The URL can be used to link to this page

Home My Public Portal About5626 PERSIMMON AVE_Plumbing__ 76AGS7 (CE-817)-4/72 i • /`'. 'APPLICATION .FOR PLUMBING PERMIT 41, COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY.ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING • ADDRESS �� + ��J1✓IMvN �1d�', HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. l�Fs�t°5»►�MI�+O/ L1 Y G.4 iC NUMBER. FIXTURE OR ITEM ® 'FEE )� / WATER.0LOS ET 1,75 ' 7r OWNER Oh/�� d!J . �/i✓�AN - MAIL BATH TUB 1,75 ADDRESS 7.a ��i1 ��►7/ls D.y✓ ��F SHOWER 1,75 '�� CITY �`E�yjfat ��jj y TEL.'NO.-f1--)45* LAVATORY 1,75 'i 3b CONTRACTOR jew�/z o Az- Me9 SINK 1.75 •J ADDRESS /� DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER 1.75 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.75 DIS RICT N1y�� GRO. WN OCE E Y LAWN SPRINKLER SYSTEM 1..75 )j. WATER HEATER 1.75 INDUSTRIAL `C'/ WASTE APPROVAL �y GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM .30 W d . h Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 31 00 TOTAL FEE APPROVALS QATE Y(OECTOR'a SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING � Address GAS PIPING City Tel.-No. GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AMD STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY 'REGISTERED AND/'OR UTILITY CO. NOTIFIED J'J'� � 0 .1,01 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND S'T'ATE OF �y / CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND 1' TEND TO `X [IV RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL SIGNATU RE OF PERMITTE�0( 41 PERMIT VALIDATION CK. CASH PLAN CHECK VALIDATION CK. M.O. !CASH r LjCo 0 7 :1 '6 J JAI4 2 4 ' 5 0 11.75- 76A667,,4GE-8171- 5/73 .21a_ (J�,7l�L APPLICATION FO PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ` MAKE CHECKS PAYABLE,TO: . ADDRESS HARVEY T. BRANDY, COUNTY ENGINEER LOCALITYt�,, .FOR APPLICANT TO FILL IN (PRINT OR TY PEI NEAREST CROSS ST. NUMBER FIXTURE OR ITEM @ FEE i WATER CLOSET 1.75 OWNER / ,�s�'✓^� r , � �vy„f• MAIL BATH TUB 1,75 ADDRESS SHOWER 1.75 CITY 0' -1 JaL� C)) TEL. NO..d� Z LAVATORY 1.75 CONTRACTORSINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. N0. CLOTHES WASHER 1.75 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. 'GROUPNE�..,PR LAWN SPRINKLER SYSTEM 1,75O 11 WATER HEATER 1.75 INDUSTRIAL. WASTE APPROVAL p� GAS SYSTEM OUTLETS 1.75 jr INSPECTION RECORD Com.) OUTLETS OVER 5 PER SYSTEM .30. + p .Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 31 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK- Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER V I AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING �. V PLUMBING. GAS TEST �� • f I HEREBY CERTIFY'THAT 1 AM-PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED 41 1� A LICENSED AS RECIUIRED BY LOS ANGELES COUNTY AND STATE OF '�' CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO �J�i`� RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL 'd✓ SIGNATU RE } '1. f OF PERMITTEE .�+� /T':^✓'•Z�J L .�1?s°Pii�'n PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 0 9-a4 MAR 15 . '5 •D- 4.7'5,A-% WORKERS'COMPENSATION DECLARATION 78p667p APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have ar certificate of consent to self r.19817(2-60) insure,or a`certificat2 of Workers'Compensation Insurance,or 'fl a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES � BUILDING AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING p EM • FEE ADDRESS 5—&'2G / bt J�II MIPII ✓r_, E] Certified FIXTURE OR IT Certified copy is filed with the county building inspection LOCALITY`7�.,,VpJ_,W r_17-1 department. WATER CLOSET Date- Applicant NEAREST y /� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER _22aYlyyl�l LAVATORY MAIL r SDN (This section need not be completed if the work involved LAADDRESS by the permit is for one hundred dollars ($100) or less.) SINK CITY-7—. C, TEL.N0f1r7—D"3 O I certify that in the performance of the work for which this DISHWASHER 3+�N� V permit is issued, I shall not employ any person in any manner CONTRACTOR cc so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS O Date Applicant SWIMMING POOL RECEPTOR U NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. LU Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. N Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS �. DISTRI T NO. R EBBED Y LICENSED CONTRACTORS DECLARATION OUTLETS OVER �� I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL �, VALIDATI ness and Professions Code, and my license is in full force and DATE Z '2 f e¢ effect. FINAL License Number Lic.Class BY �_+ Contractor Date El I am exempt from the licensing requirements as I am a Pian check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 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 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. R 3 0 9.7 A ness and Professions Code): ❑ I, as owner of the property, am exclusively contracting j o 0 0 0 0 ri with licensed contractors to construct the project o o 4 (} (Section 7044,Business and Professions Code). ` CONSTRUCTION LENDING AGENCY o o I hereby affirm that there is a construction lending agency r 3 0 T —8r' 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the !:e;rn tinned grope �rection purposes. Signature of Permittee Date