HomeMy Public PortalAbout4846 RIO HONDO AVE_Plumbing__ 76A667 OBB 17 11-50 .1 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
O. RO
/FOR APPLICANT TO FILL IN 5 ,�^/d` r+/
PLUMBER` R RECEIVED BY READY FOR •1D�AT(p Is �Ej0
FIRST INSPECTION
ADDRE8-9 '�
BUILDING
CITY TEL.No&p ADDRESSCOUNTY
LICENSE NO. 19
D EXPIRES '�O LOCALITY LAIC n
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER � �-• 1�Y1�--s
MAIL
WATER CLOSET(TOILET) @ 0.50 # ADDRESS3 Q
BATH TUB 0 0.50 CITY TEL No Q e7a�bs�
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM.3-OUTLETS 0.50
SIGNATURE OF
WATER HEATER 0.50 PERMITTE '.
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR BINK O.5C
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 J
HOUSE SEWER O.5C Z
MISCELLANEOUS 19
O
APPROVALS
DATE INSPECTOR-8 NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1;013 CESSPOOL
SEPTIC TANK. SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT I 1.00 GAS TEST
_ UTILITY CO.NOTIFIED y
TOTAL FEE /ISO O FINAL
F
WO'RKERS'T"0M0ENSATIONDECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm JKc!t I hatye� a certificate ofc�seW to*self-^ '? 4ji7A
•' insure;or a c9dificate of Workers'Cdinpensation Insurance,,, CE 817 JREV 10/31)
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy Na. Company
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
Date Appli4ant WATER CLOSET NEAREST,
CERTIFICATE OF EXEMPTION.FROM WORKERS' BATH TUB ROSS ST:' ''
COMPENSATION INSURANCE OWNER
(This section need not be completed If the work Involved by SHOWER. aP /
ALM
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS /
I'certify that in.the performance of the work for which this
permit is issued; I shall not employ any person in any manner SINK CITY I TEL.NO.
so as to beco a subject to the Workers'Compensat n Laws. DISHWASHER -
CONTRACTOR
Date pplicant CLOTWES'WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of. SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers'
CITY TEL. NO.
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be j STATE LIC.
deemed revoked. PATER HEATER LICENSE NO. CLASS,
LICENSED CONTRACTORS DECLARATION DISTRICT NO. P OCESSED BY
I hereby off irm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS r
(commencing with Section.7000)of Division 3 of the Business ' OUTLETS OVER Z .y„
and Professions Code,and my License is in full force and effect. if 5PER SYSTEM FINA _ VALIDATION 0.
��
DAT
License.Number Lic: Class
• FIN 09Contractor Date BY/
❑ I am exempt under Sec.
BAP.C. for this reason. Z
'I Plari check fee � _ Z
Date. PLUMBING PERMIT ISSUING FEE$' _
Signature
1 TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address ;"r ) {,,
Law for the following reason (Section 7031.5, Business and
(Pr ess ons Code): City Tel. No. ? 0 0 0 0 a JZ
LJ I,.as owner of the property, will do the work and the '
structure is not intended or offered for sale (Section , C 0 0 7[I. 0
7044.,.Business and Professions.Code).
CONSTRUCTION LENDING AGENCY 4r
I hereby affirm that there-is a construction lending agency for C7 d 5 :E 4
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 I
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
�above-m�oty tion purpo es. SEE REVERSE FOR EXPLANATORY LANGUAGE
ignaturate