HomeMy Public PortalAbout5350 PERSIMMON AVE_Plumbing__ 76A867=CE#817 2-62
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APPLICATION FOR -PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION FAHLREG .3 5
JOHN A. LAMBIE, COUNTY ENGINEER S I D
WILLIAM A.JENSEN, SUPT OF BUILDING
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FOR APPLICANT TO FILL IN gT.NUMBER FIXTURE OR ITEM EACH FEE ,5WATER CLOSET $1.25 BATH TUB up S
SHOWER 1.25 CITY +C / TEL. NO.
LAVATORY 1.25 CONTRACTOR _ GO
SINK 1.25 ADDRESS 2 0-'
DISHWASHER 1.25 CITY ®�_ TEL.NO.
LAUNDRY TUB 1.25 CONTRACTOR'S D G G COST [IREGISTRATION NO. O
CLOTHES WASHER 1.25 DISTRICT JNO. raotpup ZONE ESSED BY
WATER HEATER 1.50 0 O
GAS SYSTEM OUTLETS. - 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
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APPROVALS JDAT& INSPECTCR'S`IGHATU•RE
PERMIT $ 2 00 UNDER SLAB WORKr,.
ROUGH PLUMBING
TOTAL FEE it GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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
PLUMBING. HOT WATER HEATER
'
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL'O HE 70 ,AND INTEND TO '
RESIDE IN,THE ABOVE DESCRI 1 TI PERTY. UTILITY CO.NOTIFIED
.0
SIGNATURE
OF PERMITTEE
FINAL
LIDATION ROBERT A.WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
Lt ito 3 8 6 7APR 2 6 5 D 3,50-
WORKERS'COMPENSATION DECLARATION • 76AG67A (r
I hereby affirm that I have w certificate of consent to self CE 617(2-PD) APPLICATION FOR PLUMBING PERMIT
insure,or alcertificafe of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C.) uu
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company i
Certified copy is hereby furnished. I FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
OADDRESS
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE
department. WATER CLOSET �� LOCALITYzikmg4a 61;*
Date Applicant NEAREST
� BATH TUB r CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' + SHOWER OWNER
COMPENSATION INSURANCE LG
MAI L
(This section need not be completed if the work involved LAVATORY ADDRESS O
by the permit is for one hundred dollars ($100) or less.) SINK XM
CITY TEL.NO. U
I certify that in the performance of the work for which thisCONTRACTOR
DISHWASHER
permit is issued, I shall not employ any person in any manner E O
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS �!M
V
Date '—.23 AApplicant dOseso S'oA/S' i SWIMMING POOL RECEPTOR _ng a
NOTICE TO APPLICANT: If, after making this Certificate of CITY S.?' TEL.NO. CO)
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
o�mpensation provisions of the Labor Code, you must forth- ; LICENSE NO. , 3 GLASS
h comply with such provisions or this permit shall be. WATER HEATER r�
\
Gemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY
!I LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 '(commencing with Section 7000)of Division 3 of the Busi- FINAL N /'� VALIDATION
n.ess and Professions Code, and my license is in full force and 4 DATE ���:�' ? °�"
effect. 1
FINAL
License Numrrberr// Li..Class 4:^ I BY
Contracto�sEP44sAf/.s"Date 0-23 -R2 PO
I am exempt from the licensing requirements as I am a Plan'check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name '5769A
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No. # o 0 0 0 0 5
nessiand Professions Code): 2 - 5250
1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project I' 0 0 0 5 2 5 0 r5
(Section 7044,Business and Professions Code).
0'P 23-82
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
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property fo inspection purposes.
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