HomeMy Public PortalAbout4938 PERSIMMON AVE_Plumbing__ 7SK907 17 5-60 it APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRI6�YIV0. GROUP I ZONE PERMIT NO.
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PLUMBERS /g(/1 (d9� �Lvm p�N� �+�v►br�� RECEm:�
FIRST INSPECTION READY FOR DATE ISSUE D
ADDRESS/QL'�
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BUILDINGL
TEL: ADDRESS St04-9-
CITY NO./
COUNTY LOCALITY
LICENSE NO. / % EXPIRES '
NEAREST
PERMIT FEES CROSS sT. �y
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNS '� �A� s / ���r'7'✓
/ MAIL
WATER CLOSET (TOILET) 0.50 ffi a ADDRESS
BATH TUB 0.50. J-0 CITY T _EL. NO / -
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 AAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATIONAND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH AW COUNTY ORDINANCES AND
KITCHEN SINK @ 0.50 I a STATE LAWS REGULATING_,PLUMBING.
1 CERTIFY THAT e� O THE ABOVE VALID LOS
r LAUNDRY TUB'OR TRAY @ 0.50 ro. ANGELES COUNTY -CE 1 AM THE LEGAL OWNER
OF THE REBID L PERTY DESCRIBED ABO
GAS SYSTEM OUTLETS @ 0.50
SIGNATURE p
WATER HEATER @ O.5.0 rd PER
SLOP SINK @ o.so INSPECTION RECORD
FLOOR SINK @ O.sO
FLOOR DRAIN @ 0.50
DISHWASHER .@ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 ,J
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS
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0
APPROVALS
DATE INSPECTOR'S NAME
RO PLUMBING .�
GAS PIPING ^/C
r
GAS VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT•. GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE ffi 1.00 Q FINAL
7""7 DBB 17 7-51 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES EP L mum IN Efti1 1
WILLIAM J. FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DMTRICTNO. GR U O —PgwmlTriu.
4LO 6s-0
PLUMBER A A• ,�.. V RECEIVED /
BY READY DATE IBS ED
i y�y
�.O•_ vF d FIRST INSPECTION
wJ `ADDRESS �
AD)I---BUILDING n / �/�s �+ "q��Ig�p1.Se"��
CITY I TEL No. ADDRESS �.%�p� ♦4f, A 1P d. 3gy�Al�lLlsig��A
COUNTY LOCALITY TA•=A4�F+ C f
L BE N0. EXPIRES - .
NEAREST g�
PERMIT FEES CROBS ST.
NUMBER TYPE OF FIXTURE OR ITEMFEE OWNER A� -
MAIL
WATER CLOSET(TOILET) a 0.50 Ili ADDRESS
BATH TUB @ o.5o CITY TEL. No.
SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) 0.50 APPLICATION AND 13TATE THAT THE ABOVE 19 CORRECT
AND AGREE TO COMPLY WITH ALL MOUNTY ORDINANCES
KITCHEN BINK 0.5o AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY ® 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
GAS SYSTEM OUTLETS (!$ 0.50 of THE REBIDENTI PROPERTY DES
EEIBED
�SCRROVE.
WATER HEATER (it 0.50 SIGNATURE
P RMITTEE
SLOP SINK 0 13.513 INSPECTION RECORD
FLOOR SINK 0 13.513
FLOOR DRAIN 0 0.50
DISHWA13HER 0.80
DRINKING FOUNTAIN 0.50
URINAL 0.5C Q
HOUSE SEWER o.60 _Z
MISCELLANEOUS O
.O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAB PIPING
GAS VENT
CEBSPOOL 1.130 TS5
BSPOOL
SEPTIC TANK: PTIC TANK •I4 i� /1 G!G//.r.
DRAIN ( ) PIT ( ) 1.00 WER
PERMIT • �.13oS TEST
UTILITY CO.NOTIFIED
TOTAL FEE S S�
FINAL
I If
WORKERS'COMPENSATION DECLA•RATIQN �" J 1 •� `•+ ' ,APPL.ICATION FOR PLUMBING PERMIT
I herebl;t affirm that I have a certificate of consent'to 'se�f q�yq t
`Insur�'ySor,a.certificate of Workers'Compensation 11nsu$ance, 0.817(REV.y,10/8A)
or a certified copy thereof(Sec. 3800, Lab.C.) i
'I • COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Compapy
Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING�,/f oqw,e o i�,+� t
Certified copy Is filed with the county building inspec- ADDRESS Lt - 6� lC- 1 6I`'} �`
tion department. NUMBER FIXTURE OR ITEM FEE LOCALITY
�9 �
Date. Appli4arit WATER CLOSET CROSS ST. �swep x C c,—
A.
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION INSURANCE SHOWER �+ WNE 0VCe � A� Ali
(This section need not be completed if the work involved by MAIL
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the permit is for one hundred dollars.($100)or less.) LAVATORY ADDRESS (&e '' lG �u"ii
I certify that in the performance of the work for which this
permit is issued; I shall not employ=y person'in any manner SINK CITY TEL. NO. 'd/
so as to become subject to the Workers'Compen tion Laws. DISHWASHER
CONTRACTOR
Date4�5�, Applicant CLOTHES WASHER! - ADDRESSNOTIAPPLI NT: If,. after making this .Certificate of
Exemption, you should become subject to .the Workers' SWIMMING POOL RECEPTOR
. TEL.NO. n��/��,,p..
•Compensation provisions of the Labor Code, you must forth- CITY LAWN SPRINKLER SYS7ENf k. V `
with comply with such provisions or this permit shall. be STATE #r LIC.
deemed revoked. WATER HEATER LICENSE NO... CLASS
LICENSED CONTRACTORS DECLARATIONDISTRICT NO. PR ED.BY,
Ihereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER a }
and Professions Code,and my license is in full force and effect. 5.PER SYSTEM FINAL ®-
DATE VALIDATION O
License Number Lic. Class V
FI //J 0
Contractor Date B O
❑ I am exempt under Sec. UA
W
BAP.C.,for this reason
Plan check fee ;• , Z
Date:
PLUMBING PERMIT ISSUING FEE
Signature - - -
TOTAL FEE: q S6
Plan check applicant
SINGLE FAMILY -� I C 42 LL A
HQME OWNER-BUILDER DECLARATION Name
I hereby o f rm that I,am exempt from-the Contractor's,Lieense 0 0 0o- o
Law foT,•f a following reason (Section 7031.5, Business and Address
e�
.of
`O ions Code): City Tel. No. 1O v H•ar.'C
IJ I, as owner of the property, will do the work and the " c c V
structure is not intended or offered for sale (Section-
7044, Business and Professions Code). I , ;; r (�%—
CONSTRUCTION LENDING AGENCY
I hereby affirm that th*e is a construction lending.agency for
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
Lender's Name I
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. nd State law regulating Plumb'•g, and hereby
authorize preser�lative of this Cou d enter upon the I
above- nti.ioned p y or ion purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
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