HomeMy Public PortalAbout5734 PRIMROSE AVE_Plumbing__ n 7GA56'P(CE-817)- 5/73 -
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: FNEAREST
3�
HARVEY T. BRANDT, COUNTY ENGINEER a `
FOR APPLICANT TO FILL IN (PRINT OR TYPE) r /q
C/
NUMBER FIXTURE OR ITEM ® FEE
WATER CLOSET 1,75 ,Will
MAIL /J
BATH TUB 1.75 ADDRESS
SHOWER 1,75 r- CITY "p , TEL. NO. 3rd
LAVATORY 1,75 CONTRACTOR }
--3A+
SINK 1.75 ADDRESS
DISHWASHER 1.75 CITY TEL. NO.
CLOTHES WASHER 1.75 STATE LIC
SWIMMING POOL RECEPTOR 1.75 LICENSE NO. CLASS
D .CT NO. GROUP SED ZONE OCE BY
LAWN SPRINKLER SYSTEM 1.75 5r f -
WATER HEATER 1.75 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD o
OUTLETS OVER -
5 PER SYSTEM .30
r
G7
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE S 3 . 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name T ` ROUGH PLUMBING
Address r ��� GAS PIPING
City Tel. No. GAS VENT
HOT WATER HEATER
1 HEREBY ACK WLEDGE THifT I HAVE READ THIS APPLICATION
AND STATE THAT THEABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES .7-4i,7V
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE.OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO 7
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL —/Z-791
SIGNATURE � / a
OF PERMITTEE--2&- /J l'
PERMIT VALIDATIONcK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
o, 3 8AMAR 12 5' 0 1 0.4.0 ®98
'eAQB7 -APPLICATION FOR PLUMBING "PERMIT 1
PBS-17 10.59
DIVISION OR B=. ING AND SAFETY
Deportment of 'County Engineer-
County of Los Angeles BUILDING -7
JOHN A.LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D,GRIFFIN,SUPT 6F BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
OWNER DISTRICT GROUP READY FOR INSPECTION
MAIL gAge
ADDRESS c.3 /
INDUSTRIAL
CITY l TEL.NO' ds WASTE.APPROVAL
r ® INSPECTION RECORD
PLUMBER �
ADDRESS
CITY 4 TEVNO.NO. ' �✓ "- t ..2, 6 �' O
QQom�++ s
LICENSE NO.
LICENSE `y+�.L4t��.L9 �a 0��iLlc1-• •�.J
NUMBER TYPE OF FIXTURE OR ITEM. FEE .�
WATER CLOSET (TOILET) Q $1.00 $
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASHBASIN) @ $1.00
KITCHEN SINK @. $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY Q $1.00
CLOTHES WASHER @ $1..00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ •.1 00 ROUGH PLUMBING »G.+O...A
GAS PIPING _
TOTAL_FEE r�. GAS.VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ' THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS•CORRECT AND•AGREE TO COMPLY
WITH ALL -COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES -
I HEREBY CERTIFY THAT I AM PROPERLY, REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ELES COUNT STATE OF
CALIFORNIA OR THAT I AM LOS
THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDENT] TY: /
SIGNATURE
OF PERMITTEE FINAL
'OHN A.LAMBIE_ .COUNTY ENGINE0,11, VALMATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR y
-M.0. .CASH
x:02�6 0 3- lfw 21. 2.0 0
.-WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
4 ,);ereby firm that I�hov&a'eirtificate of consent to self 76A667A
'I ure, or.° ceKIificate•'of Workers'Compensation Insurance, CE 817(REV. 10/81)
or a cEi'tified'copy thereof(Sec. 3800, Lab. C..) ;, COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy Nq. Compan_y
❑ Certified copy4g:hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING n C
Certified copy is filed with tli*e county building,inspec- ADDRESS �KV.]v
tion tmlegt. a� �, NUMBER FIXTUREORITEM (ci? FEE'
LOCALITY
C ° ~ WATER.CLOSET
Date) �S pll`�an{ � NEAREST
CERPI?ICAiPOF EXEAFTJON FROM WORKERS' BATH TUB CROSS ST.
5' PEN5ATPN VASURANd' SHOWER OWNER Q4
(This sectivn�ueed pot-he completed•IF the work Involved by
the permit 1.for bne hundred dollars($100)or less.) LAVATORY MAIL
ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner -SINK CITY P/ �� TEL.NO. ,�—
so as to become subject to the Workers'Compensation Laws. DISHWASHER v=�/� af,,•
CONTRACTOR ,��►u� �'
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Q
CITY TEL.NO;Z?E4
Compensation provisions of the Labor Code, you'must forth- tJ %0
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE j'^a LIC.
deemed revoked. WATER HEATER LICENSE NO. 2,3 7 CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROC ED BY'
I hereby affirm thatI am licensed Under provisions of Chapter 9 GAS SYSTEM OUTLETS �. �j r/
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER. �f (J b
and Professions Code,and m license is in full force and effect. 5 PER SYSTEM y'
my
0 . DATEFINA1® VALIDA ON 0
�y u U
License Number`1 3� Lic::Cla
FIN
Contractor��-�� AX-S.Date I a BY 221 Q 1 A O
❑ I am exempt under Sec. # o a o 0 0'5 �i
BAP.C. for this reason ,
Plan cheek fee ' Iaa2250
Date:
PLUMBING PERMIT ISSUING FEE$ ► o o'0 2.2 5 _
Signature 0.5
TOTAL FEE Z 04.23-85
.SINGLE FAMILY
Plan cheek 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.-No.
❑ I, as owner of the property, will.do the work and the
structure is not intended or offered for sale (Section ,
7044, Business and Professions Code).
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
1 certify that I have read this application Slad state that the ►
above informati is c e I agree mply with all County
ordin s an St s regu ng Plumbing, and h reby
a r es ryes'of. is County to en r u n the
I d pr er or inspection p j e�
SEE REVERSE FOR EXPLANATORY LANGUAGE
'Signature of Permittee / Date (I