HomeMy Public PortalAbout5943 PRIMROSE AVE_Plumbing__ 76 A 667-.CE 817 7-69
APPLICATION FOR PLUMBING PER
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGxNm
BUILDING AND SAFETY DMSION SUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADORES$'
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY e
FOR APPLICANT TO FILL IN PR NT OR TYPE.. NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE .
i
WATER CLOSET 1.$0 OWNER
BATH TUB 1.50 A DRESS Q
SHOWER 1.50 ClFY TELN.
LAVATORY 1.50 CONTRACT
SINK 1.50 ADDRESS
DISHWASHER • 1..50 CITY TEL: NO:
CLOTHES WASHER1.50 STATE L-I C
LICENS O. CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. G Z E R D
LAWN SPRINKLER SYSTEM 2 00 D
WATER HEATER INDUSTRIAL
GAS SYSTEM ' OUTLETS 1.50 'INSPECTION RECORD;
OUTLETS OVER gy
30
S PER SYSTEM "' "�, R ' � gDo''_ //�(.•'��1 �IJ�C/ .1��
z
Plan check fee 257. bf•above. See reverse.
PLUMBING PEAMIT ISSUING FEE 8 00
TOTAL.FEE APPROVALS. DATE 'INSPECTOR'S SIGNATURE
Plan check-applicant
UNDER.SLAB WORK:
Name ROUGH PLUMBING
Address GAS PIPING
'GAS VENT
City. Tel. No.
HOT WATER HEATER i7•r +�
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING'FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
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
RESIDE IN,THE ABOVE DE IB RESIDENTIAL PROPERTY. FINAL &=4-7/1
-
SIGNATURE JACK R. ALLEN, SUPERVISING MECHANI AL EN
OF PERMITTEE
.=,f VALIDATION. c ... M.b CASH.
PLAN CHECK VALI°DATION CK. ee.0. CASH
WORKERS'CQMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby,offirp that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.8/86)
ora rtified co t yec. 38 C.t
Poq At
dmpany 1 ' �• �� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
❑ Certified copy is hereby furnished. BUILDING
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 7 ;
Date 1 25' �AppliganTFM
�+ WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTIORKERS' BATH TUBCROSS ST.
COMPENSATIONE SHOWER OWNER 0
(This section nood not be completed if the work Involved by MAIL T-i-41�
the permit Is for one hundred dollars($188)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.2 �� I
so as to become subject to the Workers'Compensation Laws. DISHWASHER A -
CONTRACTOR '
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR 1.
Exemption, you should become subject to the Workers' CITY ) TEL.NO "
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE ^ LIC.
deemed revoked. WATER HEATER LICENSE NO. , i,. 6 CLASS,
LICENSED CONTRACTORS DECLARATION DISTRICT NO. P D BY
OUTLETS
OUTLv
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code and my license is in full force and ff ct. 5 PER SYSTEM FINAL VALIDA ON
�. ' DATE
License Number Lic. Class ✓
FINAL 99CContractor Date—,
ate BY / �7 9 9.8 A
❑ I am ex pt under Sec. V
B.BP.C. r this reason # 0 0 0 0 0 5
Plan check fee
Date: 1 0 0 1 6,50
PLUMBING PERMIT ISSUING FEE$
Signature TOTAL FEE o 0 o 1 6505
Plan check applicant 09.25-87
SINGLE FAMILY
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 and state that the 00.
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
abov ntione roperty for inspectiory,p irposes.
tVf/.�'�Z// SEE REVERSE FOR EXPLANATORY LANGUAGE
✓0
Signature f ermittee Date