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Home My Public Portal About6122 PRIMROSE AVE_Plumbing__ �'e"eg' " 5-E0 10APPLICATION.FOR PERM - DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICTNO. GROUP I ZONE- PERMIT NO. WINTERBOTTOM Mi:,S., I ©7�7 q PLUMBER RECEIVED BY READY FOR DATE ISSUED /�} FIRST INSPECTION ADDRESS AI HAMRRA� f AI IFnRNI�Q ��,, BUILDING CITY TEL. NO. ADDRESS D r.xo •M AsIg COUNTY _LICENSE NO. I I EXPIRES hao,';(leySV LOCALITY • NEAREST PERMIT FEES CROSS ST. axx v :7 NUMBER TYPE OF FIXTURE OR ITEM., FEE OWNER ,PR C. I A m ' MAIL WATER CLOSET (TOILET) Q 0.50 S 1;- ADDRESS �.^ V9 BATH TUB Q 0.50 :CITY t TEL. NO. I SHOWER ® 0.50 -3o- I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS P LAVATORY (WASH BASIN) Q 0.50 -3 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK- @ O.50 ! STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY ® 0.50 C ANGELES COUNTY EN OR 1 A THE LEGAL OWNER OFT NT P ER I�B GAS SYSTEM-3--OUTLETS (B? 0.50 R: 5 �� 017 WATER HEATER @ 0.50 I PERMITTE SLOP SINK A 0.50 ,. INSPECTION RECORD FLOOR SINK Q 0.50 FLOOR DRAIN @ 0.50 DISHWASHER Q 0.50 /+ n DRINKING FOUNTAIN @ 0.50Iy URINAL Q 0.50 �1 /•i!/'7'% 9.9V(] /J-+tniU� .1 HOUSE SEWER ® 0.50 /�!i)D MISCELLANEOUS I F, h, ,� 0 APPROVALS rte DATE /INSPECTOR'S NAME .. ROUGH PLUMBING / ..O GAS PIPING GAS'VENT CESSPOOL ® 1.00 I CESSPOOL SEPTIC TANK: I SEPTIC TANK DRAIN ( ) PIT ( ) ® 1.00 SEWER PERMIT . I 1.00 GAS TEST 1Y►1 I 1/ MR UTILITY CO. NOTIFIED TOTAL FEE I $ J 100, I �,) � �,('�`V' FINAL WORKERS'COMPENSATION DECLARATION 76A667A r p I hereby affirm that I have g certificate of consent to self cr. at7(z-a0) A P P L i!C A T I O N FOR PLUMBING PERMIT "tUy insure, or a certificate of Workers'Corrigosation Insurance, a certified copy thereof(Sec.3800,La ) / COUNTY OF LOS ANGELES 1 DING AIN SAFETY Policy No. Compan Certified copy is hereby furnishe . FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING - ADDRESS � Certified copy is filed with the county build' g' spection NUMBER FIXTURE OR ITEM • FEE de�r��!!�f�j1� LOCALITY Date_L_LLL f pplicant WATER CLOSET NEAREST BATHTUB CROSS ST. CERTIFICATE OF EXEMP ON FROM WORKE COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved LAVATORY MAIL ADDRESS Q by the permit is 'for one hundred dollars ($100) or less.) } SINK CITY TEL.NO.2/� O I certify that in the performance of the work for which this I DISHWASHERU permit is issued, I shall not employ any person in any manner CONTRALTO so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS -leO Date Applicant SWIMMING POOL RECEPTOR 1-- NOTICE NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM IL Compensation provisions of the Labor Code, you must forth- STATE LIC. CO) p p / LICENSE NO. CLASS with comply with such provisions or this permit shall be WATER HEATER s deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER ' I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL ness and Professions Code,and my license is in full force and DATE �" / VALIDATION effect. FINAL License Numb Lic.Class �L/ BY Contractor Date f / I am ex rom t e icensing requirements as I am a Plan Check fee _ licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Bus- PLUMBING PERMIT ISSUING FEE$ iness and-Professions Code). TOTAL FEE Lie.or Reg.No. Date Plan check applicant p �•; ''+�,� frig Name ' HOME OWNER-BUILDER DECLARATION - 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. �`•'91 9.b A ness and Professions Code): ❑ i, as owner of the property, am exclusively contracting ty 0.0 0 0 o 5 with licensed contractors to construct the project 2 0 - 1650 (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency (' 1. 18-83 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 his County to enter upon the above-menti ed proper fo inspection purposes. Ll Sign ure of Ktmit fee Date