. o
I am exempt under Sec. 1v •.I rtl_ .'10$ r
B.BP.C. for this reason =,. . W
Plan check fee ► i- d
Date: PLUMBING PERMIT ISSUING FEE$ ` "H1=NCE •OCA
Signature TOTAL FEE
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant ,t ._-1_fir(;3,I
t �
I hereby affirm that I am exempt from the Contractor's License Name 11-11";
, , );,
Law for the following reason (Section 7031.5, Business and `r'rC'� y 1 ,. C•_L
Professions Code): Address
I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044,
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 ,
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
abov e-mentioned pro for i tion purposes.
�� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date