HomeMy Public PortalAbout5415 PERSIMMON AVE_Plumbing__ r' .1723M BETH 2-47 APPLICATION FOR PERWIT
_
P;;WENT OF BUILDING AND SAFETY _
COUNTS OF LOS ANGELES PLuinim1
imG
WM.J. FOX.CHIEF ENGINEER
NATURE OF INSTALLATION DI NO. GROUP O -PERMIT
ROUGH FDLTURES COMPLETE
HEATER' CESSPOOL I�9EPT1C TANK y— RBC VED BY READY FOR DA 188
FIRST INSPECTION
AS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED
PORTION ONLY
K - NAME14g /fmeq" �. ADORES&
-ADDRESS.1p}ye �� j ,.`,p LOCALITY /p A .
NEAREST
J
- CITY � � � TEL.Me �pFi low CROSS ST. �A _
COUNTY ' i
CERT.No. EICPIREB Lr-AR(n -f9 G N11 —AME Z d3A.A ,._'-'-�
LOCATION OF SEPTIC TANS, OR CESSPOOL Z MAIL �g
NORTH O ADDRESS . d "
CITY TEL.No.
IAM THE LEGAL POSSESSOR OF THE ABOVE LOB
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
_ PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE..
3 s
• OWNER
CORRECTIONS
SOUTH
J
DESCRIPTION OF WORK a
z
BATH TUB FURNACE L7
R'
HOWER - DISHWASHER p
LAVATORY REFRIGERATOR
KITCHENS.INK - WATER SOFTENER
-FLOOR SINK SAND TRAP
P SINK DOR DRAIN
�_�•' WARN TRAY URINAL AP fOVALS
' - WATER CLOSET DRINKING FOUNTAIN i
ATB 1 OPWMR'%NAMt
WATER HEATER DENTAL LAVATORY I ` it
ROUGH PLUMBING
e ETERS G— QODA FOUNTAIN I - I
GAS PIPING
GAS VENT ~
CESSPOOL I
TOTAL NUMBER OF FIXTURS SEPTIC TANK
CESSPOOL SEPTIC TANK SEWER I .,
8
TOTAL FEE UTILITY CO.NOTIFIED !f'J .fit .,P I 1•,
✓� �� '�
'
FINAL
ION
` WORKER'S I have
a certificate
of consent to 7M667 DPW 9/89 APPLICATION FOR PLUMBING PERMIT
' 7sg657A
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 thereof(Sec.3800 Lab.C.)
Policy No. Company COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
❑ Certified copy is hereby furnished. A �
FOR APPLICANT TO FILL IN(PRINT OR TYPE) gDDREDING
SS
Isy Certified copy is filed with the county building inspection
department. + NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Date D Applicant(�al .. WATER CLOSET ,O�0
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE ASSESSOR (yn
(This section need not be completed if the work Involved by the SHOWER MAP BOOK '�j0�j PAG$L PARCEL
permit is for one hundred dollars($100)or lees.) LAVATORY OWNER frl'1
I certify that in the performance of the work for which this permit Y�'
is issued, I shall not employ any person in any manner so as toMAIL
SINK
become subject to the Workers'Com ensation Laws. ADDRESS �0--^L
C�6 DISWASHER CITY TEL.NO.
Date 2--IIA-3 Applicant > CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR ®Ln��QJV
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS
provisions of the Labor Code,you must forthwith comply with such
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION �� CITY TEL.NO. a
WATER HEATER
I hereby affirm that I am licensed under provisions of Chapter 9 ` O'O
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS B'() STATE NO. CLASS (C,'
Professions Code,and my license is in full force and effect.
' OUTLETS OVER DISTRICTNQ.O� PROCESSED BY F
}}5 PER SYSTEM \JT
License Num ber<� Lic.Class
i FINAL 2
6-11
DATE VALIDATION a
2^�
Contractor Date v U
5
❑ I am exempt under Sec. I FINAL �
B.&P.C.for this reason BY ACCT.JLg
Date: Pian check fee , 53307 70.65
Signature.
8. S� �r PLUMBING PERMIT ISSUING FEE$ a 1 ITEMS
El TOTAL FEE (p TOTAL 70.65
SINGLE FAMILY Plan check applicant CHECK 70.65
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that 1 am exempt from the Contractor's License Law CHANGE .00
for the following reason(Section 7031.5, Business and Professions Addressl Pig t(�tft�bil
Code
ice
I,as owner of the property,will do the work and the structure City Tel.No. 4\rL-7-1 id J 0000-0001 2/16/93!:
is not Intended or offered for sale(Section 7044, Business
and Professions Code). ► 2
806 1 Ah111'4
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 Pool
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
pr y for InsPee' n urposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
I ature of Permittee U Date