HomeMy Public PortalAbout5814 PRIMROSE AVE_Plumbing__ 78A887-CE#817 4-64 /'op� �
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APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING
BUILDING AND SAFETY DIVISION
JOHNJOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN, SUP'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
NUMBER FIYTURE OR ITEM EACH FEE
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WATER CLOSET 51.25 OWNER
BATH TUB 1.25 ADDRESS
SHOWER 1.25 CITY TEL. N 6
LAVATORY 1.25 CONTRA R
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY 7, TEL N �09(3
EGT
LAUNDRY TUB 1.25 RIT ON NO. COUNTY
CLOTHES WASHER 1.25 DISTRICT NO. GROG NE PROC SED BY
WATER HEATER 1.50 c i
GAS SYSTEM OUTLETS 0
1.50 INDUSTRIAL
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .50 INSPECTION RECORD V
0
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W
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_ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 5; 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GASPIPING
1 HEREBY ACKNOWLEDGE THAT'S HAVE READ THIS APPLICATION GAS VENT
ANI 2. 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 �os
A ETES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1A AL OWNER OR,AND INTEND TORESIDE IN.THE ABOVEDEB IRESIDENT L PR UTILITY CO.NOTIFIED
SIGNATURE
lop
OF PERMITTEE
FINAL ✓
VAL a
VALIDATION_ —,ROBERT A. WOOD
M.O.
CK. M.O. CASHSUPERVISING MECHANICAL ENG'R
L1 2 7 2- APR 14 5 D 350N V
PLUMBING I
DEPARTMENT OF COUNTY ENGINEER 9� !
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES LDING
WILLIAM J. FOX, COUNTY ENGINEER AD
FOR APPLICANT TO FILL IN LOCALITY C
BUILDING NEAREST
ADDRESS CROSS ST.
DISTRICT N�(1,, GROUP ZONE PERMIT NO.
LOCALITY r//� .per 3 or�-
NEAREST �dV Ready for Inspection D TE ISSU D
CROSS ST.
OWNER
MAIL DUSTRIAL 00'r 9
ADDRESS WASTE APPROVAL
CITY �r TEL.No.00,
INSPECTION RECORD
PLUMBER.���/JG �Aar,
ADDRESS R-o7C
CITY TEL.NO. 6-12/2
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❑STATE /�; � �e^✓a' ,e�,t+�{�-Q.s�t��R'��
LICENSE NO. /19sy XCOUNTY f J( J
PERMIT FEES
4UM13ER TYPE OF FIXTURE OR ITEM FEE �� Z
WATER CLOSET(TOILET) Q 0.80 S
f BATH TUB Q 0.80
SHOWER ' @ 0.80
/ LAVATORY(WASH BASIN) 60 0.80 IrQ
KITCHEN SINK 0.80 ffv
LAUNDRY TUB OR TRAY 0.80
SLOP SINK 0.80
FLOOR SINK 0.80
FLOOR DRAIN @ 0.80
DISHWASHER 0.80
DRINKING FOUNTAIN 0.80
i URINAL @ 0.80
/ GAS SYSTEM.....3......OUTLETS @ 1.00 /
/ WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK t
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE _ GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP Ll- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES „ /I
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TESTAND STATE OF OR THAT I M THE LEGAL
S 'jlr `Ln
ER OF THE ABOVELIFORNIA DESCRIBED R SIDENT AL PROP RTY.OWN UTILITY CO.NOTIFIED
SIGNATURE �jp/�
OF PERMITTEE ...._..�._. i ......
FINAL
• 76A667 DBS 17 1/53
WORKERS'COMPENSATION DECLARATIONcr&887q APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have g certificate of consent to self Ice en(z-eo)
insure,or a certificate of Workers'Compensation Insurance,or
a certif)ed.copy,thereof(Sec.3800,Lab.C.)
COUNTY OF LOS ANGELES-BUILDING AND SAFETY
Policy No. Company
0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
❑ NUMBER FIXTURE OR ITEM • FEE ADDRESSZ14Pr-qt
Certified copy is filed with the county building inspection
department. LOCALITY
WATER CLOSET
Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER a
(This section need not be completed if the work involved LAVATORY MAIL
ADDRESS t'I h h s
by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL..NO. >_bh. . . d
I certify that in the performance of the work for which this DISHWASHER U
permit is issued, I shall not employ any person in any manner CONTRACTOR o
so as to become subject to the Workers' o ensation Laws. CLOTHES WASHER .�
ADDRESSxq 3:Z ak V
Date 1�l'g(T Applicant SWIMMING POOL RECEPTOR g�
NOTICE TO APPLICANT: If, aft. aki g this Certificate of CITY L.N ?�Cf.l.( a
Exemption, you should become subject to the. Workers' LAWN SPRINKLER SYSTEM STATE 2 LIC. �p
Compensation provisions of the.Labor Code, you must forth- WATER HEATER LICENSE NO. 3 CLAS
with comply with such provisions or this permit shall be
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. SED
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
7 hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL Iz q.' - / VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect.
License Number+�� � I Lic.Class , BANAL
_pp a..
Contractor ddN49LTi.. &d Date 1 f�!g
QW—
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my prbfessional 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- Tel.No.
ness and Professions Code): -r 2 0 2 8 P
I, as owner of the property, am exclusively contracting I
with licensed contractors to construct the project trt o o 0 0 o 5
(Section 7044,Business and Professions Code).
20 - 1000
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency 0 0 0 1 o O 0
for the performance of the work for which this permit is
issued(Sec..3097,Civ.C.). l 1. 1 9-81
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
aut 'rize represents es of this County to enter upon the
a -mention d pr4pility for inspection purpos
i at reef rmittee Date I
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