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HomeMy Public PortalAbout5602 PERSIMMON AVE_Plumbing__ I 78AG87 CEY*817 4-64 APPLICATION FOR PLUMBIN PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ``BUILDING AND SAFETY DMSION BUILDING ADDRESS '.S'/P97/J7 C?/7 JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. •� NUMBER FIXTURE OR ITEM EACH FEE OWNER 4 n/nw ( �/ © s/ ; WATER CLOSET $1.25 ��//iL3 � Y BATH TUB 1.25 ADDRESS �.Z �is'e r/177/19 D/ C20, SHOWER 1.25 v CITY ��777 TEL. NO. LAVATORY 1.25 �� coNTRAcioa d,�j J. /�7Q��O s SINN 1.25 ADDRESS �/ 111veW Se T`-t ale DISHWASHER 1.25 CITY a s a cf&n .9 TEL. No. f.0 5-64COCTOR'S / . STATE LAUNDRY TUB 1.25 R GIN S�TRATION NO..i 1 % 6_0 COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONEPROCES D BY WATER HEATER 1.50 ��� 1.50 LIZQ INDUSTRIAL a GAS SYSTEMOUTLETS WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD U off'T`LP o�i*✓+'L 'rg�+.J`� C_0 P APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK 3- - ROUGH PLUMBING 6- 1"4 1" TOTAL FEE �T GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A LI TION GAS VENT AND 8TATE THAT THE ABOVE IS CORRECT AND AGREE TO C MPLY I og WITH ALL COUNTY ORDINANCES AND STATE LAWS,REGULATING HOT WATER HEATER PLUMBING. 1 A 1 HEREBY CERTIFY THAT I AM�PROPERLY REGISTERED AND/OR PLUMBING FIXTURES fhv for LICENSED AS REQUIRED BY LOS ANGELES COUNT AND STATE OF CALIFORNIA OR THAT AM TME LEGAL WN OF A INTEND TO GAS TEST RESIDE IN,THE ABOV ESCRIBED ISTD T JCL PROPE UTILITY CO.NOTIFIED / SIGNATUR 'I OF PERM / FINAL VALIDATIQN--) ROBERT A. WOOD CK. M.0. (` CASH SUPERVISING MECHANICAL ENG'R L&O 8 .2 1 11 FEB 3 - 5 14 @7 5 ? WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereb20-0026 DPW 4/90 x,affirrgFthat I have a certificate of consent to self in- 76A667A sure,o a certificate of Workers'Compensation Insurance,or a certifibSd copy thereof(Sec. 3800, Lab. C.) 1 �0 S/`� ��iz� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Com pan y ❑ Certified copy is hereby furnished. ip BUILDING / FOR APPLICANT TO FILL IN(PRINT OR TYPE) f! r-1Certified copy is filed with the county building i spec' n ADDRESS NUMBER FIXTURE OR ITEM department. @ FEE LOCALITY � — Date, ` Applican� WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEM N FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY TEL. NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation.Laws. DISHWASHER / L CONTRACTOR (� 7 ss Date. Applicant CLOTHES WASHER ADDRESS ��j Gr/�!/VL'tri/ 40 NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to'the Workers'Compen- CITY TEL.N9.747 sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS �fQ� ly with such provisions or this permit shall be deemed revok- STATE / :7z'�/ a LIC. ed. WATER HEATER. LICENSE NO. < CLASS er ge LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under,provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER O and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. + HOSE BIB DATE. License Number � ���/7 Lic. Class //�� //���� FINAL 0 Contractoyw�" S�Jc�7Date BY Q F1 I am exempt under Sec. V B.&P.C. for this reason Plan check fee (J ► LU Date: PLUMBING PERMIT ISSUING FEE$ o_ 5 Z Signature TOTAL FEE ACTss SINGLE FAMILY 43 40 HOME OWNER-BUILDER DECLARATION Plan check applicant 7303 • I hereby affirm that I am exempt from the Contractor's License Name ITEMS for the.following reason (Section 7031.5, Business and Professions Code): Address TOTAL 4:3 "40 F1 1, as owner of the property, will do the work and the City Tel. No. CHECK 43.40 structure is not intended or offered for sale(Section 7044, 000 Business and Professions Code). ; CHANGE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 3/2896 the performance of the work for which this permit is issued PM 6:15 (Sec. 3097, Civ. C.). 5587 Lender's Name Lender's Address I certify'that I have read this application and state that.the , above information is correct.I ag a to comply with all County ordinances and State laws reting Plumbing, and hereby authorize represents' sof is County to enter upon the ve-m t' e o r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PerWee ee Date