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Home My Public Portal About6022 PRIMROSE AVE_Plumbing__ `l6AG67 (&E-817)-4/72 APPLICATION FOR PLUMBI G PERMWt COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO: ADDRESS 7!Y !U, �C[yj'fQOf /Jl HARVEY T. BRANDY, COUNTY ENGINEER LOCALITY ` Ar "* ��"n'' �I}f j FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEARECROSS ST. l.Ci�[7 . �(J�� NUMBER FIXTURE OR ITEM @ FEE OWNER J�'Q�2 WATER CLOSET 1.75 MAIL BATH TUB 1.75 ADDRESS may)5 SHOWER 1.75 CITY z:5111-y7110 TEL. NO. A141S 1'f_r1 LAVATORY 1.75 CONTRACTOR CCU 9J? SINK 1.75 ADDRESS' �' DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER 1.75 STATE ;, LIC LICENSE NO. CL SWIMMING POOL RECEPTOR 1.75 DIS ICTA EKCESSED BY LAWN SPRINKLER SYSTEM 1.75 �. WATER HEATER 1.75INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 '751INSPECTION RECORD v OUTLETS OVER - w 5 PER SYSTEM .30 V W C�. y Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 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 HOT WATER HEATER 1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - CALFORNIA OR THAT 1 IAM THE LEGAL OWNER OFA AND INTEND TO RES DE IN THE ABOVE DESCRIBED RESIDENTIAL R ERTY FINAL SIGNATURE OF PERMITTE � I PERMIT VALIDATION C M.O. CASH PLAN ClirCK VALID ON CK. M.O. C4SH L_L0957IS NGV i 5 D .75N 76AG67 (CE-817)- 5/73 APPLICATIO FOR PL&fJMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER Al, BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING. S ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCAL FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST, CROSS ST. / NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET 1.75 OWNER MAIL BATH TUB 1.75 ADDRESS SHOWER 1.j5 CITY LAVATORY 1.75 CONTRACT SINK 1.75 ADDRESS DISHWASHER 1.7S CLOTHES WASHER 1.75 STATE LIC L� 7 SWIMMING POOL RECEPTOR 1.75 LI'CENS NO. CLASS`J5 3 DISTRICT NO. GROUPNE O�ESSED BY LAWN SPRINKLER SYSTEM 1.75 D Q `I WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL n� OUTLETS 1.75S1 . INSPECTION RECORD v OUTLETS OVER 30 CD 5 PER SYSTEM O U W d �JpN Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 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 APPLICATIONHOT WATER HEATER . AND 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 EN LICSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER.OF, AND INT ND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL .R .PERTY. f FINAL SIGNATURE OF PE.RMITTE Z� PERMIT VALIDATION CK.,'M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH r.. 3 1 7 X13 DEC 5 5 D 4.75 �s. WORKERS'COMPENSATION DECLARATION 76ase7A I hereby affirm that I have a' certificate of consent to self eg.917(z-as) APPLICATION FOR PLUMBING PERMIT insure,or a certificate,of Workers'Compensation Insurance,or -a certified copy thereof(Sec.3800,:Lab.C.) COUNTY OF LOS A.NGE LES 71' BBUI LDiNG.AND SAFETY Policy No. Company � , Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified.copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE ADDRESS LOCALITY (71/department. Date Applicant WATER CLOSET + NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER 3 OWNER � , tea <W,4 U 5 LAVATORY MAI L > (This section 'need not be completed if the work involved ADDRESS !'a-ry'% a by the permit is for onehundred dollars ($100) or less.) SINK CITY TEL.NO. U I certify. that in the performance of.the war or which this DISHWASHERCr.permit is issued, I shall not employ any any mann CONTRACTOR 0 , so as to beco subject to the ke ensation Laws. � f CLOTHES WASHER ADDRESS U �Date'7-1� -Applicant AZ SWIMMING POOL RECEPTOR OW, NOTICE.TO APPLICANT: If,a er maki this Certificate.of CITY TEL.NO. V) Exemption, you should bec a subject. to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code,'you must forth- WATER HEATER. LICENSE NO._ CLASS with comply with such ,provisions or this permit shall,be deemed revoked. DISTRICT NO. P CESSED BY GAS SYSTEM OUTLETS p/ i LICENSED CONTRACTORS DECLARATION t OUTLETS OVER S, 0 O I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of Zhe Busi- FINAL o-r VALIDATION ness and Professions Code, and my license is in.full force and DATE effect. License Number Lie.Class FINAL r- _ BY ---�P Contractor Date I am exempt from the licensing requirements as I am.a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in 'my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL.FEE Lie.or Reg.No. . Date Plarl check applicant HOME OWNER-BUILDER DECLARATION Name „is. - , (e. (57jeA V I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section.7031..5, Busi- City � C—I Tel.No 9i5__V 3f g 52 a 2 A nes rid Professions Code): I, as owner of the property, am, exclusively contracting $i o 0 0 0 o-5 with licensed contractors to construct' the project (Section 7044,Business and Professions Code). { 2 0 01600. CONSTRUCTION LENDING AGENCY ! T o 0 0 600 U I hereby affirm that there is a construction.lending agency for the performance of the work for which this permit is r' ` '05-1 5-,81 issued(Sec.3097,Civ.C.). 1 Lender's Name Lender's Address I + I certify that I.have read this application and state that. the above information is correct.I agree'to comply with all County I SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and Stat a :Iating Plumbing, and herebyauthoriz epres ativ ofs Country to enter upon theabo -ment n pro ty pection purposes. , Signa r of P ititt Data '