HomeMy Public PortalAbout5003 SERENO DR_Plumbing__ TEAEBT-CKA[IT 1E-04 10876 CM OF TTeLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGOMM SERIES
BIIII II�GL ES FETY FMION eDnDlxa
JO M I OUNTr NGIN!!R ADDRESS 5003 Sereno
COLEMAN W JENKINS, SUPT OF BUIL.I.. LOCALITY Temple Ci
ty
FOR APPLICANT TO FELL IN NEAR"'
CROSS BT Acaso Dr.
NUMBER FIXTURE OR ITEM EACH FE!
WATER CLOSET 8125 NAM Lawrence L. Adrian
SRAM
BATH TUB 145 ADDRESS Same
SHOWER 145 CITY TEL NO
LAVATORY 175 CONTRACTOR General Installation Co.
81NE 113 ADDRESS 6558 West Blvd,
DMHWASIM 123 CITY Los Angeles TEL NO PL 5-2841
LAUNDRY TDB 125 REGISTRATION NO C-$8 181889 787coDnn
CLOTHES WAS® 115 DISTRIgr NO GROUT ZONE ED er
WATER HEATER 1 50
MAB SYSTEM OUTLETS ISO INDUSTRIAL Iy
WASTE APPROVAL 6
OUTLETS OVER 5 PER SYSTEM 40 INSPECTION RECORD V
1 Water Softener 1 50 Ready for Inspection Nov m
0
W
6
co
APPROVAL$ DATE INSPECTOR 5 SIONATUR[
PERMIT 51 2 00 UNDER SLAB WORK I
ROUGH PLUMBING I
TOTAL FEE 3 50 GAS PIPING j If
1 N[Ror wcXNowL[OGe THAT 1 NAV[ RGO THIS wAL1uT10N GAS VENT
AND [TAT[ THAT TX[ AAGV[ I[ Co BISECT AMD AOR[[ TO COMPLY
WITH ALL COUNTY ORDIMANCKS AND [TAT[ LAW[ RAGULATINOI J
HOT WATER HEATER
PLUMBING l
I HK CERTIFY THAT I AM MOP[RLY IKOIAT[IRR O AMD/OPLUMBING FIXTURES /
LIC[XU[[D A[ REQUIRED BY LO[ ANG[LCOUNTY AND [TAT! OP GAS TEST
CALIFORNIA OR THAT I AM TX[ LEGAL OWNER OF AND IMTCND TO
.IDE IN TH[ABOVE DESCRIBED II[[IDE IAL PNOP[RTr UTILITY CO NOTIFIED
SIGNATURE
OF PIRMITTEE p t�
FINAL I
�
RLIDATION ROBERT A WOOD
CK M O CASH SUPERVISING MECHANICAL ENG R
LAI,o 4 O; e JUL 28 5 D 3.50-
1
7EAS67C IC[-mal -Sp[
AePLICATION FOR PLUMBING PERMIT
BUILDING SAFETY DIVISIO
FOR APPLICANT TO FILL IN (PRINT OR TV PEI I BUILDING
NUMBER FIXTURE OR ITEM ® FEE ADDRES
WATER CLOSET LOCALITY
BATH TUB NEAREST
CROSS ST
SHOWER OWNER
LAVATORY MAIL
ADDRES
SINK CITY TEL NO
DISHWASHER CONTRACTOR Au
CLOTHES WASHER
ADDRES
SWIMMING POOL RECEPTOR �/
CIN L NO
LAWN SPRINKLER SYSTEM
STATE LIC n ,PI
WATER HEATER LICENSE NOCLASS `GWJ
U
GAS SYSTEM OUTLETS O DISTRICT NJO /Oj/� Z(JQJNE RO ESSE By
OUTLETS OVER O V V1
5 PER SYSTEMINDUg L U
WASTE APPROVAL H
INSPECTION RECORD Z
Plan check fee E
PLUMBING PERMIT ISSUING FEE 5
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR B eiaNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel No 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 HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CAI( NIA OR THAT THE GAL OWNER OF, AND INTEND TO
RE01DE IN THE ABOV ESC IB EITIAL PROP[ N UTILITY CO NOTIFIED
SIGNATURE
OF PERMIT / ` FINAL
PLAN CHECK V LIDATION CK M o CASH PERMIT VALIDATIONM o CASH
, > �A 9 6 0 .AIL 27 5 D �� 0.0 0 sy,
Ll 3 / 29^7� V7D
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
ffum thr i T hie o certificate of consent to self 20 0026 DPW 8/87
certtfi_ate of Workers Compensation Insurance 78A887A
coply,thereof(Sec 3900 Lab C ) COUNTY OF LOS ANGELES - DEPT OF PUBLIC WORKS
Poi Compony
❑ Certified copy is hereby furnished ,
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified
\ /J
Certified copy sbuilding
filed with the county A
inspec- ��� /�,�r
hon department NUMBER FIXTURE OR ITEM ® FEF LOClWTY
Date AppliSant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST
COMPENSATION INSURANCE OWNER
ZrA—
(This section need not be rnrepiefed H the work Involved by SHOWER IC
the permit Is for oM hundred dollen ($100)or less) vvATORv ,.ILL Q Q
I certify that in the performance of the work for which the ,.
permit is issued, I shot[not employ any person In any manner SINK CITY T P/`n TEL NO
so as to become subject to the Workers'Compensation Laws DISHWASHER C.
CONTRACTOR
Date Applicant r CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If, after making this Certificate of
Exemption,, you should become subject to the rWorkers' SWIMMING POOL RECEPTOR
crry TEL No
coCompensationprovisions of the Labor Code, you must forth LAWN SPRINKLER RINKLER SYSTEM
with compplyywith such provisions or itis permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO CLASS
L. LICENSED CONTRACTORS DECLARATION DI TRICT NO'> BY
I hereby affirm that I am licensed under provisions of Chapteri? GAS SYSTEM OUTLETS (JY
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is In full force and effect 5 PER SYSTEM FINAL�O /n pO VALIDATION
TE
License Number I is Class
FINAL Q/JyJ,,,s_, O
Contractor Date By G ��Oe'^ `
❑' 1 am exempt under Sec % 0
B&P C for this reason NyJl
Plan check fee
Date Z
Signature
PLUMBING PERMIT ISSUING FEE$
`
TOTAL FEE
Plan check applicant
SINGLE FAMILY - 5.�y. Ts•1
HOME OWNER BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractors AU
T.0
Address
Law for the following reason (Section 7031 5 Business and
Profession*
J � Code) City Tel No 3W .34.50
lCJ I, as owner of the property, will do the work and the 1 I IiJA74 J
I _ structure is not intended or offered for sole (Section TOTAL 34.50
50
7064, Business and Professions Code) �t
CONSTRUCTION LENDING AGENCY CHECK 34.50
1 hereby affirm that there is a construction [ending agency for MslAu'r e�
the performance of the work for which this permit is issued r OWE
(Sec 3097 Gv C ) '
Lender's Name 0000-0001 91 ISM
Lender s Address T 5519 1 IN 8152
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 St lows regulating Plumbing and hereby
authorize reprele"ItclAves of this County to enter upon the
a e menioneld Fybperty for inspection pure es .
SEE REVERSE FOR EXPLANATORY LANGUAGE
g.
4gnature Pof Permittee f Date
t