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Home My Public Portal About5614 PERSIMMON AVE_Plumbing__ 76A667-CEit817 6-65 `� �j �jw� APPLICATION FOR PLUMBING PE14MIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING e JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY `� FOR APPLICANT TO FILL IN NEAREST NUMBER FIYTURE OR ITEM EACH FEE CROSS OWNER' CA WATER CLOSET 31.25 MAIL BATH TUB 1.25 ADDRESS r SHOWER 1.25 CITY I Ad TEL. NO LAVATORY .1.25 CONTRACTOR t^� SINE 1.25 ADDRESS DISHWASHER 1.25 CITY TEL.KO. AtO b STATE LIC LAUNDRY TUB 1.25 LICENSE NO. � CLASS CLOTHES WASHER 1.25 DDI ICT NO, GR R BY WATER HEATER LSO L//p► �J/y GAS SYSTEM OUTLETS 1.50 WASTEINDUSTRIAL TRI OVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U DoT eA�j✓ O U W a N Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE 18 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 RE IDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE FINAL OF PERMITTSE--Rg tjO A" VALIDATION CK. M.O. CA§H Lliuo3 9'3 _-11�, i5m 5 5 D 325 76A667-CE#617 2-66 10 (/ APPL,.IcATI. N FOR PLU BING PERMIT COUNTY OF LOS ANGErL@S DEPARTMENT OF,COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 9614 PERSTMMON COLEMAN W. JENKIN.S. SUPT. OF BUILDING iOCALMY FOR APPLICANT TO FILL IN. 1CRTS'SIT.I.IVEFREER STR.. NUMBER F114TURE.OR ITEM EACH FEE OWNER WATER CLOSET $1.25 RICE BATH TUB 1,25 ADDRESS 614 PERSIMMON SHOWER 1,25 CITY 5-MPLE CITY TEL NO. I , LAVATORY 1,85 CONTRACTOR A D. COOPER COMPANY SINS 1.25 ADDRESS 3510 SOUTH HILL STREET DISHWASHER 1.25 CITY ANGELES TEL. N0231_5 LAUNDRY TUB 1 STATE LIC LICENSE NO. CLASS CLOTHES WASHER 1.25 DISTRICTN0. G Z O ED BY WATER HEATER 1.50 GAS SYSTEM -. OUTLETS 1.50 ;WASTE AIPPROVAL o OUTLETS OVER 5 PER SYSTEM .90 _ INSPECTION RECORD r CD sC A4. �rC / � - o C, !/ ./ v - W C Z_ ..� o APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING 1 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 PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES NTY AND STATE OF ,GAS TEST CALIFORNIA�ABOVT TH LEGAL O N OF ANO INTE TO RESIDE IN, R D REST TI ERTY UTILITY CO.NOTIFIEDSIGNA OF PE FINAL AIMATION JACK R.ALLEN cK. M.Q. CASH SUPERVISING MECHANICAL ENGIR. .D:3':L;0 ee US 13 5 D 3.5. 0- WORKERS%C PENSATION DECLARATION t� i� �A®� ��p ®pit ll�herely affirrA that•1 have a certificate of consent to self 76A667A APPLI ATT O1`Gd DR PL�UMIiIN PERMIT an,*.•aet'e;�Nda certificate of Workers'Compensation Insurance,, CE 817(REV. 10/81) " or a c�ttfied4copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING ti ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �� )1 LEE 5 Date Appli4ant �' WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. �. COMPENSATION INSURANCE SHOWER OWNER (This section need not be eomploted If the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I'Y k71ZFI certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. so as.to become subiect to the Workers'Compensation Laws. DISHWASHER � CONTRACTOR Date _46-256P Applicant CLOTHES WASHER ADDRESS NOTIC TO APPLICANT: If, after making this Certificate. of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY6'JVW TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROC ESSFrD BY I hereby affirm that I am licensed under provisions of Chapter 9 / GAS SYSTEM OUTLETS � . (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER. AL and Professions Code,and my license is in full force and effect. 5 PER.SYSTEM FINA 0 DAT VALIDATION License Number Lic. Class 09 FI ' O Contractor Date U I am exempt under Sec. � B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ •Signature TOTAL FEE SINGLE FAMILY Plan check applicant ' HOME.OWNER-BUILDER DECLARATION Name I 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. N.o: I, as owner of the property, will do the work and the structure is not intended or offered for.sale (Section c 5 5 8 5 A 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY # 0 0 0 0 0 5 I hereby affirm that there is a construction lending agency for ° ° 3 Q,5 0 the performance of the work.for which.this permit is issued (Sec. 3097, Ci'v. C.). ° ° ° 34.50 Lender's Name 0 1.06-86 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-mentioned property for inspection purposes. �.� � SEE REVERSE FOR EXPLANATORY LANGUAGE k��!b�XA .Signatu.,re of Permittee Dbte