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Home My Public Portal About5539 WELLAND AVE_Plumbing__ ` DEPARTMENT OF COUNTY ENGINEER ' vPLUMBING DIVISION OF BUILDING AND SAFETY fiaW PERMIT APPLICATION �� COUNTY OF LOS ANGELES BUILDING LLIAM J. FOX, COUNTY EN13INEER ADDRESS Q. V�1? ,��/✓1s1-� �(' LOCALITY FOR APPLICANT TO FILL IN BUILDING NEAREST .ADDRESS I W� CROSS ST. _ DISTRICT NO. GROUP PERMIT NO. LOCALITY �' I� C C-' V 1,;NE J . NEAREST )IE �VED BY Ready for Inspection DATE ISSUED CROSS ST. �, � /� —0.7-65- )v � r OWNER e' N �^ I 'L' /iY� / MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY TEL./NCO. / INSPECTION RECORD _PLUMBER_e. S I A / F Z 4�^ Y ADORESS I2 C j HO d C V 7 CITY ,� C. TEL.N0..IrC `O C Sf _ TATE LICENSE NO. Z.� COUNTY J PERMIT FEES z z lIUM9ER TYPE OF FIXTURE OR ITEM FEE Q WATER CLOSET(TOILET) @ 0.80 $ O BATH TUB @ 0.80 Q SHOWER @ 0.80 LAVATORY(WASH BASIN) @ 0.80 G� KITCHEN SINK @ 0.60 5740 LAUNDRY TUB OR TRAY @ 0.80 U SLOP SINK @ 0.80 FLOOR SINK @ 0.80 FLOOR DRAIN @ 0.80 DISHWASHER DRINKING FOUNTAIN @ 0.80 URINAL @ 0.80 GAS SYSTEM. .....OUTLETS @ 1.00 WATER HEATER @ 1.00 co MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE —4 UNDER SLAB WORK !� {r��s� PERMIT $ 1 00 ROUGH PLUMBING -�! 'l r lit// TOTAL FEE GAS PIPING A-7/ �.�-:.�t. r•s� I HEREBY ACKNOWLEDGE THAT I HAVE READ TH S APPLI• GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER /r1:r- TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS I� REGULATING PLUMBING. PLUMBING FIXTURES x^AZT 'Jif al L..t�!/I -r•+w 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ,s AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST 1Pst��+ .✓ L*+� c1-'r:z d AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ER OF THE AB DESCR ED ID N OEEBx-Y. UTILITY CO.NOTIFIED �' � �•�,t.��fir + SIGNATURE ? OF PERMITTEE......_. ..----.... -......_.........._.................... FINAL �� i �✓GI/✓+ l �� 76A887 DBS 17 ra -S I i WORKERS'COMPENSATION DECLARATION 81 A ,APPLICATION FOR F L U M B I N G PERMIT I hereby affirm that I have a' certificate of consent to self CIE cE e»(z-eo) insure,or a certificate of Workers'Compensation Insurance,or I "i a certified copy thereof(Sec.3800,L . .) COUNTY OF LOS ANGELES I BUILDING AND SAFETY Policy No. Compan 0� . em,� Cl Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS �( Certif' copy' filed with the c nt building r action MBER FIXTURE OR ITEM • FEE ^ mW*11410 WATER CLOSET LOCALITY Dae t NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER "Sill MAIL (This section need not be completed if the work involved LAVATORYADDRESS . �0 A by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO._Vgq � I certify that in the performance of the work for which thisDISHWASHER U permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS (�\ !� Date Applicant SWIMMING POOL RECEPTOR �✓ •cC U NOTICE TO APPLICANT: If, after making this Certificate of CITY CL_ n TEL.NO. /�` �O a Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE rl,l 1 6 �0 LIC. oC�Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO. _oa'I 11 O 0 with comply with such provisions or this permit shall be DISTRICT NO. RO SSE By deemed revoked. GAS SYSTEM OUTLETS fJ LICENSED CONTRACTORS DECLARATION OUTLETS OVER Ihereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL le;' �.. B VALIDATION ness and Professions Code,and my license is in full force and DATE �' d effect. p r } r /^ FINAL TA imher / T.V 11.Z1? BY Contr ate ElI am exempt from the licensing req irements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code.). TOTAL FEE I Q Q0 Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name o 051,3A I hereby affirm that I am exempt from the Contractor's Address � License Law for the following reason Section 7031.5, Busi- # o o o o o 5 ( City Tel.No. ness and Professions Code): 2❑ o o 1'GOO �f�• I, as owner of the property, am exclusively contracting with licensed contractors to construct the project x (Section 7044,Business and Professions Code). o 0 0 1 C.O 0 c3 CONSTRUCTION LENDING AGENCY 0727-81 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is }j Win issued 'Sec.3097,Civ.C.). d raga 0 Y a. fjp MI j�� iNs p Lender's Name �R Lender's Address � ✓�® I certify that I have read this. application and state that the above information is correct.I agree to ply with all County ' SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Pl tubing, and ere authorize rep of this Count to enter o he f above-men . ned property ins ec ' purp igna r ee ate