HomeMy Public PortalAbout4950 PERSIMMON AVE_Plumbing__ 7&/667 D69 17 11-513 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING '
COUNTY OF LOS ANGELES
WILLIAM J.FOX, CHIEF ENGINEER
FOR APPLICANT TO FILL IN DIS R' RC .
-PLUMBER sr > RECISI• E BY READY FOR DATE ISSUED
'� � J ��j'� FIRST INSPECTION
ADDRESS r ,'�• r c�1� (..1 J
BUILDING C
CITY TEL No. ADDRESSCOUNTY
/��Q 'l//!�(,J�if1/G��r✓�LJH4 AYE-+
L CEN E NO. EXPIRES LOCALITY
NEAREST v� /
PERMIT FEES CROSS ST. r r1��rh�t?..� .A
(���4_,41J�iy
t�i7��r„9�.1J Q1y
OWNER
NUMBER TYPE OF FIXTURE OR ITEM FEE
MAIL
WATER CLOSET(TOILET) @ 0.50 !Li ADDRESS
BATH TUB @ 0.50 tr ( /}�f
CITY �
;
1.-_tTEL. No. -l"99 ,Q 5d'
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE/THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT i POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
J� OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM.i„�OUTLETS @ 0.50
SIGNATURE
WATER HEATER @ 0.50 PERMITTEFl��'�%G-t (�/ !.t '�� SCI �1 LA0,1�.-,t
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50 r-47) +r;v� .�irM !7 ' 7-�J Cn utc
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 � �pU,., /�. •J
HOUSE SEWER 0'0.513 C2D ,. Q
MISCELLANEOUS
CELANEOUS
G 13
APPROVALS
DATE IN9PECTOR•S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1;00 CESSPOOL
SEPTIC TANK: BEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT1.001 GAS TEST 10-Zz 6 Y rt °tel
• UTILITY CO.NOTIFIED 1'n'°j'
TOTAL FEE � � ��
FINAL
76A667 DOE 17 11-50 .. APPLICATION FOR PERMIT
DEPARTMENT OFNG AND SAFETY PLUMBING
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT NO. GROUP I ZO.NE PER IT NO
FOR APPLICANT TO FILL IN ��, ��.
. RE�OEI,VtED I READY FOR
DATE ISSUEDPLUMBER
FIRST INSPECTION
ADDRESSBUILDINGCITY TEL.No. ADDRESS % V, - S 1�I14o
Q
COUNTY LOCALITY TA-Al P k JP /I /
V
LICENSE NO: / EXPIRES NEAREST
PERMIT FEES DRDBB sT. a W e V� �yZ�L�S �i
NUMBER TYPE OF RIXTUR6 OR ITEM FEE dWNER�/�i�f�EiO�f�L [Y�K��YI�tiC�® /////i"CbV!J
MAIL /'G
WATER CLOSET(TOILET) 0.50 '� C`� ADDREH9 { [�
BATH TUB Q 0.50 q"dCITY f`jam,& ,, TEL ND E 50'O
. O-
SHOWER 0 0.50 1 HERESY', ./ACKNOWLEdOE THAT 1 HAVE READ THIS
B LAVATORY (WASH BASIN) @ 0.50' APPLICATIdN AND STAT,F/THAT THE ABOVE IB CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK O.5d AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0 0.50 ,0 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPS DESCRIBED ABOVE.
GAB SYSTEM OUTLETS 0.50 SIGNATURE OF}0�jg,„ /���wao
WATER HEATER 0.50 �`�(,7 PER
�' `��
SLOP SINK (() 0.50 IIQSPECTION RECORD
FLOOR BINK @ 0.50
FLOOR DRAIN 0.50 Zj�YJ
DISHWASHER 0.60 S�Ph� A.L�
DRINKING FOUNTAIN 0.50 .(/f'[= AnN�7. �rvcrT.�h9 ASC lilG4S?•--
URINAL 0.60 Q
HOUSE SEWER 0 0.50 \h Z
MISCELLANEOUS m
Q.'
O
APPROVALS
DATE INBPEOTORIE NAME
ROUGH PLUMBING
OAR PIPING w
rGASNT /YC- 'A CiCESSPOOL @ 1;1313 OLSEPTIC TANK: TANK �.cnDRAIN ( PIT ( ) 1.00 �C� _rte cy rY�
PERMIT t.oa GAS TEST v
TOTAL FEE l �� UTILITY cc-NOTIFIED f ✓ 1
ION
WORKER'S I have
a certificate
of consent to 76AS6aDPw9/69 APPLICATION FOR PLUMBING PERMIT
78A867A
I hereby affirm that I have a certificate o}consent to self Insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab.C.)
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company
❑ Certified copy Is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 4- Q
F1 Certified copy is filed with the county building inspection
department. NUMBER FIXTURE OR ITEM G FEE LOCALITY
Date Applicant / WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. VF-'
COMPENSATION INSURANCE BATH TUB ASSESSOR
(This section need not be completed if the work Involved by the / SHOWER MAP BOOK PAGE Q ZL�. PARCELDO.�
permit is for one hundred dollars($100)or less.) OWNER
LAVATORY
I certify that in the performance of the work for which this permit
Is issued, I shall not employ any person In any manner so as to SINK ADDRESS,+ 'f iC� A.become subject to the Workers'Compensation Laws.
DISWASHER C C� t9. . TEL.NO.
Date Applicant CLOTHES WASHER CONTRALTO J V
NOTICE TO APPLICANT: If, after making this Certificate of �ljp',l1.dti� GGeGt �e.P./
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code,you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION / CITY TEL.NO. >
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS STATE
NO. CCA•SS V
Professions Code,and my license is in full force and effect.
OUTLETS OVER DISTRICT n� PROCESSED BY CE
5 PER SYSTEM G'
License Number Lic.Class
FINAL Z01 ' VALIDATION
DATE
CL
Contractor Date
❑ FINAL Z
I am exempt under Bec. BY
B.&P.C.for this reason5
Plan check fee 2 115:
Date. PLUMBING PERMIT ISSUING FEE$ 17,15- ACCT■v
Signature3307 97.50
❑ TOTAL FEE O1r
SINGLE FAMILY Plan check applicant • 1 ITEM
HOME OWNER-BUILDER DECLARATION Name TOM 97.50
1 hereby affirm that I am exempt from the Contractor's License Law CHECK �t
for the following reason(Section 7031.5, Business and Professions Address 97.51I
Code):
❑�� City Tel.No. CHANGE ■Ill
I,as owner of the property;will do the work and the structure
Is not intended or offered for sale(Section 7044, Business
and Professions Code). , 0000_0001 121 9/92'
CONSTRUCTION LENDING AGENCY 6962 1 AH 10 a 2$
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.)
11
Lender's Name
I
Lrerider's Address
Ip certify that I have read this application and state that the above 001.i formation is correct. I agree to comply with all County ordinances
and State laws regulating Plumbing, and hereby authorize
re resentatives of this aunty to enter upon the above-mentioned
p arty for jfi a tion ur aes. SEE REVERSE FOR EXPLANATORY LANGUAGE
9-
naturel of Per ittee Date