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Home My Public Portal About6234 ROWLAND AVE_Plumbing__ 78A667 DBS-f7 9.93 APPLICATION FOR 'PLUMBING .PERMIT 1 DMSION OF BUMDING AND SAFETY Deportment of County Engineer County of LOS Angeles BUILDING WM.J. FOX, COUNTY ENGINEER ADDRESS J�A3 44 _e CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. OWNERLIV DISTRIC >O. GROUT MAIL � I Z;O;No ADDRESS / I READY FOR INSPECTION � INDUSTRIAL CITY TE WASTE APPROVAL PLUMBER INSPECTION RECORD ADDRESS r CITY 'TEL.JNO. Z %SII` LICENSE NO. O 12-- NUMBER Z NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) 1`t,Y 1 A4 //1 I-) 7,C ///Y; 9 , BATH TUB Flo � SHOWER. / '4413 c 9rr -7141jyt -f1z1?f/r/A► --LAVATORY (WASHBASIN) rr /�,e / t /PyIzza-f r i KITCHEN SINK DISHWASHER !Zn Mh ,rl l/1. 49- LAUNDRY TUB.OR TRAY CLOTHES WASHER TOTAL NO. ® 0.80 Al — APPROVALS 1 DATE INSPECTOR'S SIGNATURE o(IGAS SYSTEM OUTLETS � 1.00 / I _ WATER HEATER 1.00 UNDER SLAB WORK ROUGH PLUMBING PERMIT S 1 00 !� ;• J GASPIPING ,t '•� ( : ��r/ TOTAL FEE (o d GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER r AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS. ANGELES COUNTY AN q STATE'OF 1 � A�s CALIFORNIA OR THAT I AM THE LEG 0 NER qF/1'HE ABOVE UTILITY CO.NOTIFIED z.1®: ,('"-4YW� `? DESCRIBED RESIDENTIAL PR C^L Pf -- SIGNATURE A� ��/� OF PERMITTEE FINAL �' %, 'a� _( WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD,C141EF PLBG.INSPECTOR jC0 6 4 0 1S AUG 8 3 8,6 0 u, WORKERS'COMPENSATION DECLARATION CR .1 w APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a' certificate of consent to self ce e+7(z-eo) insure. or,a certificate of Workers'Compensation Insurance,or a cd"d ied copy thereof(Sec.3800,Lab.C.) . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ® FEE ADDRESS department. LOCALITY" p� ` Date Applicant WATER CLOSET NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL (This section need not be completed if the work involved ADDRESS rL by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO. _ 0 I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR 0 so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ~ ADDRESS tU Date y— Applicant SWIMMING POOL RECEPTOR fL NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code, you must forth- LICENSE NO. S with comply with such provisions or this permit shall be WATER HEATER seemed revoked. GAS SYSTEM L.OUTLETS DISTRICT NO. PR CESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER ✓_- �/ hereby affirm that I'am licensed under provisions of Chapter 5 PER SYSTEM (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATI less and Professions Code, and my license is in full force and DATE �, �get 'ffect. FINAL d =� Icense Number Lic.Class BY ontractor Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Q Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name J I hereby affirm that I am exempt from t ontractor's Address !, o 0 D o c Licoase Law for the following reason on 7031.5, Busi- City Tel.No. u e nes.an ��ions Code): I, as owner !- am exclusively contracting 0 0 0 i (, r- wit sed contractors to t the project ection 7044,Business and Professions Co 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned p ope y for inspectio rposes.. � r Sig ture of Permittee Date