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Home My Public Portal About5040 RIO HONDO AVE_Plumbing__ 76A667-CEVS17 4-64 ` APPLICATION FOR PLUMBINPERMIT COUNTY' OF LOS ANGELES DEPARTNIENT OF COUNTY ENGINEER BUILDING AND SAFETY DMS.ION BUn�ss sr#a �. �/� JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM:A.JENSEN,SUPT OF BUILDING LOCALITY I '��. GJT y FOR APPLICANT TO FILL IN CROSS Si: IA Aas,4 NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET . 51.25 oZ MAIL BATH TUE 1.25 ADDRESS0 SHOWER 1.25 CITY' A-&M pZ E C>y-.V TEL.NO. 47' 78.2.26 LAVATORY 1,25 CONTRACTOR SINS 1,25 ADDRESS DISHWASHER 1.25 CITYSTATE ' LAUNDRY TUB 1,25 CONTRACTOR'S COUNTY p CC REGISTRATION NO. CLOTHES WASHER 1.25 J DISTRICT NO. GROUP ZONE PRPCEgfdgD BY WATER HEATER 1.50 GAS SYSTEM OUTLETS I'50 INDUSTRIAL STE _ APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INSPECTIPN RECORD V VP M_ � � o W N Z O C App- PATE INSPECT R'S SIONA R PERMIT $ 2 00 UNDERB WORK 4 .145 ROUGH PLUMBING TOTAL FEE .� GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING HOT WATER HEATER PLUMBING. IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COURy AND STATE OF GAS TEST �- CALIFORNIA OR THAT 1 AM THE LEGAL OWNE ,AND INTEND TO RESIDE IN, OVE DESCRIBED REBIDENTIA�IPEffrv- UTiLITY CO.NOTIFIED SIGNATURE • ! OF PERMITTEE FINAL --Fa LIDATION ROBERT A.WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG''R j 3 9 9 4i2 XL26 5 D 1 0.0 ON cv 76A667 DOS 17 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING �� ' COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER EITINTRIDTO. BR13UP ZONE PERMIT N13. FOR APPLICANT TO FILL IN PLUMBE Jtn.."J-ld * Q _ RECEIVED MY READY FOR DA•rE ISS ED FIRST INSPECTION / ADDRESS 7 , //'-L/ `LA C BUILDING s CITY C� r� 4 No.S0 ADDRESS O O ry COUNTY NO. , 6 (� EXPIRES �� Q"5 LOCALITY Q_fV ` =.A NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER�//(�i� JC�/V�.+D MAIL //�� WATER CLOSET(TOILET) 0 0.50 41 ADDRESSR C.0-44:24 s BATH TUB @ 0.50 CITY TEL NQ -77 3� SHOWER 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) GO 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK ft0 0.50 AND STATE LAWS REGULATING PLUMBING. ICERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANOELEB COUNTY LICENSE. OR 1 AM THE LEGAL OWNER GAS SYSTEM-N-1_OUTLETS db 0.50 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. SIGNATURE DF WATER HEATER 0.50 PERMITTEE GLOP SINK 0.50 INSPECTION RECORD FLOOR SINK 0.50 FLOOR DRAIN 0.50 DISHWASHER O.SO DRINKING FOUNTAIN Q 0.50 URINAL Q 0.50 'J a HOUSE SEWER 0.50 Z MISCELLANEOUS I7 AA 13 APPROVALS DATE INSPEICTOR'9 NAME ROUGH PLUMBING GAS PIPING GAB VENT CESSPOOL a 1.00 CESSPOOL (/ SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . I 1.00 GAS TEST UTILITY CO.NOTIFIED / 'f""eeY I 9_ TOTAL FEE FINAL WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76A667A ILII ata certif('d copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT..OF PUBLIC WORKS Policy N Company � Certified coy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING AA Certified copy is filed with the county building inspec- ADDRESS V (� - �Hndeparture t.. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMP ON FM WORKERS' BATH TUB CROSS ST COMPENSATION INSA CE OWNER (This section need not be completed if the work Involved by SHOWER the ermit is for one hundred dollars $100 or less. MAIL P ( ) ) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued,1 shall not employ any person in any manner SINK CITY Cl TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR` %4%0C-G- Date Applicant Q CLOTHES WASHER ADDRESS r- NOTICE TO APPLICANT: If, after making this Certificate of l Exemption, yoy should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY C TEL. NO. with comply with such provisions or this permit shall be STATE ,!L� �y LIC. deemed revoked. WATER HEATER LICENSE NO. `C b CLASS LICENSED CONTRACTORS DECLARATION DIS ICT NO. POC ED BY I hereby affirm that I am licensed under provisions of Chapter 9 c= GAS SYSTEM OUTLETS ' (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,an4 my license is in full force and effect 5 PER SYSTEM FINAL } g ��'i� DATE VALIDATION C Nim License ber Lic. Class V C� FINAL IM Contract o Date / BY C ❑ 1 am ex mpt under Sec. BAP.C. for this reason Plan check fee ® �� Cr Date: PLUMBING PERMIT ISSUING FEE$ f Signature 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 ACCUO Law for the following reason (Section 7031.5, Business and 30.37J� lbotl Professions Code): City Tel. No. 3 ❑ I, as owner of the property, will do the work and the 1 ITEM structure is not intended or offered for sale (Section ® TOTALo � 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 4+ � 16.MI hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANE o00 (Sec. 3097, Civ. C.). Lender's Name 10WO—M01 7/24/89 Lender's Address 4641 1 iX�ri110.14 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 ;bov -m nt' ned pro rty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE g at a of Per. Date f