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Home My Public Portal About5644 PAL MAL AVE_Plumbing__ nv[P0.n -a '^moi bJ 76A667-=17-8-58 COUNTYo I AArrct- ION FOR PLUMBINGG P RMIT 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION B� &ISNNSG L. `yjl rr ff Al LAMBINr Cemt� Evq�n..r CAH814TT D aRDRur sun I cf Hu'Idina Loc FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATE TDB ADDRESS SHOWER CITY TEL NO LAVATORY CONTRACTOR. , f1 Q {rl SINK ADDRESS Ct Nlof DISHWASHER CITY TEL NO 622 CONTRACTOR S /�� D STATE LAUNDRY TUB REGISTRATION NO COUNTY CLOTHES WASHER DISTRICTNO GROUP ZONE P 59 Y WATER HEATER -- A— GAS SYSTEM INDUSTRW. WASTE APPROVAL INSPECTION RECORD �1 APPROVALS Oa F NHE� i I O l7 DATE INSPECTOR 5 SIGNATURE UNDER SLAB WORK PERMIT S 2 00 ROUGH PLUMBING TOTAL FEE p OAS PIPING 1 HEREBY ACKNOWLEDGE 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 1 HEREBY CERTIFY THAT 1 M PROPERLY REGISTERED AND/OR DAB TEST LICENSED AS REQUIRED BY LO IGELES COUNTY AND STATE OF CALIFORNIA OR THA I A) H LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDE L ER SIGNATURE FINAL OFPERMITTE ROBERTA WOOD ®� VALIDATION SUPERVISING MECHANICAL ENG R C6 Y 0 CASH wL. IG2869�" SEP 18 5 A 300 q 76A667-CE817 r9-58 r e APPTY LICATION FOR PLUMBOS ANGELES ��GPERMIT 1 . DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION DAH S9 ALL A L L OHN A LA!®TE Coantj eer C xx D 4HlPPIN. 9uD! R! uild�vq LOCALITY %�31/L.e L � ('i( FOR APPLICANT TO FILL IN NE RM �� D.O CROSS ex NUMBER FIXTURE OR ITEM OWNER ( WATER CLOSET MAI. BATH TUB ADDRESS SHOWER / CITY TEL NO LAVATORY / CONTRACTOR GVsM / 6 SEI[ / -L ADDHE89 J DISHPWAM CITY TEL. NO CO CTOH 8 REGISTRATION NO / Zt�J 7 0 COUNTYCLODISI'RI O Ggg{�P Z/�ONEWAT /''►GAR INDUSTRIAL WASTE APPROVAL INSPECTION HECORD Tu r3 o cs +` PF'19v vv APPROVALS ® ITEM $100 RE y /.,O J DATE INSPECTOR S SIGNATURE lV UNDER SLAB WORK -/, PERMIT TOTAL 2 00 ROUGH PLUMBING f�rj d - TOTAL FEE GASPIPING 11,1(x. ,f..e I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLT HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES e 1 HEREBY CERTIFY THAT 1 M PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REOUIR D ANGELES COUNTY AND STATE OF CALIFORNIA OR TH E LEG OWNER OF THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDEN 1 TY SIGNATURE PERMI'ffE FINAL `®r ROBERTA WOOD VALIDATION SUPERVISING MECHANICAL ENG R CC Y O CASH LACo 2 5 '5 4 -; SEP 14 5 A 800 WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1 have a certificate of consent to self m � 20-0026 ADPW 4/90 �I sure,or a certificate of Workers Compensation Insurance or a L I certified copy thereof (Sec 3800, Lob C ) IILJII COUNTY OF LOS ANGELES DEPT F PUBLIC ORKS Policy No Company E] Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS 'Z department NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date ' Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATHTUB CROSS ST a IGS COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work involved by MAIL the permit Is for one hundred dollars ($t DD)or less ) LAVATORY ADDRESS I certify that in the performance of the work for which this per SINK City NiO mit is issued, I shall not employ any person in any manner so as to become subject to the Workers' pensotion Laws DISHWASHER l CONTRACTOR - Date /d'� J Appl icon CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making this Certificate of Ex SWIMMING POOL RECEPTOR emotion you should become subject to the Workers Compen ��pp sation provisions of the Labs Code you must forthwith camp LAWN SPRINKLER SYSTEMS CITY TEL NOM ..'Ya0{7 ly with such provisions or this permit shall be deemed revok STATE �j LIC �J�j� ed - WATER HEATER LICENSE NO 6/R1 �Q CLASS(�c�JV LICENSED CONTRACTORS DECLARATION - DI57 IR D BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM 'OUTLETS rill 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 JDJA l t, tett (, HOSE B18 E License Number a Lit Class O L E� V Contractor . -Y.IY/ Dale ��7�1� NV S I am exempt under Sec ^\9 U B 8P C for this reason W Plan check fee , la Data N PLUMBING PERMIT ISSUING FEE$ _ Signature TOTAL FEE SINGLE FAMILY Plan check applicant ' HOME OWNER BUILDER DECLARATION pP I hereby affirm that I exempt from the Contractors Name 43.40 Law for the followingg r reason (Section 7031 5 Businessss and d ' Professions Code) Address a(+ ElI as owner of the property, will do thework and the Gry Tel No '�' "• ' -""""" - r - 1 / 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,for which this permit is issued - (Sec 3097 Civ C ) Lender s Name s Lender s Address I ce'rtify 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 above-mentioned prop y for inspection purposes.9. /-x -J1� SEE REVERSE FOR EXPLANATORY LANGUAGE e446 Signature of Permittee Date ,