HomeMy Public PortalAbout5103 PAL MAL AVE_Plumbing__ D.B.S.17 25M SETS 12.44 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING T•
Wm.J. FOX.CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUPI ZONE PERMIT NO. -
.r-
R000H FIXTURES i'COMPLETE -�^ P rJ lT 7 .i
READY FOR
HEATER CESSPOOL �I SEPTIC TANK RECEIVED.BY DATE ISSUED
�,.� FIR8 I SPECTION
GAS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB.
a NAME /t"1 1.I A/. ��7 !.�'l_i!1 t:.'��=Lc ADDRESS
ADDRESS e� �/1'1--'f-!�'f �17 gr—ft-rl LOCALITY ("w;:-�..'1 k'`�-i••f_t'
NEAREST
CITY f`i` 1P1 TEL.No. CROSS ST.
COUNTY •/ (= t
CERT.No. (� EXPIRES I, NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL- x MAIL
3 ADDRESS Ck ! 7
NORTH
CITY f ,�1-t:-t'1;-� , TEL.No.
I AM THE LEGAL POSSES OR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICAfE� F.QUVALIFICATION. p
�W"��
- PLUMBER %(
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIB
ABOVE.
OWNER
CORRECTIONS
i
SOUTH
DESCRIPTION OF WORK:-
ATH TUB FURNACE
0
w
-SHOWER DISHWASHER
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK. SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE 1NSPeeroR'8 NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
METER—GAS SODA FOUNTAIN
OUTL GAS PIPING I I
EAS VENT
CESSPOOL ` '✓(M+� ��'
TOTAL NUMBER OF FIXTURES SEPTIC TANK
/CESSPOOL SEPTIC TANK !';:3 SEWER
s - I•
I TOTAL FEE' I uriLITY co.NOTIFIED I
FINAL
D.B.6.17 ROM SETS 12.44 - APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES �����'��
Wm.J. FOC.CHIEF ENGINEER
ATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMITNO.
ROUGH FIXTURES COMPLETE S •'. /7 ( -9.2- 11
RECEIVED.BY READY FOR DATE ISSUED
HEATER CESSPOOL -I SEPTIC TANK FIRST INSPECTION
GAB MISCELLANEOUS 7_ 02;3
Y�
r� APPLICANT FILL INd HEAVILY OUTLINED POO/RTION ONLY
JOB �/
E NAME /� � �77u��G( �/j��+/4G/LA ADDRESS �
ADDRESS /" �i,y� -�(�firl�/ LOCALITY �j
d , i ',_ NEAREST f�
CITY ,c�.fiyrr�rGs TEL.No.-,--
A. ./ CROSS ST.
COUNTY 3/1// ./ CM NAME G - /✓!?il�L-Q�
CERT.No. // EXPIRES` 'J/ r
LOCATION OF SEPTIC TANS, OR CESSPOOL -Z MAIL
ADDRESS
NORTH O
CITY TEL.NO.
IAM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERRTIF?ICAATTK,OOFQUUALIFICATION.
PLUMBER O
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
�y OWNER
CORRECTIONS,�;
I /yl l r it a,i VA
i
SOUTH
DESCRIPTION OF WORK
/ ATH TUB FURNACE
/ SHOWER DISHWASHER
21--LAVATORY REFRIGERATOR
/ ITCHEN SINK WATER SOFTENER
-FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN
/ WASH TRAY URINAL 'APPROVALS
WATER CLOSET DRINKING FOUNTAIN +
I1 '',DATE INBPECTOR'8 NNALE
/ ' WATER HEATER DENTAL LAVATORY ROUGH PLUMBING IAlI ' l.A= `l��?. RfV
/ ////ETER�GOAS SODA FOUNTAIN GAS PIPING V
UTL
-GAS VENT /
CESSPOOL ✓ I
o TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOL SEPTIC TANK SEWER I
F. r
I TOTAL FEE I UTILITY CO.NOTIFIED '
O FINAL
WORKERS'COMPENSATION DECLARATION. I APPLICATION FOR PLUMBING PERMIT'
L hereby affirm that I have a certificate of consent to self. 76 667A
insure, or a'certificate of Workers`Compensation Insurance, CE 817(REV. 10/81) '�
or a certifies(, copy thereof(Sec. 3800, Lab. C.) 1 COUNTY OF LOS ANGELES / �I BUILDING AND SAFETY
policy
cy N . PQ�YCw)CiL I 1
Certified copy is hereby furnished.
r i FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
'Certified copy is filedlrith thcounty building inspec- ADDRESS
tion department. NUMBER FIXTURE OR ITEM Q FEE y
LOCALITY �y
Date a Appligant�wnCL.1��Gc�(a� I WATER CLOSET
NEAREST
CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB '
COMPENSATION INSURANCESHOWER OWNER AAr h e,in
(This section need not be completed if the work involved by I.
the permit is for one hundred dollars($100)or less.) ` LAVATORY ADDRESS 5/.03 Pa
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY - TEL.Nq-II(I
so as to become subject to the Workers'Compensation Laws. I DISHWASHER
CONTRACTOR !+'t G�.I
Date Applicant I CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of 330
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITI'�5 41. 10e5a TEL•
with comply with such provisions or this permit shall be STATE �y��//'/� LIC. I=
si deemed revoked. i WATER HEATER LICENSE NO. ( /�.�(� / LASS
LICENSED CONTRACTORS DECLARATION I DISTRICT NO. PROCESSED B
GAS SYSTEM OUTLETS
I I hereby affirm that I am I'icensed under provisions of Chapter 9 G
(commencing with Section 7000.)of Division 3 of the Business OUTLETS OVER a
�1 and Professions C�oddee,.and my is in full force and effect. 5 PER SYSTEM FI
NA� VALIDATION Q
411�E"r�L U`1 �iJ e DATE ��� CJ
• License Number Lic. Class CG
011 FINAL ,(' C
„Cl�le �CJL(� BY
Contracto z., _ate
❑ 7IL
I am.exempt'uiider Sec. Q V.
i 2
B.&P.t. for this reason I
Plpn check fee
Date: I PLUMBING PERMIT ISSUING FEE$
Signature
i TOTAL FEE One
Plan check applicant -r G 1.v A
SINGLE FAMILY
HOMEOWNER-BUILDER DECLARATION Name 'i 0 0 a 0 0
I hereby affirm that I am.exempt from the.Contractor's License Address ~
Law for the following reason (Section 7031.5, Business and 0 0 J 5
Professions Code): City Tel. No.
❑ 1, as owner of the property, will do the work and the ° 0 0 7l C
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.).
i
Lender's Names
Lender's Address
I.certify that I have read this application and state. that the ►
above information is correct. 1 agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mention d property for inspection purposes.
`� i SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
it