HomeMy Public PortalAbout5019 PAL MAL AVE_Plumbing__ 76A667 17 25M SETS 7-48 APPLICATION IFOR PBYA�I i
(DEPARTMENT OF BUILDING AND SAFETY- i5� to uu a �p
COUNTY Off' LOS ANGELES PLUMBING e
WM.J.FOX.CHIEF ENGINEER
NATUREOF ST TI® DI 1 O. OR OU O E PERMIT
ROUGH T FIXTURES v COMPLETE
_ A ��®®
HEATER _ CESSPOOL /� HEPTIC TANK RECEIVED BY READY FOR DATZIShUnD
G�e FIRST INSPECTION oy
AW MIHCELLANEOUS ` f
APPLICANT Y+'ELL IN HEAVILY OUTLINED PORTION ONLY
•NAME JOB ADDRESS c��//.WW° �(�� . dFdq
® ADDRESS LOCALITY �I-i/�/f®
S
NEAREST �� /al
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CITY TEL.NO. CROSS ST.
COUNTY --
OUNTYp�� �yy�
LICENSE NO. EXPIRES �' NAME 30)+ W l f II flOM F&?,D
LOCATION OF SEPTIC TANS, OR CESSPOOL 3 MAIL
DDRESHl® S' DA6N , DRIVE,
NORTH O Ap .y �Q
CITY 6 b Q TEL.NO.P� -A M l
1 AM THE LEGAL POSE OR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
` 3 PLUMBER
1 AM THE LEGAL OW O HE PROP TY DESCRIB
ABOVE.
�
�4 OWNERd
CO ECTIONS
1 SOUTH J
DESCRIPTION OF WORK _Z
BATH TUB FURNACE 0
!C
HOWER DISHWASHER
t
LAVATORY REFRIGERATOR
._KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
GAS PIPING
WASH TRAY URINAL ' APPROVALS
_WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOSR'S HAMS
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I 2 I
METE(+ A -ASUTL ODA FOUNTAIN I I
m cels CLSee�artr° -
GAS VENT
Ail CESSPOOL
TOTAL NUMBER OF FIXTURES ca /�� SEPTIC TANK
_CE88P00I SEPTIC TANK B ,3�V SEWER I I
®-® UTILITY CO.NOTIFIED
TOTAL FEE vo
FINAL
7SASS7 1.7 SSM SETS 7-4B v APPLICATION FOR PEi1W
DEPARTMENT OF BIDING AND-SAFETY
COUNTY.OF. LOS ANGELES PLUMBING
WM.J.,FOX.CHIEF ENGINEER
NATURE OF INSTALLATION DISTRI O. GROUP O. FEWMIT No.
ROUGH FIXTURES COMPLETE
HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR. DATE ISSUED
_ FIRST'INSPECTION .`�
Flwd
MI CELLANEO A_1 tot—tAPPLICANT FILL IN HEAVILY OUTLINEWPORTIONONLY
MN 6AktR' SEPTIC TANK CO. DDRESS /J- SO223 E. Hu, 74mG,om DRIvE
DRESS LOCALITY NEARESTY.. TEL:NO. CROSSST.UNTYENSE NO. -. EXPIRES 6' NAME
LOCATION OF SEPTIC TAN], OR CESSPOOL . 431 MAIL V
ADDRESS V
"NORTH. O
CITY• TEL.No..
I AM THE LEGAL POSSESSOR,OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATIOUlt
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
OWNER
CORRECTIONS
SOUTH J
DESCRIPTION OF WORK z_
ATH TUB °`URNACE O
Q'
SHOWER DISHWASHER D
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
QLOOR SINKSANDTRAP
LOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN, DATE. tNBPLCfOR'B NAMR
WATER HEATER DENTAL.LAVATORY ROUGH PLUMBING I
ET6Q SAS SODA FOUNTAIN GAS PIPING I I
OUTL I
GAS VENT
+ CESSPOOL_ ' I
TOTAL NUMBER OF FIXTURES SEPTIC TANK 11% 9rG .._
�.CESSPOOI a�oTIG TANK _ SEWER I
B /
-UTILITY CO.NOTIFIED I
TOTAL FEE �`* • /S-
FINAL
WORKERS'COMPENSATION DECLARATION
hereby affirm that I have a certificate of consent to-self 76A667A APPLICATIONFO���---yR--- PLUMBING PERMIT
insure, or a certificate of Workers'Compe sation Insurance, CE 817(REV. 10/81')•
or a certified copy thereof(Sec. 3800,L . G.) I /
COUNTY OF LOS ANGELES BUILDI N SAFE
Policy No: Compan
Certified copy it hereby furnished. FNUMBER BUILDING
FOR APPLICANT TO.FILL IN.(PRINT OR TYPE) ADDRESS -e GLI1191 Certified copy is filed with the county b di 'inspec- . MaJtion department•. FIXTURE OR ITEM @ FEE' LOCALITY
Date Appligan WATER CLOSET NEAREST'
CERTIFICATE OF EXEMPTIO OM 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($100)or less.) LAVATORY MAIL
ag
I certify that In the performance of the work for which this ADDRESS h r
permit is issued,I shall not employ any person in any manner SINKCITY TEL.N
so as to become subject.to the Workers'Compensation Laws. DISHWASHER
CONTRACTO..
I' Date ApplicantCLOTHES WASHER
NOTICE TO APPLICANT: If, after making. ADDRESS this Certificate of
Exemption, you should become subject to the Workers.' SWIMMING POOL RECEPTOR
CITY TEL. NO.. ��/
Compensation provisions.of the Labor•Code; you must forth- LAWN SPRINKLER SYSTEM r7021
with comply with such provisions or this permit shall be STATE / LIC.
deemed revoked. WATER HEATER LICENSE NO.., / .. CLASS C
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PrPCC0QCIJ'BY
I hereby'affirm that I am licensed under provisions of Chapter 9' GAS SYSTEM OUTLETS
(commencing'with Section 7000)of Division 3 of the Business OUTLETS OVER ='
and Professions Code,and my license is in full force.and effect. 5 PER SYSTEM FINAL 126DATE �~ VALIDATION O�
License'Number Lic. Class 0. 09
FINAL
Contractor Date B>� x V
aIL
I am exempt under Sec. 9/a� IL
B,AP.C..for this reason
` Plan check fee � . � a .,, •• ,
Date:
PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE ,.
, 11 o o o. o c 5
' Plan check applicant ^,b
SINGLE FAMILY 116 5 0
HOME OWNER-BUILDER'DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License' G O'u
Law for the following reason (Section 7031.5, Business and Address
Professions:Code): City Tel. No. L' t 0 97 4
1, as owner of the property, will do the work and.the 4 I
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 j
Lender's Address Il
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 representaaI
County to enter upon the ; P
above-men Toned propection purposes. I
SEE REVERSE FOR EXPLANATORY LANGUAGE ;
1
Sig re of Permittee ate
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