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Home My Public Portal About5740 RIO HONDO AVE_Plumbing__ COUNTY OF LOS ANGELES APPLICATI®N FOR 3PEBRW Department of County Eagineer DIVISION OF BUILDING & SAFETY12 11.am WILLIAM J. FOX, County Engineer DISTRICT P . � • � F R - - ANT TD FILL IN � - �- / ---#'00, PLUIyBE READY FOR RFEI_y�,D 9' DA IBSU ys��y FIRST INSPECTION ADDRESS J . /L CITY -41,01 L,N �4��%� t- ADDRESSCOUNTY LICEN E O. EXPIRE9� `� LOCALITY NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) R 0.50 III ADD S BATH TUB 409 O.SO CITY -TEL N 7AZE SHOWER -0 0.50 1 HE Y ACKNOW BE THAT 1 HAVE READ THIS LAVATORY (WASH BA91N) 0.50 APPLICA ION ANDS E THAT THE ABOVE IS-CORRECT AND AGREE TO COM WITH ALL COUNTY ORDINANCES KITCHEN BINK 0.50 AND STATE LAWS R GULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LI ENBE, OR 1 AM THE LEGAL OWNER OF THE REBIDENTI PS TY DESCRIBED ABOVE. BAB SYSTEM OUTLETS 0.50 SIGNATURE OF �!!��iG ��+F/ WATER HEATER. O.SO �J PERMITTE GLOP SINK O.5D INSPECTION RECORD FLOOR`SINK 0.50 FLOOR DRAIN Q 0.50 DISHWASHER 0.50 DRINKING FOUNTAIN R 0.50 URINAL Q 0.50 HOUSE SEWER 6 .0.50 Z MISCELLANEOUS APPROVALS •� DATE INBPECTOR'B NAME yROUGH PLUMBING i GAB'PIPING BAS VENT -- CESSPOOL 1.00 1 CESSPOOL SEPTIC TANK., SEPTIC TANK DRAIN ( ) PIT ( ) 1.00 . SEWER PERMIT 1,00 BASTE UTILITY CO.NOTIFIED TOTAL FEE , 42- FINAL 76A667 DBS#17 10/58 i J WORKERS'-COMPENSATION DECLARATI nt APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A6667A PW 4/87 sure,or a certificate of Workers'Compensation Insurance,ora CE 817(REV.8/86)' I I certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS LLLJJJ Policy No. Company ' Certified copy is hereby furnished. (�'�'�Jl.tt FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ADDRESS J�?�0 R L.� „� department. @ FEE. LOCALITY Date Applicant WATER CLOSET-(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUBCROSS.ST. COMPENSATION INSURANCE SHOWER OWNER ff(F6p0tz S AL4 S N� (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.). LAVATORY ADDRESS S R Wl I,certify that in the performance of the work for which this per- .mit is issued, I shall not employ any person in any manner so SINK CITY TEL. NO. as to become subject to the Workers'Compensation L ws. DISHWASHER �—^ _0. CONTRACTOR Date o[ Applican CLOTHES WASHER ADDRESS biv NOTICE TO•APPLICANT: If, after making this Certificate of Epi- SWIMMING POOL RECEPTOR emption-,you should become subject to the Workers'Compen- CITY TEL. NO. ,sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit-shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED'CONTRACTORS DECLARATIONDISTRICT No. OCESSED BY I hereby affirm that I am-licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division of the Business OUTLETS OVER �' D and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION >_ feet. _ DAT CL 'License Number Lic. Class V FIN �g Contractor Date BY O I am exempt under Sec. W B.&P.C. for this reason Plan Check fee ► CO) Date: PLUMBING PERMIT ISSUING FEE$ O Signature thz TOTAL FEE SINGLE FAMILY. HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name � Law for the following reason Section 7031.5, Business and r•��" Professions-Code): Address _, 28. )l '350 I, as owner:of the property, will do .the work and the City Tel. No. T _ ,�. structure is not intended or offered for sale'(Section 7044, ' i EM s Business and Professions Code). ► ,•,-•a- t. CONSTRUCTION.LENDING AGENCY t1- ,L}ell 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued e013 (Sec. 3097, Civ. C.). Lender's Name f yj^r__; I_I Lender's Address 1421 iAll, 8-1501 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 above-mentioned operty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date