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Home My Public Portal About5314 PERSIMMON AVE_Plumbing__ 75A667 (CE-817)-4772 J APPLICATION FO PLUMBI G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: FBRUILD( SSS , SHARVEY T. BRANDT, COUNTY ENGINEERITY'FOR APPLICANT TO FILL IN (PRINT OR TYPE) ST ST. Imo' NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1,75 OWNER J� MAI L BATH TUB 1.75 ADDRESS 014 AL/E SHOWER 1,75 CITY TEL. NO. — LAVATORY 1,.75 CONTRACTOR SINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER 1.75 STATE LIC SWIMMING POOL RECEPTOR 1.75 LICENSE NO. CLASS DISTRICT NO. GROUP :ZONE P CESSED BY LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1.75 INDUSTpIAL y 11-7 WASTE APPROVAL GAS SYSTEM OUTLETS 1.75• INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM .30 W d h Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name Cw klaiR- ROUGH PLUMBING •" ..r- AddressGAS PIPING City Tel. NO. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING i PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANVOR UTILITY CO. NOTIFIED LI CENSEO AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. 'FINAL •Z�� j/,J�.,rl SIGNATU RE OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH i`r 1 1 1. 073 flAY 14 5 D 4.75^` 76 14 967 — CE`B!7 7-69 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOST ANGELES DEPARTMENT OF COUNTY ENGINEER RZnLDn�c BUILDING AND SAFETY DIVISION ADDREss ��, � JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W..JENKINS. SUPT. OF BUILDING LOCALITY �1 FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST -CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET OWNER MAIL BATH TUB 1.50 ADDRESS SHOWER 1.40 CI TEL'.NO. LAVATORY 1.40 CONTRACTOR SINK 1. o ADDRESS DISHWASHER 40 CITY NO. CLOTHES WASHER 150 STATE LIC LICENSE NO. l7 CLASS SWIMMING POOL RECEPTOR 50 7 DISTRICT NO. GROUP ZONE SSED BY LAWN SPRINKLER SYSTEM .00 WATER HEATER 1.50 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 175 INSPECTION C OUTLETS OVER 5 PER.SYSTEM .30 �D v ` � 0 us N Plan•check fee 25% of above. See reverse. ` PLUMBING PERMIT ISSUING FEE 8 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan Check applicant 101 UNDER SLAB WORK Nam ROUGH PLUMBING Address �8 GAS PIPING GAS VENT Ci� Gf Tel. No HOT WATER HEATER 1 HEREBY,ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PL1U 1 EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIF D LICE D•AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFO IA THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN,THE HIDED RESIDENTIAL PROPERTY. FINAL SIGNATURE JACKAL EN, SUP RVISI M CHANICAL ENG'R. OF PERM E PERMIT VALIDATION CK. M.O. CASH PLAN CII ALWAJW CK. M.O. CASH LA%o 2 2 6 6'� Str 5 D WORKERS'COMPENSATION DECLARATI. 8A887A ! r� Cr-817 I hereby affirm that I have a certificate of cone ,:-80, APPLICATION .FOR P L U M.BI N G PERMIT , _.,��; o ipsure,or a certificate of Workers'C ensation In �a cert' fed copy thereofp0mcpan'. .3800, ab..C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY TY Pol� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM • .FEE ADDRESS. all •Cgitified copy is.fijgd with a count buil spection 'a f•: , >`' ' WATER CLOSET LOCALITY +a A� ` Date �pplican—~'� - NEAREST ' BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER' LAVATORY MAIL (This section need not.be. completed. if .the work'involved ADDREss;J�� d } by. the permit is for :'one hundred dollars ($100) or less.) SINK CITY L.IVO. 47 I certify that in the performance of the work for•which this DISHWASHERAdlV permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS � O Date Applicant SWIMMING POOL RECEPTOR U NOTICE TO APPLICANT: If, after making this Certificate of CITY _. EL.NQ" Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. U) Compensation provisions of the Labor Code, you must forth- LICENSE N S CLASS LU with comply with'such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT N . P ESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER V l �� I hereby affirm that..I am licensed under provisions of Chapter 5 PER SYSTEM. 9 (commencing with Section 7000)of Division 3 of the Busi- - INAL .�,7 ness and Professions Code, and my license is in full force and DATE1L,� `� VAL DATION effect. FINA icense Numb BY .Lic.Class BY rl �C '�I71J :f� DateLf= I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer, PLUMBING PERMIT ISSUING FEE$ .acting in my professional capacity .(Section 7051, Bus- 3 4 9 A iness and Professions Code). TOTAL FEE -0 0 0 0;0 5 Lie.or Reg.No. Date. Plan check applicant 13/ 1. o03Q50 HOME OWNER-BUILDER DECLARATION Nam I hereby aaffirm that I am .exempt from the Contractor's Address �d� 0 0 0 3 (15 050 • License .Law for•the following reason (Section.7031.5, Busi- City 4AtEEP T .••No ness and,Professions.Code): j 1.•14-!-85 0 'I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (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 Lender's Address I certify that I have read this application and state that the above information is correc gree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State s re u ing Plumbing, and hereby suth represen .1v, of s ounty to enter upon the ve=me Toned t ins ction purposes. Si ature of lnittee Date