HomeMy Public PortalAbout5341 SANTA ANITA AVE_Plumbing__ DEPARTMENT OF COUMY ENGINEE3t.
L I
DIVISION OF BUILDING ANb SAFETY J PERMIT APPLICATION
'COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ;ADDRESS _27 3
LOCALITY
PPLICANT TO FILL IN NEAREST
ADDRESS BUILDING, � Double Drive CROSS ST..
LOCALITY Temple'C ity DISTRICTJIi0. GROUP I ZONE \` PERMITNO.
NEAREST
CROSS ST. RECE V D BY Ready for Inspection DATE ISSUED:.
OWNER Paul Hart
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
_ CITY TEL.NO. INSPECTION RECORD
PLUMBER Belvedere Plumbing Co.
ADDRESS 11900 E. Garvey Blvd. ,
CITY E1 Monte TEL.NO. FIO 89836
[I STATE
_LICENSE NO. 54932 L COUNTY
PERMIT FEES z_
VOMBER TYPE OF FIXTURE OR ITEM FEE @J
2 WATER CLOSET(TOILET) 8f 0:80 S
Q
1 BATH TUB 8f 0:80 80
1 SHOWER @ 0.80 80
2 LAVATORY(WASH BASIN) @ 0.80 1 60
1 - KITCHEN SINK 0 0.80 -80
1 LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK 0.80
s FLOOR SINK df 0.80
FLOOR DRAIN @ 0.80.
DISHWASHER @ -0.80
DRINKING FOUNTAIN df 0.80
URINAL 0.80•
l GAS SYSTEM.. ....._OUTLETS df 1.00 11.00
1, WATER HEATER @ 1.00 100
MISCELLANEOUS
1 disposal APPROVALS
1 bendix 480 1, DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK 4�v
APERMIT $ 1 00 ROUGH PLUMBING /�tiGAS PIPINGTOTAL FEEGASVENT r1 HEREBY ACKNOWLEDGE THAT 1. HAVE READ THIS APPLI-
CATIONAND STATE THAT THE ABOVE I8 CORRECT AND AGREE NOT WATER.HEATERTO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES O !�
MD1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED t�
A /OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESl0EN AL PROPERT UTILITY CO.NOTIFIED
SIGNATURE ��IVA
OF PERMITTEE...L.GAI. _ .._ Cly.....:......
FINAL
6AG67 DBS 17 i..- _ __ I l 1 eGF
76A667-CE08.17 8-65 J
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 1l _ R
COLEMAN W. JENICINS. SUPT. of BUILD•IIVG �L
LOCALITY
FOR APPLICANT TO FML IN NEAREST T R F_ E
NUMBERFIXTURE OR ITEM EACH FEE
OWNER A v
WATER CLOSET 11.25
BATH TUB 1,.0 ADDRESS RESS v 3 eV1 20 O IV&L E D9.
CITY TZL: NO.
SHOWER 1.25
LAVATORY 1.2.5 CONTRACTOR
SINS 1.25 ADDRESS 3 4;wcailk As/R_
D53HWASHER 1.25 CITY A74 A4aAfrl,.:' TEL.NO.el4laa Z e d,
STATELI C
LAUNDRY TUB 1.25 LICENSE NO. CLA
CLOTHES WASHER 1.25 DISTRICT NO. GROU I ZONE PROCESSED BY
WATER HEATER 1.50 -xie � 77-A7`
GAS SYSTEM OUTLETS 1.50 g INDUSTRIAL. a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORDCLO
V
0
V
W
a
to
c
Z
• - r
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE ` GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE. ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT 1 AMS 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,AND 'INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE . 1 i
FINAL
r.,V,AUDAnON
CK.
M.0. CASH
Ao 5 0 9 8:"0 AIN 2'7 5 D 3'.5 0- �
M.RKEk%"COMPENSATION DECLARATION ,76AG67n
I hereby affirm'that I lAve a certificate of consent to self "•me e1r,(a-eo) APPLICATION FO'R P:L'U MB:ING. PER IT
insure,.or a certificate of Workers'Compensation Insurance,or
a certified sopy;thereof(Sec.3800.,Lab.C.) . i'
� COUNTY OF LOS ANGE LES:�f BUI LDING AND SAFETY
;Policy NooSnpanY
a
0, Certified copy is,liereby furnisfied. FOR APPLICANT TO FILL IN (PRINT OR TYPE)
:BU 1•LDING. �^ /
ti ADDRESS c�7 (
Certified copy:is filed with the count4b�uilping inspection
NUMBER' FIXTURE OR ITEM' • FEE .,
d ment. LOCALITY
Dat ilplicantWe.
WATER CLOSET
NEAREST
BATHTUB CROSS ST.
CERTIFICATE OF EXEMPTION FRKERS'
COMPENSATION I.NSURA.NCE SHOWER OWNER. .
(This 'section need not lie .completed if the. work involved LAVATORY
IMAIL
ADDRESS
by the permit is 'for one hundred dollars ($100) or. less.) r
SINK TEL.'NO -
p DISHWASHER
E'R �
certify that. in the performance of the work for which this C.1
.permit is,issued, I:shall-not employ;any person in any manner CONTRA
so as to become subject.to.the Workers'Compensation Laws. .,CLOTH.ES'WASHER
es 9�M
Date Applicant. ADDR
SWIMMI:N,G POOL RECEPTOR V.
NOTICE TO APPLICANT: If, after making.this.Certificate of CITY TEL.N
Exemption, you should become subject to the Workers' LAWN SPRINXLER'SYSTEM
Compensation provisions.of,the,Labor Code;you must forth- S� z
STATE' LIC.. '
with comply with such provisions,or this permit .shall be WATER HEATER LICENSE NO �7 CLASS.�t
deemed revoked. GAS SYSTEM OUTLETS DISTRICT N.O. P CESSED BY
LICEN:S:ED,CONTRACTORS'DE.CLA.RATION. OVER
• OUTLETS VE
I hereby'.affirm that:i.am.licensed under provisions.of Chapter 5 RE.R SYSTEM.
Lam-
9 (commencing with Section.7000)of Division 3 of the Busi- FINAL //'
ness and Professions Code,.and my license.is in full force:and DATE C0 VALIDATION
effect.
ZRLicense Numb e3 � tLic.Class �C (..�r ^"+�'v
" FINAL
Contractor Date' '
:
I I am censing requirements at I am a
Plan check fee ��
licensed archite registered professional engineer
PLUMBING PERMIT ISSUIN'G:.FEE.$
acting in my .professional :capacity (Sect'ion 7051, Bus=
iness and:Professions Code). �f
TOTAL FEE
Li..c.•or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name , �`;5.2 a 5'R
Address
I 'hereby affirm that I am exempt :from the Cont'ractor's #'o o'6 o o.5
License .Law for the following reason •(Section.7031.5:, Busi= City Tel.No.
tress and Professions Code): 1 Q.Q
'I, as owner of the property, -am exclusively contracting _
with licensed contractors ;to construct the project, a o 0 1 0.0 OZ.
(Section 7044.,-Business and Professions•Code):
05, 15-81
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.pro rty'for inspection purposes.
'Signature of Permit Date