HomeMy Public PortalAbout5327-5329 SANTA ANITA AVE_Plumbing__ 76A667 (CE-817) - 1/75
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: ADDRESS ' _ — C j/�
f
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY
,FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST.
NUMB FIXTURE OR ITEM @ FEE 'OWNER
WATER CLOSET 2.00 /_I, C) Cdc 0
MAIL
BATH TUB 2.00 n v ADDRESSy� D dOl2'
1Z SHOWER 2.00 v CITY 10're mit �j TEL. NO.
LAVATORY 2.00 a o 0 CONTRACTOR S• L CK
SINK 2.00 C7 0 C) ADDRESS
DISHWASHER 2.00
Q CITY �1�� � vds-.tea_ TEL. NO.
Z CLOTHES WASHER 2.00 STATE I
LICENSE N0._30 l0 � / CLASS
SWIMMING POOL RECEPTOR 2.00
DISTRIC NO.GFjPUP ZONE PR ESSED BY
LAWN SPRINKLER SYSTEM 2.00 ,I�, O�j L fe 3
•
WATER HEATER 2.00 rp p v INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 2.00 v INSPECTION RECORD v
OUTLETS OVER
5 PER SYSTEM •30 � /�r3�tFr)' J G✓l$ ,�]V' L`��j (/„y ✓CD
c-
z
Plan check fee See Reverse Q
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant q APPROVALS DATE INS nEcr-oJi•s SIGNATURE
. SCJ UNDER SLAB WORK S� y }6-A
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. No. GAS VENT A
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ .THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES -14 1h•y
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
I HEREBY ,CERTIFY THAT 1 AM PROP LY REGISTERED A D/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGE S COUNTY D S TEOF
CALIFORNIA OR THAT I AM THE G OW R 0 AN-D ND TO
RESIOE IN THE ABOVE DESCRIBE DENTI P FINAL? ``E`t` '�z�'y�;.� •�_
SIGNATURE • °i" ••
OF PE'RMITT E •
PERMIT VALIDATIONCK. M.D. CASH
PLAN-CHECK VALIDATI N CK. M.O. CASH
4 2 DE--'PR 20 5 D 7 0.5 0 ���
WORKER'S COMPENSATION DECLARATION. 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT
76A867A
I herebyaffirm that I have a certificate of consent to self Insure,
pr a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3000 Lab.C.)
/� � �0La o J-,air
❑ COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No.t/ � mpany
Certified copy Is hereby furnished.
B
FOR APPLICANT TO FILL IN(PRINT OR TYPE) DING
ADDRESS
Certified copy is filed with the county building spection
department. J� NUMBER FIXTURE OR ITEM @ FEE LOCALITY i C
Date 7_-11_96 Applicant -! WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WOR S' CROSS ST. i. /Z.
COMPENSATION INSURANCE BATH TUB ASSESSOR
(This section need not be completed If the work Involved by the i SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or leas.) LAVATORY OWNER C'10 hu aa�Z.
I certify that in the performance of the work for which this permit
IL
is issued, I shall not employ any person in any manner so as to SINK ADDRESS C'
become subject to the Workers'Compensation Laws. .ars �r � l
DISWASHER CITY l i±if 1,1 J Ie— 'f TEL.NO.
Date Applicant CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT: If, after making this Certificate of UOns v�//i•
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code,you must forthwith comply with such ADDRESSt��V s. /�/� W•M tJ�
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATIONCITY TEL.NO. yy �-
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER S
LICwith Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS CENSE NO. S V " CLASS 6 _20, C-26 V
Professions Code,and my license Is In full force and effect.
OUTLETS OVER 6RI NO ES BY
_ 5 PER SYSTEM
License NumlZer Lic.Class `2 C` 1 I='
/� , .99 Se za FINAL V LIDATION
IL
contractor , / `z Date,7—.�3 -`�D DATE
❑ I INAL
am exempt under Sec. BY
B.BP.C.for this reason
Date: Plan check fee ► /
Signature PLUMBING PERMIT ISSUING FEE$ }
❑ TOTAL FEE
SINGLE FAMILY Plan check applicant 0 15C 5
ACCT
.r OWNER-BUILDER DECLARATION Name ACC i.r
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Address 3307 20.511
Cade):
City ' Tel.No. 1 ITEMS
❑ I,as owner of theproperty.will do the work and the structure n �S�
Is not intended orof offered for sale(Section 7044, Business TOTAL 2113.50
and Professions Code). 011. CHECK 20.52'_1
CONSTRUCTION LENDING AGENCY CHANGEV e I�I
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.)
0000-ICI9 1 7/23/91!
Lender's Name 1983 1 +M 10 a 113.
Lender's Address t0 i
I certify that I have read this application and state that the above Pol.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