HomeMy Public PortalAbout5542 PAL MAL AVE_Plumbing__ 78A887-CFR17-8S8
APPLICATION FOR PLUMBING PERMIT I
COUNTY OF LOS ANGELES
DEPARMW OF COUNTY ENGlNEER
BDB.DING AND SAFETY DIVIMON
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WCALITY
FOR AFPLICANT TO FUL IN
NUMBER FIXTURE OR ITEM
OWNER
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WATER CLOSET mAII.
BASH IDD 2
SROWSR CITY TEL NOqffrA
LAVATORY commcroBSm ADDRESS jiDD38WA8HRB CITY TEL NO.
LA�RT'� 1EG�ATION NO.CLOt�WASH® DIBTR�O GROUP ZON%WATER HEATER .1/- - A- 1
GAS SYSTEM IDOD@TBDU.
WASTE APPROVAL
ON RECORD
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APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER BLAB WORK
PERMIT S 2 GO ROUGH PLUMBING
TOTAL FEE GAB PIPING
I HEREBY ACXKOWLEDGE 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
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF _
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE U 1 O IFIED
DESCRIBED RESIDENTIA PROP
SIGNATURE FINAL
OF PBRMITTE
ROBERTA WOOD
0. VALIDATION SUPERVISING MECHANICAL ENGR
CL ■ 0 CASE
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APPLICATIO OR PL ING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY/
FOR APPLICANT TO FILL IN IPRINT OR TYPEI BUILDING
ADDRESS,�S �A ?�
NUMBER FIXTURE OR ITEM 0 FEE /
WATER CLOSET LOCAUTY x e !
NEARBY ./ ///
BATH 1U8 Y ?/Ci
SHOWER OWNER //f�F 6uf.-D
LAVATORY DA oR -. Y A AE Ai y 7�
SINK CITU` /Lc /.. TEL NO f .I�p y.7-
DISHWASH CONTRACTOR
CLOTHES WASHER ADDRESS
SWIAMUNOPOOL RECEPTOR
Cltt TEL NO
LAWN SPRINKLER SYSTEM STATE LK:
WATER HEATER LICENSE NO CLASS
GGAASSLSYSTEEM OUTLETS APPROVALS DATE MPECTOR S SIGNAMI E
3 PER MTEMR UNDER SLAB WORK
ROUGH PLUMBING y
GAS PIPING O¢
GAS VENT w
d
HOT WATER HEATER E0
PLUMBING FIXTURE
GAS TEST L
Plon check fee UTILITYCO NOTIFIED _
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
Plan check cppllconl PLAN CHECK VALID I
Name
Addreu
Cay Tel No A 10 2 7 A
I N[NEeY ACKNOWLEDG[THAT I HAVE READ THIS AInN.AT10M AND STAT[ M e S
THAT THE(JOVE LS CONNECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AMD fiATE uWb REGOUTUIG PLUM[IM PERMIT VALIDATION 1 • • 1600
I HERESY CEMT I w PAOP[RLV REGIST[RED /aR LIC[NS[D AS
NEOUIRED[r Lab• OaRT'wD STAT[or CAUFg1 w TNAT 1 w THE • H - 16005
LEGAL OWNER Or AN�It INTHE A[DV[0 ED RESID[NTLLL
rNOnm
1027-78
eNiNATURH /
OF PHRMITTfifl
asr� D Br
a
INDUSTRIAL
WASTE APPROVAL
WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT �7
I thereby affirm fhal I hove a certificate of consent to self 20-0026 DPW 6187 G I
Insure or a cemflcote of Workers Compensation Insurance 7GA667A list
or a certlfred copy thereof (Sec 380E Lab C) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
Policy No Company
Certified copy Is hereby furnished BUILDING
Certified c FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS L' L L F/E
copy Is filed with the county building Inspe<- '�/
tion department NUMBER FIXTURE OR ITEM ® FEE LOCALI CH /,-y
Dole Appi.;ont WATER CLOSET NEAREST /
CERTIFICATE OF EXEMPTION FROM WORKERS BATHTUB CROSS ST ` F'
COMPENSATION INSURANCE SHOWER OWNER E ��
(This section need not be camplefed H twork ork Involved by
else permlt Is for one hundred dollars({100)or leu) LAYATORv FRISS (�
1 certify that In the perfwmonce of the work for which this
perms Is Issued, I shall not employ any person In any manner SINK CITY TEL IJ� Z.
so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR i�
Dote Arpllcont CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT if, after making this Certificate of SWIMMING POOL ��
Exemption, you should become subject to the Workers CITYCompensation provisions of the Labor Code, you must forth LAWN SPRINKLER SYSTEM TEL NO
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I here affirm that 1 am licensed under GAS SYSTEM OUTLETS
by provluans of Chapter 9
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER }
and Professions Code,and my license is In full force and effect S PER SYSTEM FINAL VALIDATION 6.t
LicenseNumberNumbI lc Class DATE
p U
FINAL S
Contractor Dote BY
ACCT.:
I ism exempt under Sec 3307 35.50B BP C far this reason Plan check fee /ly 1 ITEMSto
Dote s Z
Signature PLUMBING PERMIT ISSUING FEE$ TOTAL 35.50 '1
TOTAL FEE CHECK 735.50
SINGLE FAMILY Plan check applicant owe .010
HOME OWNER-BUILDER DECLARATION Name
1 hereby affirm that I am exempt from the Contractor's License Air Yt- AL 1 3�,��
Law for the following reason (Section 7031 S Business and essA.�:J ?
�Professions Code) Ciry E Tel No � j 9750 1 AM 9:00
I, as owner of the properly, will do the work and the ►
structure Is not intended or offered for sole (Section
701, Business and Professions Code)
CONSTRUCTION LENDING AGENCY
1 hereby affirm that there no construction lending agency far
the performance of the work for which this permit is Issued
(Sac 3097, Clv C )
Lenders Nome
Lender s Address
I certify that I have read this application and stole that the polo
Information Is correct I ogres to comply with oil County
ordinances and State jaws regulating Plumbing and hereby
authorize raw
of this County to enter upon the
bo e-menho�i d property for inspection rposee
SEE REVERSE FOR EXPLANATORY LANGUAGE
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Signature o Perm e t