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Home My Public Portal About5503 PAL MAL AVE_Plumbing__ 76A 687 ICE-8171-8-71 APPLIC' /'A-rriO_ N F6R PLUMBING PERMIT n COUNTY OF LOS ANGELES u DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING !t•Q 1 n_// / ADDRESS O1^� LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST CROSS ST NUMBER FIXTURE OR ITEM O FEE I OWNER / WATER CLOSET 1 76 MAIL BATH TUB 1 75 ADDRESS SHOWER 1 75 CITY TEL NO LAVATORY 1 75 CONTRACTO SINK 1 75 ADDRESS DISHWASHER 1 75 CITY TEL NOy CLOTHES WASHER 1 75 STATE LiC LICENSE NO Q 4EO CLASS SWIMMING POOL RECEPTOR 1 75 LAWN SPRINKLER SYSTEM 7 7S DISTRICT O GROUP E P CESSED BY a p0 Z / WATER HEATER 1 75 11157E .APAPROVAL Q GAS SYSTEM OUTLETS 1 76 INSPECTION RECORD V OUTLETS OVER 30 0 5 PER SYSTEM F v W L N z Plan check fee See reverse PLUMBING PERMIT ISSUING FEE s 3 00 TOTAL FEE APPROVALS DATE INSPECTOR a SISNATU R[ Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT I M[Nuv ACKNOWLEDGE THAT 1 HAVE (IUD THIS •PPLICATIOH HOT WATER HEATER AMD STAT[ THAT TM[ 11wv[ 1. C...III AND ADN[[ TO coMPLI PLUMBING FIXTURES WITH ALL <ou HTY 011DINANCES AND STAT[ LAWS REGULATING GAS TEST PLaMS1Ha I HLSESY CERTVY TM T 1 AM Pe [Rw AEG,IST[RED AND/OR UTILITY CO NOTIFIED LICENSED AS Rc00R[ LOS AI [ kR c0 MTT AMD RTAT[ Or CALIFORNIA OR TMAT AM THE L AL 0. 0I AND INTEND TO RESIDE IN THE AROV D[SCRISED E �DX 1 PROPERTI FINAL SIGNATURE OF PERMIT T E PERMIT VALIDATION CA M D CASH PLAN CHECK V (DATION CK M o CASH v LAW 9577;S 10 2 5 D .75~ v LAW 0 5 7 84 ABY 2 5 0 4.00-- 0 TRweaT APPLICATION FOR PLUMBING PERMIT 1 BRR I"Y)IVISION OF BUMD21G AND SAFETY DRP(atment of County_vEn'vpin w County of LG/ Angel" BUILDING JOHN A LAMBIE. COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN,SUP T OF BUILDING LOCALITY f-MR.APPLI TO FILL IN NEARCROSSI ST EST • IOROWNER DISTRICT NO GROOUP yMIRSPRLIGI MAIL O Q ADDR INDUSTRIAL CITYTA .yLA TEL NO WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS CITY L NO 1964c- LICENSE NO NYMB[R TYPE OF FIXTURE On ITZM PRR WATER CLOSET (TOILET) 100 BATH TUB $100 SHOWER $1 00 LAVATORY (WASH BASIN) SI00 KITCHEN SINK 43 v 00 DISHWASHER 4t00 LAUNDRY TUB OR TRAY #100 CLOTHES WASHER $1 00 WATER HEATER 4100 OAS SYSTEM 1100 04 APPROVALS DATE INSPECTOR S SIGNATURE UNDER SLAB WORK M— PERMIT >, t 00 ROUGH PLUMBING OAS PIPING TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER NEATER AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR OAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR T AM THE LEGAL OWNER OF THE ABOVE UTILITYCO NOTIFIED DESCRIBED RESIDE TIA FROPER SIGNATURE OF PERMITTEE FINAL JOHN A LAMB) COUNTY ENGINEER VALMATIQiC`ft� ROBERT A WOOD CHIEF PLBG INSPECTOR u ■ • wvR X8In 293" .x-16 3 20C %1� woCOMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT e L hereby�l(;irm rm th that 1 hove a certificate of consent to self in 7A�4/87�/ 5 I sure ora certificate of Workers Compensation Insurance or a CE 817(REV 8/80) U certified copy t` A(,& Company n01hereo (Sec c 3800, Lab C ) �/�tOT�c[ COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No� Certif c!co�copy is hereby furnished FOR APPLICANT TO FILL IN(PRIM OR TYPE) BUILDING R I;'}�Certified copy n fled with the county bmldi n act on ADDRESS WILMI uuaa department NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date 4/�.q., ApPlimnt WATER CLOSET(TOILET) O NEAREST CERTIFICATE OF EXEMPTI N M WORK BATH TUBCROSS ST COMPENSATIO URANCE SHOWER -421-20 OWNER (This section rued not be completed H the work Irwelved by MAIL the permit is for one hundred dollars(11100)or less) LAVATORY MAIL55 I certify that in the performance of the work for which this per //�� mit is issued, I shall not employ any person in any manner so SINK CITY -L��a L NO 011to become subject to the Workers Compensation Lows DISHWASHER CONTRACTOR Dole—Applicant offer tit CLOTHES WASHER ADDRESS r W, C's *16"W" NOTICE TO APPLICANT If after making this Workers Co of Ea- SWIMMING POOL RECEPTOR emphon,you should become subject to the Wwken Compen- Ctrs, TEL NO sation provisions of the Labor Code