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Home My Public Portal About5749 ROWLAND AVE_Plumbing__ 76A667-CE#617 -66 01=P-1 C C/ / APPLICATION FOR PLUMBING PERMIT �D COUNTY OF LOS ANGELES PARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 7 G /� JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS '7� COLEMAN W. JENKIN•S. SUPT. OF,B.UILDING LOCALITY--/-- t- FOR APPLICANT TO FELL INCA gs ST . l NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET 51.25 -OWNER R BATH TUB 1.25 MAIL ADDRESS SHOWER 1.25 CITY 7/I^.L� TEL. NO. LAVATORY 1.25 CONTRACTOR P(-& �• SINK 1.25. . ADDRESS - - (moi/ DISHWASHER 1.25 CITY �y TEL. N�Z"LIC / �d/� LAUNDRY TUB 1.25 STATELICENSE NO. 7- !S CLASS l� 7 CLOTHES WASHER 1.25 _ DISTRICT NO G P ZONE PR E BY WATER.HEATER 1.50 5� 7 i GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL o OUTLETS OVER 5 PER SYSTEM AD INSPECTION RECORD o CD ��'A'� � Ula, '�"'�.• d APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK ROUGH'PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT PERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRE OS NG ES COUNTY AND STATE OF CALIFORNIA OR THAT A E GA WNER OF,AND INTEND TO GAS TEST -6,6 f RESIDE IN,THE ABO DE RI E SI NTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE �AIIDATION JACK R. ALLEN CK. M.O. CASH SUPERVISING MECHANICAL ENG'R. LAL;O1 9 49—%o 140u29 5 D 5.0 0^' v :-` , WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I'hsreby�affirm that I hove d'Wrtificatb of consent to self 20-0026 DPW 6/87 insu;'e or 9 certificate g orkers'Compensation'Insurance, 76A667� or a�sbrs?ified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company !rf_J'1 Certified copy is hereby furnished. ❑ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE ° LOCALITY WATER CLOSET I / Date AppMPTI CROSS ST. ®/��/1��~ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB COMPENSATION INSURANCEIn 60OWNER �e/o/ (This section need not be completed If the work involved by SHOWER �/��_S , the permit is for one hundred dollars($100)or loss.) 2 LAVATORY J'AADDRESS �� I certify that in the performance of the work for which this p� permit is issued,I shall not employ any person in any manner i SINK TEL.N020✓�,�T so as to become subject to.the Work. Compensation Laws DISHWASHER CONTRACTOR drol.." � Date-7-42-4 -42, pplican �� CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL.140. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. LICENSED CONTRACTORS DECLARATION DISTRICT N ESS BY T hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VA DATION DATE C License Number Lic. Class i L FINAL Contractor Date BY Ell am exempt under Sec. V t B.&P.C. for this reason Plan check fee ® CA Date: PLUMBING PERMIT ISSUING FEE$ 105-0 Signature TOTAL FEE Plan check applicant J SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name QOCT.V I hereby affirm that I am exempt from the Contractor's License 3 50 Law for the following reason (Section 7031.5, Business and Address 3307 aft. -P®essions Code): City Tel. No. 1 ITEMS ✓!y I, as owner of the property, will do the work and the --s structure is not intended or offered for sale (Section TOTAL 34 m 51131 7044, Business and Professions Code). CHECK 34-50CONSTRUCTION LENDING AGENCY i hereby.afflrm that there is a construction lending agency for CHAKE .00 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name 0000-0001 8/28/89 Lender's Address 5327 1 AM Bo-15 1 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 oboe -mentioned property for inspection purposes. p SEE REVERSE FOR EXPLANATORY LANGUAGE Y19-nature of Permittee Date • WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a cetificate of consent to self in- 766A667A 4/87 sure,or a certifidate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) _ certifiecopy theteof(Sec. 3800, Lab. C.) PC l cy tb: Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) r�i/ T� Certified copy is filed with the county building inspection ADDRESS J `r' /Sd Ltl G� department. NUMBER FIXTURE OR ITEM @ FEE �+ LOCALITY � Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST J4A0Z?�/�?-1Fn/ COMPENSATION INSURANCE SHOWER OWNER �eA.1 (This section need not be completed if the work involved by MAIL �j v the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY � � y TEL. N ,?,3--/ 7 as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION 0 rDISTRICid. OCE55 D BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS (� (Js( 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER r and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VAJDATION fect. DATE C License Number Lic. Class U FINAL Contractor Date BY i O I am exempt under Sec. W CL B.BP.C. for this reason Plan check fee , Date: PLUMBING PERMIT ISSUING FEE$ 10150 Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION PP I hereby affirm that I am exempt from the Contractor's License Name Z the following reason (Section 7031.5, Business and p>� �oAns Code): Addresss owner of the property, will do the work and the City Tel. No. sA07 16.50 cture is not intended or offered for sale(Section 7044, 1 IT0103 Business and Professions Code). ► TOTAL 16.51131 CONSTRUCTION LENDING AGENCY �� 16.55:1 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHA 000 (Sec. 3097, Civ. C.). Lender's Name 0000-01,191 9/20780, Lender's Address 9803 1 AN 8-0 22 1 certify that I have read this application and state that the above information is correct. I agree to comply with all County 010. ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ab ov entioned property for i ection purposes. W /a �d SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date