HomeMy Public PortalAbout5833 TREE ROSE TER_Plumbing__ 67
TeAeeT CE."' 'DAPPLICATION FOR PLUMBING PERMIT U
COUNTY OF LOS ANGELES Lot
DEPARTMENT OF COUNTY ENGIIiEER RuaDIHa
BUILDING AND SAFETY DIVISION BUILDING e e
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING LOCPJM
FOR APPLICANT TO PILL IN PR NT OR TV PE CROSS y� }�
NUMBER FIXTURE OR ITEM EACH FEE D♦oINER T p Weber LOVBZO nt
WATER CLOSET ISO OwN Y D
BATH TUB 1 50 ADDpyea 5926 TomWIP Qlty Blvd,
1 SHOWER 150 1 �T Tem Git TEL NO
LAVATORY 150 CORTRACTOH�HIIB Plumbing GOB of G19ndo
1 SINK 150 1 U IDRTJIb
442W. Fleetwood Plaoe
DISHWASHER 1 50 C7TT STATEr�r��9 TEL TO
CLOTHES WASHER ISOLIC
LICENSE NO 209431 CLASS
SWIMMING POOL RECEPTOR 1 SO DISTRICT NO GROUP I NE P [ 6D Y >
LAWN SPRINKLER SYSTEM 2 00 = 1
O
WATER HEATER 1 50 INDUSTRIAL U
WARTE APPROVAL G
GAS SYSTEM OUTLETS 1 50 1 50 DASPECTION RECORD
OUTLETS OVER 30
S PER SYSTEM y
2
Plan check fee 2S% of above See reverse
PLUINIBING PERMIT ISSUING FEE—S 2 100
TOTAL FEE 18 150
APPROVAL S 11 DATE INPECT0 •SIGNATURE
Plan check applicant UNDER W RK
\fie ROUGH PLUMBING j7
Address GAS PIPING
City Tel No GAS VENT
HOT WATER HEATER
1 M[IOr ACKNOWUM[ THAT I NAV[ RSAD TIIS A LIGATION
AMO ==THAT TN[ ADOV[ IS CoR*SCT AND AGAZE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDIMAMCKS AND RAT[ LAWS IROYLATIMO GAS TEST
PLUMBING
1 IOnOr CERY"T THAT I AN PRDP[KLT REGISTERED AND/OR UTILITY CO NOTIFIED
LICENSED AS REOUIIQD BY LOS AMG[LU COUNT AND RAR OF
UY
FORM IA OR THAT I AM TN[ L[OAL OWNER OF AND IMUID TO �✓
Mal OR IN TH[A ff DESCRIBED RESIDSHTIAL PROI[my FINAL
SIGNATURE ,R ALLEN, SUPERVISIN HANK AL ENG•R
OF P[RMITT[[
PERMIT VALIDATION cK M o CASH
PLAN CHECK VALIDATION CK M o H
Lijuoz) 9 1 7.j Awl 5 A 1 8S0-
eU
'/ .. ' 1
-' TION
I �SyOrm that
Ihove COMPENSATION DECcafe of corse APPLICATION FOR PLUMBING PERMIT
I r' reby aHnm that I hove o certificate of consent to sell 76A667A
insure or a certificate of Workers Compensation Insurance, CE 617(REV 10/01)
or a certified copy thereof(Sac 3800 lab C ) ../I COUNTY OF LOS ANGELES BUILDING AND SAFETY
Q �6 Company TW90 1T
Carhfi copy Is hereby furnished
FOR APPLICANT TO FILL W(PRIM OR TYPE) BUILpNG
anif,ed copy n filed with the county building Inspec• ADOR65 3 3
tion,department NUMBER FIXTURE OR ITEM FEE LOCALITY
Dot,-2- //- 9'1 Aph,anJe� WATER CLOSET
L61-42a NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST
COMPENSATION INSURANCE SHOWEROyyMq
(This section nand net be completed H the avork Invoked by MALI
the permit Is for one hundred dollen($100)or Ian ) LAVATORY ADOjbE$$
I certify that in the performance of the work for which this
permit is issued I shall not employ any person,n any manner SINK CITU TEL NO
so as to become subject to the Workers Compensation Lows
DISHWASHERgp�ROg
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT If after making this Certificate of ADDRESS r L.
Exemption, you should become subject to the Workers SWIMMING POOL RECEPTOR
Compensation provuiom of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL
with comply with such provisions or this permit shall be STATELIC
deemed revoked WATER HEATER LICENSE CLASS
LICENSED CONTRACTORS DECLARATION DISTIR NO� BY
1 hereby affirm that 1 am licensed under provisions of Chapter 9 OAS SYSTEM OUTLETS
(commencing with Section 7000)of Div,von 3 of the Business OUTLETS OVER 1 >-
and Profess,om Code and my license n in full force and effect S PERS FINAL
DATE /r VATION O
LcemaNummberrlg-E7 * L
Lic Cie. 73
Date2'
❑ I am exempt under Sec
B BP C far this reason =
Plan check fee
Dote PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE O
SINGLE FAMILY Plan check applicant ;k 2 4 3 8 A
HOME OWNER BUILDER DECLARATION Nam • • • it • 5
1 hereby affirm that I am exempt from the Connector s License Address Law far the following reason (Section 7031 S Business and ( • *—' C150
Professions Code) Cy Tel No2,6P C7 13I, as owner of the property will do the work and the • • • v3 ra 5 Q b
structure Is not intended or offered for sale (SectionPoo0 7 1 2-85
41
70Business and Professions Code)
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a comnuclion lending agency for
the performance of the work for which this permit is issued
(Sec 3097, Civ C)
Lender s Name
Lender's Andress
I certify that I have rood this application and sate that the 10,above information is correct 1 ogres to comply with all County
ordinances and State lows eguI ting Plumbing, and hereby
authorize repose ativ o this County to enter upon the
e mentio or chop purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
,gnoture f Perminee Dote