HomeMy Public PortalAbout5517 ROBINHOOD AVE_Plumbing__ 76AO67--"4 e2 TEMPLE CiTy
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF OAF COUNTY ENGINEER
$ � �il�i�� �NIVIS�ON
W,ILLIAIi A. JQVtYN, Sur-T or, IlUILDINa LQCAI,IT7
FOR APPLICANT TO F LL IN cRo1s
NUM■IER FIXTUR[OR rTIM [.ACH IF EK Ow*R
WATER CLOSETIl t6 � r
]$ATS ME 133 AA
SHowse - L.=5
cm TEL NO
LAVATORY 13i CONTIACTOR C L/
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ADDEHSS
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LAUNDRY TUB L CO CTO STATE
1ZOMTRATION NO. COLIN"
CLOTSFM WAS]ATEH R i i5 D�C?o , a IE r ■Y'
WATER HHAlBH 130 � D Vf�
OAS ffT3hl[ ObTLLR'S 1 nOUNTELAL
WAM AFF10V14L
OUn4m Owl b PER dTSTEm x D�SPECTION 1=01D
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APPROVALS DATE INSPECTOR'S SIGNATURE
PEF{Mrr S '� UNDER BLAB WORK
ROUGH PLUMBING
TOTA FEE
GAS PIPING
I SH[ImY ACKNOWLAOM THAT I HA ISD TWO ArruuTlbrr GAS VENT
AMD TAT= THAT THE ABOV* 1+ CO AND AGISQ TO COMPLY
WfTH ALL. COUNTY ORDIMANCS1 AND STA'¢ r..AWS REOULATINt
r1..UM■1Ha. IJOT WATER HEATER
I HXJ"Y cillo FY THAT 1 AM rROrt RLY RESISTiI® AMD(oR PLUMBING FIXTURES
kICiMStD AS REQUIPEM ■Y LOO ANGi L94 COUNTY AND STATE Op�
CALJFORNEA OR TIJAT 1 AML THL LEGAL GWMXl4 Or,AND INTEND TO GAS TEST
RKSIDE 111,THE A1bVE DSSCRISED RL/IDLNTIAL UTILITY CO. NOTIPTEQ
•IaNATORS
G f'ERl111TTEE
FINAL
AATION ROBRT A. WOOD
crc � EM.O. cAaH SUPERVISING MECHANICAL ENG'R
A0.3307r. APR 15 5 D 5.75
y T
+ WOIthat IS have
a c7JSATION DECLARATION ,�DPW e'er APPLICATION FOR PLUMBING PERMIT
I hereby elflrm that I have a certllloete 01 consent to self Insure,
or a certificate of Worker's Compensatlon Insurance, or a cordfled
copy thereof(Sec.3600 Lab.C.)
Podby No. Comp" COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
❑ CerttW copy r hereby ft.W ed.
F#1 APPLJCANT TO FLL IN(PRINT OR TYPE) BUILDM� { —t2 � _1
F1C.115od oopy M fltsd with the county Wkdhg Irr p.M. ADDRE1 /�
Aks-
deperttnent. NUMBER FD(7URE OR REM O FEE L le-
Data Apprkx" WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORUKERS' BATH TUB C8068 ST.
COMPENSATFON INSURANCE ASSESSOR
(This section need not be completed tf the wort Involved by the SHOWER MAP BOOK PAGE PARCEL
permit b for one hundred dollars(;100)or lees.) LAVATORY OWNER
I oertlfy that In the performance of the work for wh thle perm
Is leaued, I shall not employ any person In any m n r to SINK Mme_
t»oorne subject to the Workers'Com on ADDRESS 1
D18WA8NF7a CITY TEL NO
APP�nt /�
NOTICE TO APPLICANT: I1, after making this Certlfloate of CLOT[ES WASHER CONTRACTOR r A-CoA,
Exemption,you should beoome suNOct to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith oomply wtth,suoh A"E88
provision or this permit shall be deemed revoked. LAWN SPR 0a-ER SYSTEM
UCENSED CONTRACTORS DECLARATION CRY TEL-NO. �
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (L(commencing with Section 7000) o1 Division 3 of the Business and �� O /-b d�C�� 8
end m
Profeaelons Code, y Iloense is In full force end effect GAS SY8T9d OUTLETS �� a
OUTLETS OYFA DknR�NO. PROCE68✓�BY IX:
ffl
6 PSYSTEM 15� Q
Lberiee Num Lb.CI■es(-� CJ U
IMAL
oe>n ATE
D
��` VALIDATION LU
DATE a
❑ 1 arts exempt under Sea FI Z
B.BP.C.for this reason
Plan check fee ,
Date:
PLUMBING PERMrr ISSUING FEF; 5
nahue
❑ TOTAL FEE A'r.CT.i
SINOLE FAMILY Phan dieck t `73D7 39.30
HOME OWNER-BUILDER DECLARATION Narne 1 ITtFiCu k7
I hereby affirm that I am exempt from the Contractor's License Lew �d O f'7
for the following reason(Section 7031.6, Business end Professions Address TOTAL 7w J
Code): city
F-1 1. as owner o1 the property,will do the work and the structure Tel.No. CWCX -39.30
Is not Intended or offered for sale (Section 7044, Buslness , .W
and Profeastorw Code).
CONSTRUCTION LENDING AGJENCY
I hereby affirm that there Is a construction lending agency for the 0000-OMI w$�/24/9
ppertormanoe of the work for whloh this permit Is Issued (Seo. 3097, 1 1 Ali 7:67
Lenders Name
Lenders Address
I certify that I have read this application d state that the above ,
Information le correct. I ■ to ■11 County ordinances
and State laws re Is PIu g d hereby authorize
epresentettvee of Is my er n the above-mentloned
In n SEE REVERSE FOR EXPLANATORY LANOUAOB
IgnMre of Permittee Date