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Home My Public Portal About5115 SANTA ANITA AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION 20-OM.DPW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate'of consent to self in- 76A667A sure,or a certificate of Workers'Compensation Insurance,or a I n certified copy thereof(Sec. 3800, Lab. C. U Folici`No. Company Lp COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Clrtified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with-the county building inspection NUMBER FIXTURE OR ITEM department. @ FEE LOCALITY' Ddte Applicant •WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNERe. (This section need not be completed if the work involved by MAIL • the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS �/ I certify that in the performance of the work for w h this per- SINK CITY �j TEL.NO.�(,U $��. mit is issued, I shall not employ any on' manner so f 1 _ as to become subject to the Work Co e o Laws. .` DISHWASHER CONTRACTOR 8 Date Appli ant CLOTHES WASHER 4DDRESSfJ �•Qr� s NOTICE TO APPLICANT: If, after making Certifiat ce of Ex- SWIMMING POOL RECEPTOR oZ` emption,you should become subject to a Workers'Compen- CITY a �"A TEL NO.165^ If sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE ,_ g LIC. 7� / ed., WATER HEATER /_ D LICENSE NO. 93 $�7 CLASS UJ^7 LICENSED CONTRACTORS DECLARATION �v DISTRICT NO. PROCESSED BY 4 hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVERO and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL �1 r�/ALIDATION Li ct. S^93 -7 �r/ HOSE BIB DATE �^�iZ-"l� ACCT a A License Number �L Lic. Class / ov FINALC ContractorC:F5 agffls _ Date BY � 4&40 ❑ I am exempt under Sec. I� 1 ITEMS IC- B.&P.C. for this reason Plan check fee f' TOTAL 43 o 40 a Date' -PLUMBING PERMIT ISSUING FEE$ a7 Q CHECK 4,�a4o ' signature � 3. O CCHANGEvOo • TOTAL FEE SINGLE FAMILY Plan Check a licant HOME OWNER-BUILDER DECLARATION pp 1I17I96 I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and 4.313 1 PM12-'46 Professions Code): Address I„as owner of the property, will do the work and the City Tel."No. 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 y Lender's Address I certify that I have r d t is application and state that the ' above informa' n r .I gree to comply with all County ordinan d S egulafing Plumbing, and hereby out ze re t' of ounty to enter upon the ve-m a ert inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur rmit ee Date D.B.B.17 2SM BETS 10-47 APPLICATION FOR PERWII�- DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES �L� ��G 1 '` WM.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DLaTlal rl . c o ZONX ----Pw?MIT NO. ROUGH FIXTURES COMP LLHEATER CESSPOOL SEPT{CREC ! >iY READY FOR DATE ISSUIZFolk PIRBT INSPECTION AS- MISCELLANEO 8 �-L IN APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB K NAME ADDRESS W G ADDRE88 LOCALITY �� x O NEAREST CITY EL.No. CROSS ST. COUNTY 1 CERT.No. EXPIRES p NAME LOCATION OF SEPTIC TANS, OR CESSPOOL z MAIL p 3 ADDRESS 3 (6 Map v NORTH O CITY �.�. 1�6 TEL.No 1.AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. _ PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY:.DESCRIBED r ABOVE. A— Ev 3 �D� OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK _z BATH TUB FURNACE Q' ROWER DISHWASHER A LAVATORY REFRIGERATOR ITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY .T_URINAL APP ALS WATER CLOSET DRINKING FOUNTAIN DATE � INaP R's NAga XI WATER H TER DENTAL LAVATORY ROUGH PLUMBING I A -:z METE AS SODA FOUNTAIN CIAS PIPING OU TL GAS VENT -CESSPOOL I TOTAL NUMBER OF FIXTURES .3 �� SEPTIC TANK 1Z11A CESSPOOL��EPTIC TANK SEWER TOTAL. FEE UTILITY CO.NOTIFt FINAL t•'�'""' COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer " DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer PLUMBING I FOR APPLICANT TO FILL IN D15 R ND. [3ROUP ZONE . PLUMBER ®�re /: RESSIV D BY READY FOR DATE ISSUED p' �7 g C '9 FIRST INSPECTION ADDRESS ��kJ y&X r CITY TEL.No. a ADDRESS COUNTY EXPIRES LOCALITY -ri qP�e b e CITY LICENSE NO. , NEAREST PERMIT FEES CROSS ST. IC pQ NUMBER TYPE Cr FIXTURE OR ITEM FEE OWNER WATER CLOSET(TOILET) MAIL Q 0.50 S ADDRESSu�,,G``f�` BATH TUB 0 0.50 CITY a c ` TEL No. 04 1, SHOWER 00 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) 00 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 