The URL can be used to link to this page

Home My Public Portal About5627 WELLAND AVE_Plumbing__ 76A667-CE#817 2-62 \ /' �i C;�c• 1 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 1=WILLIAM A.JENSEN,SUPT OF BUILDING LOCALITY2�w FOR APPLICANT TO FILL IN NEAREST CROSS ST. rZ.lA�r t NUMBER FIXTURE OR ITEM EACH FEE y �� WATER CLOSET $1.25 OWNER BATH TUB 1.25 ADDRESS Z3 W � elWf— r SHOWER1.25 CITY -p�11 C• TEL. NO. LAVATORY 1.25 CONTRACTOR 77�� SINK 1.25 ADDRESS /¢ DISHWASHER 1.25 CITY { TEL. NO. LAUNDRY TUBCONTRACTOR'S / STATE 1.25 REGISTRATION NO. ..�/ COUNTY CLOTHES WASHER 1.25 DIS RICT C. GROUP ZONE P SED BY WATER HEATER 1.50 /�J GAS SYSTEM '9_OUTLETS 1.50 O INDUSTRIAL WASTE APPROVAL Ar OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD d u Lm g 1 e APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING I w TOTAL FEE ,'� �a / 4 — GAS PIPING 1J /p2 J I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT b AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES 1 LICENSED AS .REQUIRED BY LOS ANGELES COUNTY AND STATE OF f CA .LI FORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST ///%l;L :�• lj RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL ROPERTY. UTILITY CO.NOTIFIED i �"vL " A� i r,1 SIGNATURE .�, �� OF PERMITTEE FINAL VALIDAtOROBERT A.W60D CK. M.O. CASH SUPERVISING MECHANICAL ENG'R LAG0 6 4 6 4% NOV. 5 5 D 3.5 0, 4 ' VNRKERS'COMPENSATION DECLARATION APPLICATION FOR' PLUMBING PERMIT I hefeby, affirm that I have a certificate of consent to self in- j ��b�A 4/87 sure, of Workers'Compensation Insurance,ora CE 817(REV.8/86) certified copy thereof(Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. + I FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection I ADDRESS , department. NUMBER FIXTURE OR ITEM. @ FEE LOCALITY WATER C A-1—1-6 `O 7 Applicant r WATER CLOSET(TOILET) NEAREST Date� ` BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' . COMPENSATION INSURANCE ' SHOWER OWNER (This section need not be completed if the work involved by _ the permit is for one hundred dollars($100)or less.) j; LAVATORY ADDRESS I certify that in the performance of the work for which this per- I n mit is issued, I shall not employ any person in any manner so ) SINK CITY !r Uv L;NO. as to become subject to the Workers'Compensation Laws. I DISHWASHER c CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR ADDRESS emption,you should become subject to the Workers'Compen- CITY TEL. N0 A sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION . DISTRICT NO. PRO ED j hereby affirm that I am licensed under.provisions of Chapter I GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business . OUTLETS OVER and Professions Code, and my license is in full force and ef- ; 5 PER SYSTEM FINAL VA ATION >' fect: �^ '• I DATE C License-Number Lic. Class FINAL Contracto ate „ BY O I am exempt under Sec. ' W � d B.BP.C. for this reason I Plan Check fee ca Date: I PLUMBING PERMIT ISSUING FEE$ Signature i TOTAL FEE SINGLE FAMILY2 8 6.1.,1 A HOME OWNER-BUILDER DECLARATION ! Plan check applicant I hereby affirm that I am exempt from the Contractor's License ' Name + # 0 0 0 o a 5 Law for the following reason (Section 7031.5, Business and I o 0 1 6 5 Professions Code): Address ' I, as owner of.the property, will do the work and the I City Tel. No. 0 0 0 16.5 0 structure is not,intended or offered for sale(Section 7044, Business and Professions Code). ► 121 6 87 i . CONSTRUCTION LENDING AGENCY I 1-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.). 1 Lender's Name r Lender's Address t I certify that I have read this application and state that the i above 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 1 4c, e-m Wfiloneefor inspection purposes.os �_ SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur Date I