you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions m this permit shall be deemed revok- STATE ,�{E ad WATER HEATER LICENSE NO T 3 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT N I hereby off uOm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS O 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and ef- 5 PER SYSTEM FINAL fact � ALIDATION a L iL') DATE C License Number sA Lc Clan yt_ V FI j! Controcto�� Dote 462A J&3 BY p ❑ 1 am exempt under Sec B AP C for this reason Plan check fee ;P 9 4 8 9 A Dote PLUMBING PERMIT ISSUING FEE$ # e e e e s 5 Signature —Dote FEE I l is *52.50 SINGLE FAMILY l HOME OWNER-BUILDER DECLARATION Plan check applicant e e e 52506 I hereby affirm that I am exempt from the Contractor s License Name Low for the following reason (Section 7031 5 Business and k 2 9-8 8 Professions Code) Address I) 1 as owner of the property will do the work and the City Tel No structure is not intended or offered for sole(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 far which this permit n issued (Sec 3097, Civ C ) Lender s Nome Lender s Address I certify that 1 have rood this application and state that the ► above information is co fact I agree to comply with all County Zordinances and ate regulating Plumbing, and hereby lf repr nta v of this County to enter upon the obov for inspection purposes l� SEE REVERSE FOR EXPLANATORY LANGUAGE S nature of PONK.Itafs Daae IqRKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT �7 ,4 lsoreby� uthat that 1 have o certificate of consent to self m 7 A, DPW 41e7 sure,or a certificate of Workers Compensation Insurance or a CE 817(REV 8/86) certified co thereof(Sec 3800 Lob C ) Policy No n k9ftn CompanyF7Wjjtl 71,r COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING e' department ted copy is filed with the county building inspection ADDRESS J J� depomment NUMBER FIXTURE OR ITEM FEE LOCALITY �/., y WATER CLOSET(TOILET) ` Dote�_.C!_�O—_._Applicant I.� C NEwRE87 Of CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER • f (This section aced not be completed if the work involved by the permit is for one hundred dollars ($1011)or Was ) LAVATORY ADDRESS MOL 1 certify that in the performance of the work for which this per mit is issued I shall not employ any person in any manner w SINK CITY ,� j EL NO as to become subject to the Workers'Compensation Laws yy��(L, 411, DISHWASHER CONTRACTOR DateY�Applicant &W /F/1i�NC CLOTHES WASHER ADDRESS � � NOTI TO``APPLICANT If after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption you should become subject to the Workers'Compen- moCITY s•Q TEL _ tion provisions of the labor Code you must forthwith comp LAWN SPRINKIER SYSTEM ly with such proviuons or this permit shall be deemed revok- STATE UC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRr P By I hereby affirm that I am licensed under provisions of Chapter OAS SYSTEM L 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER OUTLETS and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL V DATION d F� /� -V,, DATE C License Number u,1161.i.8.L_tic Cl.l V e FINAL ContractorL �L Date BY p U I am exempt under Sec yL B 8P C for this reason Plan check fee Dole PLUMBING PERMIT ISSUING FEES 1 19 5 Q 5 A Signature TOTAL FEE SINGLE FAMILY Plan check applicant # • • • • • 5 HOME OWNER BUILDER DECLARATION PP I hereby affirm that I am exempt from the Contractor s License Name I • • 1 IS 5 0 Law for the following reason (Section 7031 5 Business and Professions Code) Address . . . 16505 1, as owner of the property will do the work and the City Tel No 0502-88 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 performonce of the work for which this permit is issued (Sec 3097 Civ C ) Lender s Name I Lender It Address I comity that 1 have read this application and state that the above information is correct I agree to comply with app County ► ordinances and State paws regulating Plumbing and hereby outhon:0 repres ntatives of this County to enter upon the above menti proper for'Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE $ignyt re Ines Date