HomeMy Public PortalAbout5338 PARMERTON AVE_Plumbing__ -76/667 CE#817 4 67
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bua S pF
`f
JOHN A LAMBIE COUNTY ENGINEER ADDRESS 1V
COLEMAN W JENKINS SUPT OF BUILDING LOC ���
FOR APPLICANT TO FILL IN ��ST,1, E
NUMBER FIXTURE OR ITEM EACH FEE
OWNED S `
WATER CLOSET $125
MAIL
BATH TUH 1 25 ADDRE '33 VE
SHOWED 125 CITY C �LAVATORY 125 CONTRACTORSINK 125 ADDRESS
DISHWASHER ]25 CITY
LAUNDRY TUB 1 25 STATE LIC
LICENSE NO CLASS
CLOTHES WASHER 125 DISTRICT NO GROUP ZONE PROC ED BY
WATER HEATER 150 ,� —/
GAS SYSTEM OUTLETS ' 50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM 00 >
INSPECTION RECORD 1
O
1 U
Aw N S /N.tL T
00
O
U
APPROVALS DATE INSPECTOR 6 SIGNATURE
PERMIT $ 2 00 UNDZR SLAB WORK
eo ROUGH PLUMBING
TOTAL FEE
CAS PIPING
1
HEREBY
THAT
TH ABODGE THAT HAVE Reno THIS APPLICATION
AND BALL THAT THE ABOVE IG LAND S AND AGREE E COMPLY CAS VENT
PLUMBING
ALL counrr ORDINANCES AND 6Twre uws RecuunNa HOT WATER HEATER
PLl1MBING
1 HE
CERA FY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICEN 6E0 AS REOUIRE0 BY LOS ANGELES COIINTT nNO Te OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER ANO 1 T NO TO GAS TEST
RESIDE IN THE ABO 9CRIBEO 61OEN PR ERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMI FINAL
VALIDATION JACK R ALLEN
CK M ti cwSH SUPERVISING MECHANICAL ENG'R -
�Hf� izodOci16 5 D 4C0-
WPRKERS COMPENSATION DECLARATION 1, � ' APPLICATION FOR•,PLUMBING PERMIT
� >• 4 �?D 0026,DPW a/87
I
e,4firm that haven certificate of consent to sell in- 76A667A + r. . ° t • l I ° s
sure or a certificate of Workers Compensation Insurance ora- CE 817-(REV 8/86)
certified copy thereof (Sec 3800 Lab C ) -
t COUNTY OF LOS ANGELES �DERT OF PUBLIC_
WORKS'
Policy No t .`� a v y1�` �.� ��:, ,c` >vt
Certified copy ,s hereby-furnished
r FOR APPLICANT TO FILL IN (PRINT OR TYPE) Sr BUILDING
❑ <Certified copy'is filed with the county budding inspection• "' - AD SS
L'deparimant •• • + NUMBER F` y FIXTURE OR TEM* - 1 @ FEE' ` -
LOCALITY
,Date C i 1 ! Applicant - c ' t WATER CLOSET(TOILET) NEAREST - �" o _
rn a '' i y -` / r . t 'CROSS ST - J ` ;t a _
'Ib CERTIFICATE OF EXEMPTION'FROM WORKERS r BATH TUB`' r ,
' + COMPENSATION INSURANCE ' - •OWNER �iR�
' SHOWER
(Thu sect,on,need not be completed if the work involved by ,
the permit ,�"s for o` IL
no hundred dollars ($100) or LAVATORY ADDRESS-
Pcenrfy That in the performance a the work for which mann per, s r - 9/ '
m,itu XW�?7,W
- shall not employ any person m any manners _ _ SINK CITY , <. `TEL (O r
+os' ihetWorkers' pen mit Laws i s t DISHWASHERt S f t t i
�< CONTRACTOR.
DA hca ' CLOTHES WASHER` ADDRESS
'
NAPPLICANT,If `a t in ernhc to of Ex - - s - r a +
e4pnon you-should become sublect,to the Workers Compen 4 • SWIMMING POOL'RECEPTOR "; , d „ ,
rsahwi
on provisions of the Labor Code you must forthth comp LAWN SPRINKLER SYSTEM x'°' ` _ CIT r TEL NO
t ly with such provisions or tkivpermit shall be deemed revok - STATE LIC
,ed Wy h V} a,P 'C '1 ' 'r r'• t'•WATER HEATER, r ' • ,_.-f + }° LICENSE NO '.Y CLASS �r
LICENSED CONTRACTORS DECLARATION` : DISTRI O ESSED�Y`
I
herebyaffirm that I om'hcensed under P GAS SYSTEM 'r OUTLETS �L.�'
provisions a Cha ter L O
a 9(cam men�mg with Section 7000)of Drvivon 3 of the Business OUTLETS OVER �/
and Professions Code ond'my license is in full force and ef` 5 PER SYSTEM S
fect tom, - FIN VALIDATIO • i
DA
rL¢ense Numberr Lit Class t ' S U
Contractor Date_'+ O
'I am exempt under SecLIJ
IL
:y
B BPC for this reason . y
a Plan check fee, ► _
T Date ' q5 PLUMBING PERMIT ISSUING FEE E
Signature , 4 _
I r !> - 7 - • > TOTAL FEE 1
' - SINGLE FAMILY -
' 'HOMEOWNER-BUILDER DECLARATION' % ° Plan checkjapplicant-
5 I hereby affirm that I am exempt from the Contractor s License Name _ rT
Law for the following reason (Secnori 7031'5, Business and
Professi one Code) rr a YAddress
I as"owner of the property will do the work,and the" City' `'t Tal No > " z +
structure is not intended or offered for sale(Section 7044
"y usinessl
Band Professions Code) ,. `;- r r,. .r > _ ty ,.
CONSTRUCTION LENDING AGENCY "• _ . - '
I hereby affirm that there is a consirucnon)lendmg'ogency for- ,t a e'! • 5
the performance'of the work for which this permit is issued
(Sec 3097'C,v c ) � (I,•!• 2 a'5'0
i Landers Name ^. ^' '!Y ', P '- 'T . ~ e'ea506
09, 1`3-88
Lander s Address . _ -
.E,I certify that have rand this appbcohon.and stote`Ihat the'
'•,above informolion,s correct agree to comply with all County 7
ces a d State laws gulan ng Plumbing and hereby s - '� - , - " +• '
jn
e_re esentanves this Cou)ty to,.enter upon the + < ^ G' i
m tied or
for ins a Ron pu`rpo es'
SEE REVERSE FOR EXPLANATORY LANGUAGE
P it , D te. i r ? +•r k a , r