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Home My Public Portal About5515 PERSIMMON AVE_Plumbing__ `7�A667A -SCE 817 IREV.6/78) ®s APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN[PRINT OR TYPE) BUILDING �- NUMBER FIXTURE OR ITEM ® FEE ADDRESS WATER CLOSET O LOCALITY re t� NEAREST BATHTUB � � CROSS ST; SHOWER OWNER Ale . S�� LAVATORY MAIL ADDRESS S I �-�I �� A SINK .CITY �Iv TEL.NO. DISHWASHERCONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR d CITY / TEL.NO. O LAWN SPRINKLER'SYSTEM. STATE LIC. WATER HEATER LICENSE'NO. �.� [ CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK _ 5 PER SYSTEM ROUGH PLUMBING • GAS PIPING GAS VENT 99 HOT WATER HEATER PLUMBING FIXTURES. GAS TEST Plan Check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ 76-f 0 TOTAL FEE � FINAL 4-8( PLAN.CHECK VALIDATION Plan check applicant ) Name 3 !a �/7a •- 7 Address 90 2 69 A City Tel.No.# o 0 0 0 o5 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 2 0 1 9.00 AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED'AND/OR LICENSED AS O O O 1 9,00u REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RESID IN THE ABO DESCRIBED RESIDENTIAL _ 0 9, 15-78 PROPERTY. SIGNATURE OF PERMITTEE DISTRICT NO. PRbCESSED BY INDUSTRIAL WASTE APPROVAL 78A867-CE#817 4-64 �p APPLICATION F R PLUMB NG PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION FEA '✓i �, JOHN A. LAMBIE, COUNTY ENGINEER JWILLIAM A.JENSEN, SUPT OF BUILDING q FOR APPLICANT TO FILL IN NUMBER FIXTURE OR ITEM EACH FEE OWNER /J 1� �' J c� 1 WATER CLOSET $1.25 MAIL �7 BATH TUB 1.25 ADDRESS S / 0T 2 S/ tr O A) SHOWER 1.25 CITY �z m �c l 7 / TEL. NO. LAVATORY 1,25 CONTRACTOR SINS 1.25 ADDRESS DISHWASHER 1.25 CITY TEL. NO. LAUNDRY TUB 1.25 RCONTRACTOR'S GIS RATION NO. COUNTY Q CLOTHES WASHER 1.25 DISTRICT NO. GROiiP RO ES WATER HEATER 1.501 C Q 'r 'r I — } GAS SYSTEM OUTLETS I-so INDUSTRIAL WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V O H U W O. h z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT N 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE �U GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 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 I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN.THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE EmEm FINAL VAL (PROBERT A. WOOD M.0. SH CK. M.O. ( CASH /)SUPERVISING MECHANICAL ENG'R llk _j- 7 3 9 % MAR :L5 D 5.0 0^' WORKERS'COMPENSATION DECLARATION 1 76AG67A ' I hereby affirm that I have a7 certificate of consent to self I CE 617(2-66) APPLICATION FOR PLUMB 1 N G PERMIT insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company I ['1 I, O F TI O Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING r t ADDRESS 5 Certified copy is filed with the my Duodin inspection i NUMBER FIXTURE OR ITEM FEE Dateale a me WATER CLOSET LOCALITY Applicant NEAREST n BATH TUB CROSS ST. Mme' CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER MAIL �- e (This section need not be completed if the work involved LAVATORY ADDRESS 1L by the permit is for one hundred dollars ($100) or less.) SINKO CITY` TEL.NO.I V I certify that in the performance of the work for which this DISHWASHER 1= permit is issued, I shall not employ any person in any manner CONTRACTOR O so as to b4cogle subject to th rkers' p nsation Laws. CLOTHES WASHER �� Dat.4// ADDRESS � 2O � �J''��'�-•� (~j, V Applicant SWIMMING POOL RECEPTOR lJJ 'NOTICE TO APPLICANT: If, after aking this Certificate of CITY TEL.NO. Vq01N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE nn q LIC. ! Compensation provisions of the Labor Code,you must forth- LICENSE NO. OC�� / CLASS (0a with comply with such provision's or this permit shall be � WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter i 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- { FINAL � Z�� VALIDATION ness and Professions Code, and my license is in full force and I DATE l effect. p FINAL J �� License Number 6 Lic.Class C3 I BY p "' i Contractor at „ F1 I am exempt from the licensing requirements as I am a, Plan check fee licensed architect or a registered professional engineer i PLUMBING PERMIT ISSUING FEE$ aO acting in my professional. capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE t7 Lic.or Reg.No. .Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor'•s Address ;F21 1,4 A License Law for the following reason (Section.7031.5, Busi- City Tel.No. ness and Professions Code): , • '#f'o o o a o 5 I, as owner of the property, am exclusively contracting with licensed contractors to construct the project 2 0 1 Q 0 0 (Section 7044, Business and Professions Code). ' '0 � � 1 0,00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency q 1,30-81 for the performance of the work for which this permit is READYa �] p 4 issued(Sec.3097,Civ.C.). _'9 li9i .Lender's Name + fl ?'JON 1 Lender's Address r I certify that I have read this application and state that the l 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 presentatives of this County to enter upon the 1 above ant' ned pr party for inspection purp es. Signatur ermittee Date 1 0 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT a` •I'heZ ffirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy hhereof(Sec. 380 ,Lab. .) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nd L'�— "' 7U Pa a, ❑ Certified copy is hereby furnished. BUILDING /y� FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS �5 Abs/ / o Certified copy is filed with the cgunty buildin ms es- tion department. /t/��`�ru y Ul s �� NUMBER. FIXTURE OR ITEM (� FEE LOCALITY pWATER CLOSET , Date �d � Appli4ant •r12?/_51 NEAREST CERTIFICATE OF EXEMPTION FROM WORKER BATH TUB CROSS ST. Dri COMPENSATION INSURANCE SIO/Ail OWNER � � (This section need not be completed If the work involved by SHOWER the permit is for one hundred dollars $100 or less. MAIL P ( ) ) LAVATORY ADDRESS � /ICY) I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CIT so as to become subject to the Workers'Compensation Laws. DISHWASHER " CONTRACT R G F•d'd�0'2 C(yrp Date- opplicant CLOTHES WASHER ADDRESSS � P LW192, Qpm NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY 1510 07Ci.EV BTR ET�� No Compensation provisions of the Labor Code, you must forth- GI�JjJ� with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STA-MV. r-nCirtLAP 14 deemed revoked. WATER HEATER LICENSE NO. 3 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. [/ PROCESSED I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS I �• !4( (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (�J and Professions Code,and my I'cense is in full force and effect. 5 PER SYSTEM FINAL / V DATION O / DATE ! J�/t ��c U License Number-3Lic. Class�ig6 ' t; Fl Contractor/✓ � Date BZ <\ Z�. ! h� 1:11 am exempt under Sec. U1 B.&P.C. for this reason ` 4 e► Plan check fee -- ® ...:.,e:,�, .. Date: PLUMBING PERMIT ISSUING FEE$ Signature 5) TOTAL FEE �_ SINGLE FAMILY Plan check applicant ;9 4 9 3 8 A HOME OWNER-BUILDER DECLARATION Name # o o o 0 0 5 1 hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. 0 01 65 G ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® 00016,506 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY O Q 7'I —86 1 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 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-me ' ned prop sp rty for i ection purposes. �- SEE REVERSE FOR EXPLANATORY LANGUAGE , Signa a of Per ittee Ocite