00 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER OAS SYSTEM OUTLETS 00 0.50 OF THE RESIDENTIAL ROPERTY ESCRISED ABOVE. WATER HEATER 0.50 SIGNATURETEF SLOP SINK 0.50 INSPE ION RECORD FLOOR BINK 00 0.50 FLOOR DRAIN 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN 00 0.50 URINAL 00 0.50 J Q HOUSE SEWER 0 0.50 Z MISCELLANEOUS a re APPROVALS DATE INSPECTOR'S NAME [ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL 00 1.00 CESSPOOL SEPTIC TANK., SEPTIC TANK / DRAIN ( ) PIT ( ) 1.00 SEWER C i \ PERMIT 1.00 GAS TEST TOTAL FEE $2- a00 UTILITY CO.NOTIFIED FINAL 7GA667 DRS#17 10/58 76A6E7-CEe17 8.58 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONt, g�DIN �c p u aOHN A.LAMBIE,County Engineer SSATT D. GRIFFIN,Supt of-Building LOCALITY i FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS CITY TEL.NO. SHOWER / LAVATORY CONTRACTOR sm ADDRESS V 1,2g: CLV DISHWASHER crrY �� ,/ TEL NO. (! CONTAACTO S STATE LAUNDRY TUB REGISTRATION NO. C COUNTY ❑-' vifidddw�atv _ CLOTHES WASHER n DISTRICT NO. GROUP ZONE P SED BY WATER HEATER ! GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD p- f 6f t 0 51.00 PER ITEM Q ®0 OR FIBTUHE $ I (J APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 200 UNDER SLAB WORK �r TOTAL FEE D p () ROUGH PLUMBING ��?? �(�♦f Lam. GAS PIPING f.S' < ��✓�� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. `�s I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTI�PRXILUTITY CO.NOTIFIED ! /U SIGNATURE t ` OF PERMITTE FINAL r y V v.,.. ®g VALIDATION ROBERT A.WOOD, CE. M.O. CAM SUPERVISING MECHANICAL.ENG'R N LACuo 0 3 0 ' ;2 JUL 21 5 D 1 0.0 0 ^ 76AO67 17 5-50 It APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ' PLUMBING 1 WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO. PLUMBER re.3 �Qq� (y�� RECEIVED BY READY FOR DATE ISSUED qpm �v phi FIRST INSPECTION ADDRESS �5-�� g. 'U'� , � � ApL. �� ,/� p BUILDING CITY � �Ib TEL. NO ® tVy l''�� ADDRESS -�P COUNTY LOCALITY .r {�6s Q 1 LICENSE NO. EXPIRES PERMIT FEES CRCSS•sT. �� f'\ A$�� NUMBER. TYPE OF FIXTURE OR ITEM FEE �`"OWjVER /e F05 b i "- IdAIL a WATER CLOSET (TOILET) @ 0.50 S %ADbRESS ��s DO U 03 Lie A?N�(�p BATHTUB @ 0.so CITY �t4fzi &TUTEL. NOA SHOWER @ 0.50ff 1 HEREBY ACKNOWLEDGI9 THAT 1 HAVE READ THIS LAVATORY'(WASH BASIN) @ 0.50 J APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.30 STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1. POSSESS THE. ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ 0.50 SIGNATURE E /.. WATER HEATER @ 0.50 !nk ,"J" SLOP SINK @ O.So I INSPEC ON RECORD FLOOR SINK @ 0.50 FLOOR DRAIN' @ 0.50 DISHWASHER @ o.so 1or DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 ,I HOUSESEWER @ 0.50 Q Z MISCELLANEOUS U� a 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING W ` .1 e Al JV GAS PIPING �3--4v K GAS VENT CESSPOOL @ t.06 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT I.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE I $ FINAL .79067 17 8-130 15 APPLICATION FOR PERMIT ' DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES L S N 07 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. -'� yy,- 0%3 PLUMBER .G//� 3�4") L:' �'fp°,s�?'Z•f .i�. RECEIVED BY READY FOR DATE ISSUED Q pp��'�11 FIRST INSPECTION ! -.3o ADDRESS �00~1 �Jr/.t�-.1 / _Jl!Jfi.�fa. / �. V�1>>�� BUILDING i CITY �Il%'J".�' �!�.' (s 7.1PPs TEL. NO.F0 - r)JV ADDRESS ADDRESS COUNTY ' �f LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. / NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) @ 0.50 S ADDRESS O BATH TUB O.50 CITY � TEL. NO. SHOWER. @ 0.50 1. HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) C91 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT.AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND. KITCHEN SINK ® 0.50 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER- OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS Q O.50 y1 !' SIGNATURE OF �, �'"•"•r I � WATER HEATER @ 0.&0 PERMITTEE ,t3 !, %i f �:" :•. 7"? r' SLOP SINK 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN 0.50 DISHWASHER 0.50 I DRINKING FOUNTAIN @ 0.50 I .! URINAL 0.50. ,J HOUSESEWER @ 0.50 MISCELLANEOUS U� o vor APPROVALS DATE INSPECTOR'SNAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ). @ 1.00 SEWER PERMIT 1.00 -GAS TEST UTILITY CO. NOTIFIED TOTAL FEE S / I�O FINAL