HomeMy Public PortalAbout4839 PERSIMMON AVE_Plumbing__ 78A887-CE0817 12-84
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES J
DEPARTMENT OF' COUNTY ENGINEER
BUILDING AND SAFETY DIVISION f;O
ILDING j/�-1 9 e� ��O
JOHN A. LAMBIE, COUNTY ENGINEER DRESS �/ 2f
COLEMAN W. JENKINS,SUPT OF BUILDING
OSS
CALITY Loliyl �� Cc•
FOR APPLICANT TO.FILL IN ARE Toss T, w ev. /q . !J S �
NUMBER FIXTURE OR ITEM EACH FEE OWNER n /Q
WATER CLOSET $1.25 2 S Q SIL ,
1 BATH TUB 1.25 Z 5� ADDRESS
SHOWER 1.25 CITY 'Lp /e C TEL. NO.
a: LAVATORY 1.25 CONTRACTOR jj- eWj S ..
SINS 3.23 PZS7 ADDRESS g S � ONcc /14d9f
DISHWASHER 1.25 CITY, u I tea, TEL. NO. 96 G 3J///
LAUNDRY TUR 1.25
REGISTRATION NO. 3 1 3 , COUNTY
g. STATE
❑
CLOTHES WASHER 1.25 I DISTRICT NO. GROUP NE PaWESPED BY
WATER HEATER 1.50
GAS SYSTEM OUTLETS 1.50 f S0 WASTE INDUSTRIALAPPROVALOff.
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
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IL
1C�.t��� Ai fi� ,Aide IL�.+ . ��'.!' • n z
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APPROVALS DpXF INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK Lr Ua4wAdl,��4
O ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE,THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES /v
' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE. OF /� p• �"� /
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER•OF AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIA PROPERTY. UTILITY CO.NOTIFIED
SIGNATUREr A d 1 /� -- -
OF PERMITTEE FINAL r
LIDATION ROBERT A.WOOD
CK. M.O. i CASH SUPERVISING MECHANICAL ENG'R
I
cv
L&O 5 6 SSP 8 5 D 15.0 0'" 1,11
WORKER'S COMPENSATION
ate of consent to 2o_0026
67A DPW 9/89 APPLICATION FOR PLUMBING PERMIT lJ
I hereby affirm that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance,or a certified
copy th f Qc..3800 Lab.C.)
11 VGl COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company
❑ Certified copy is hereby furnished. BUILDING F/�n
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS y�J
C Ifi d copy is filed with the my building inspection
d a ant. / NUMBER FIXTURE OR ITEM FEE LOCALITY
Date Applicant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
COMPENSATION INSURANCE BATH TUB ASSESSOR
(This section need not be completed If the work Involved by the SHOWER MAP BOOK # PAGE PARCEL
permit is for one hundred dollars($100)or less.) LAVATORY OWNER
I certify that in the performance of the work for which this permit MAIL I f✓ � P//�
is issued, I shall not employ any person in any manner so as to SINK ADDRESS
become subject to the Workers'Compensation Laws.
DISWASHER CITY TEL.N
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR �y
provisions of the Labor Code,you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.NO. }
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER Ii
(commencing with Section 7000)of Division 3 of the Business and STATE LIC. V
Professions Code,and my license is In full force and eff GAS SYSTEM OUTLETS LICENSE NO. CLASS
OUTLETS OVER DISTRICT NO. PROCESSED BY �
�� _/I 5 PER SYSTEM A Q
License Number Lic. lass 6 (� U
FINAL DATE VALIDATION W
j1AAnIC—/ a
Contracto a cry ✓ 7 6 CO)
H�•S•I o 4
I em exam p under Sec. FINALBY
B.&P.C.for this reason 3397 43 o 65
Date: Plan check fee
1 ITEM
Signature PLUMBING PERMIT ISSUING FEE$
TGTAL 40- 65
❑ SINGLE FAMILY TOTAL FEE
Plan check applicant CHANGE
-;0.41
HOME OWNER-BUILDER DECLARATION Name 4
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Address'
Code): 130036-0031 V 6i93
❑ City � Tel.No.
1,as owner of the property,will do the work and the structure i 9576 1 All ?0 C
is not intended or offered for sale(Section 7044, Business
i
and Professions Code). Pool
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
Lender's Address ;
I certify 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
property for inspec'on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE