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HomeMy Public PortalAbout5022 RIO HONDO AVE_Plumbing__ `7fgA667 oBs 17 It-so APPLICATION FOR PERMIT ?bEPARTMENT OF BUILDING AND SAFETY • '" COUNTY OF LOS ANGELES i WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1 G R FOR APPLICANT TO FILL ��IN�� DISTRICT d O. ZONE PERMIT . /3O�Q_ ,� PLUMBE �, w -ir' RECEIVED BY READY FOR DAT/E ISSYEEDD pd FIRST INSPECTION `L ADDRESS , Gf�. f/ !/Ia!/' CITY ��r r rw�.. o TEL.No. ADDRESSULIN" ��( 1Y el' COUNTY / �� m`" LOCALITY LIOENSE NO. �/ EXPIRES ry aVdr NEAREST PERMIT FEES CROSS SST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNE"� .PV 'oO tom' S'►M'y�.. is _'" _'_rim MAIL I WATER CLOSET(TOILET) @ 0.50 $ ADDRESS, Q BATHTUB @ 0.50 CITY�v Ysi� , TEL Np,. © �eiD a SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POBBEBB THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER GAS SYSTEM OUTLETS @ 0.50 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. WATER HEATER @ 0.50 SIGNATURE �` 'u-"` a, SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 J Q HOUSE SEWER @ 0.50 Z MISCELLANEOUS / 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING n GAB PIPING GAS VENT /2r7'G rr CESSPOOL @ 1:00 CESSPOOL v SEPTIC TANK: SEPTIC TANK DRAIN ) PIT ( ) @ 1.00 SEWER PERMIT I 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE IS "/ FINAL t� 1 ` WORKERS'COMPENSATION DECLARATION 20-0026 APPLICATION FOR PLUMBING PERMIT �*L hereby,' jm rthd{II have a certificate of consent to self in- 76A6667ADPW 4/87 su",or a ceitificate ofMorkers'Compensation Insurance,or a CE 817(REV.8/86) certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. BUILDING r FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS }�� department. NUMBER FIXTURE OR ITEM @ FEE �J LOCALITY e)M Date Applicant WATER CLOSET(TOILET) (/D NEAREST - BATH TUB n,A CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' (J COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by _ the permit is for one hundred dollars($100)or less.) f LAVATORY(dOMMI SilOZJ ADDRESS S 1 certify that in the performance of the work for which this per- SINK CITY TEL. NO. mit is issued, I shall not employ any person In any manner so as to become subject to the Workers'Com a do Laws. DISHWASHER r CONTRACTOR Date Z Applicant CLOTHES WASHER ADDRESS NOTICE TOA LICANT: If, after making this6tertificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY / TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROSSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER A& and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINALVALI ION >_ fecf. DATE - 0 License Number Lic. Class V FINAL ContractorDate BY O I am exempt under Sec. vyk W f3 B.&P.C. for this reason Plan check fee ► Date: PLUMBING PERMIT ISSUING FEE$ Signature SINGLE FAMILY TOTAL FEE 2 10 7 9 A HOME OWNER-BUILDER DECLARATION Plan check applicant # 0 0 0 0 0 5 I hereby affirm that I am exempt from the Contractor's License Name C, w Q ( o o 4 Q 5 0 Law for the following reason (Section 7031.5; Business and Professions Code): Address v - 40.505) 1, as owner of the property, will do the work and the I Citype t Tel. No. 3"-6 structure is not intended or offered for sale(Section 7044, 1 1,07-88 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 I certify that I have read this application and state that the ► 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 abo t. d p perty f spection purposes. � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature GVPern0tee Deffe