HomeMy Public PortalAbout5756 RIO HONDO AVE_Plumbing__ 78AB67 DB917 II-90 APPLICATION FOR PERMIT
DEPARTMENT OF NG AND SAFETY PLUMBING
COUNTY OFF LOS LOS ANGELES
WILLIAM J. FOX, CHIEF ENSINEER
DISTRICT GR P .
FOR APPLICANT TO FILL IN I ZONE �31;, �
PLUMBER Revere Service 9=1RECEIVED Sir READY FOR DATE ISSUED
/ 1 IRSTINSPECTION
ADDRESS Teale ` S r
BUILDING
CITY C (;j TEL.NO. gX ADDRESS r
COUNTY LOCALITY
LICENSE No. r EXPIRES .�
e NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) 0.50 8 ADDRESS Sam as above
BATH TUB @ 0.50 CITY TEL No.
SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORYAWASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND BTATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID L138
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LIOENQE, R I AM THE LEG Is OWNER
OF THE RESIDENTIAL P OgEE"RTYY++DESCRIBED NE.
GAS SYSTEM OUTLETS 0.50 SIGNATURE OF `y�r.ln�� �[ -��, ,i
-17
WATER HEATER @ 0.50 PERMITTE
SLAP 13INK @ 13.50 INSPECTION HtCORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50 W
URINAL @ 0.50 Q
HOUSE SEWER @ 0.50 E]
MISCELLANEOUS J
1 tater Softener 0 c
APPROVALS
DATE INBPEOTORIB NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.013 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ) PIT ) @ 1.00 SEWER
PERMIT 1.013 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE Fs 3. 1.50
FINAL
ION
WORKER'S I have
a certificate
of consent to 7�B7A PW9le9 APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self Insure,
or a certificate of Workers Compensation Insurance,or a certified
copy thereof(9bc.3800 Lab.C.)
Policy No. V Company COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
F1Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
!ISO
Date Applicant WATER CLOSET40.7 NEAREST '
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
or 16 caa—xz—COMPENSATION INSURANCE ASSESSOR ?N
ra ct C,6(s 1
(This section need not be completed if the work Involved by the SHOWER MAP BOOK PAGE PARCEL VI
permit is for one hundred dollars($100)or less.) LAVATORY OWNER
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as toSINK ADDRESSAIL '`
become subject to the Workers'Compensation Laws. _
DI ASHER TEL.NO. &!0%5t
Date Applicant ' CLOTHES WASHER CONTRA R
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS
provisions of the Labor Code,you must forthwith comply with such
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION WATER HEATER CITY TEL.NO.
I hereby affirm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS CENSE NO. CLASS C
Professions Code,and my license is in full force and effect.
OUTLETS OVER DISTRICT ep ITOCESSED BY
5 PE STEM4 ; D 7
License Number Lic.Class I"'
FINAL DATE ! VA6.{�A (S o try O.
Contractor Date 1 ITEMS
FINALz
❑ I am exempt under Sec. BY o
B.&P.C.for this reason &� TOTAL 1.705 o 65
Date: Plan check fee CHECK 175.65Signature PLUMBING PERMIT ISSUING FEE$ ► CHANGE ■00
❑ TOTAL FEE
Plan check applicant W ", r
SINGLE FAMILY �f 1—Q [j1 4/12/93
HOME OWNER-PUILDER DECLARATION Name ,I, 9161 �} ■is
I herebyaffirm that I am exempt from the Contractor's License Law j'� 8-0
for the following reason(Section 7031.5, Business and Professions Address
Code):
City Tel.No.
i7 I,as owner of the property,will do the work and the structure
is not Intended or offered for sale(Section 7044, 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 above-mentioned
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
r
SIOn tura oee Date