HomeMy Public PortalAbout4908 WILLMONTE AVE_Plumbing__ 76A667 (CE-817)-4/7'2 '
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO: FNEAREST
G Q J
HARVEY T. BRANDT, COUNTY ENGINEER
Y
FOR APPLICANT TO FILL IN (PRINT OR TYPE) T.
' NUMBER FIXTURE OR ITEM @ FEE
OWNER 1
WATER CLOSET 1.75
MAIL
BATH TUB 1.75
ADDRESS
SHOWER 1.75 CITY TEL. NO. 3` Z
LAVATORY 1,75 CONTRACTOR C a C
SINK 1.75 ADDRESS 2-
DISHWASHER 1.75 CITY TEL. NO. -dZ
r.
CLOTHES WASHER 1.75 STATE LIC
LICENSE NO. S + CLASS.
SWIMMING POOL RECEPTOR 1.75
LAWN SPRINKLER SYSTEM 1.75
DISTRICT NO. G UP N. PR CtESSE BY
�✓` �$ � ll
WATER HEATER 1.75INDUST•R17AL 777
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.75 v
INSPECTION RECORD
OUTLETS OVER 3D C1...
5 PER SYSTEM . 67
01
l��- P- 7SLLJ
. - 7
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER'SLAB WORK
Name ROUGH PLUMBING
I• Address GAS PIPING
City Tel. No. GAS VENT
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLIGATLON HOT WATER HEATER
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. GAS TEST
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
y LICENSED AS RECFUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OFr ND INTEND TO
RESIDE IN THE ABOVE DESCRI.B. RESIDENTIAL PRO 'TY. FINAL
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATIO CK. M:O. CASH
PLAN CHECK VALIDATION CK.. M.O. CASH
ce
t� e999t.) FED TIP 5 D 8.25N
76A887-CE#817 S•61- `
APPLICATION FOR -PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENumrl R
BG AND SAFETY DMSION BUILDING ,e ,
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS. O �+V
WILLIAM A..JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FU'IN NEST
CROSS:ST.
NUMBER FIXTURE OR ITEM OWNER Gig _
WATER CLOSET �D MA>L '
' I
BATH TUB ADD DH888
CITY TEL.NO.
sxowsa �'y o - coNTaAcr'oa Valley Plumbing Co.
�,, LAVATORY = ----Z• - - --
SINS + Z5 ADDRESSw l� dp�a o
DISHWASHER CITY r1011dor& TEL NO. IN
CONTRACTOa'S.
LAUNDRY TUB BSGISTSATION Nod COUNTY
CLOTHES WASHER I DIST. CI'NO. G N P 8ED BY
WATER HEATER ISDG� 0
GAS SYSTEM 19INDUSTRIAL V
WASTE APPROVAL
III MCTION RECORD
O
?Ag5a4115A_,� . /Z A0v
W
,
G $1.00 PER ITEMI p O
_.OR.FIXTURE S I -APP ALS DjkTgf- INSPECTOR•S:SIGNITURB
PERMIT 51 2 1 00 UNDER ORK /
TOTAL FEE 8
ROUGH'PLUMBING 1 , �� _�-r� o'`
S GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY GAS VENT `�'q
WITH ALL BOUNTY ORDINANCES AND. STATS LAWS REGULATING HOT WATER HEATER Rf• „.
PLUMBING. _
I HEREBY CERTIFY THAT I, AM PROPERLY REGISTEREDAND/OR PLUMBING FIXTURES I
LICENSED AS REQUIRED BY LOS,ANGELES COUNTY AND STATE OF GAS TEST 1
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY.. UTILITY CO.NOTIFIED �� 6
SIGNATURE
OF PERMIT
TE FINAL -
ATION ROBERT A.WOOD
CK. M.O. CASH SUPERVISING MECHANICAL:ENG'R
LEDA 8 TOGS j-19 s e -'1 .5:.00- Q
ION
WORKER'S I have
a certificate
of consent to 7SA667APw8189 APPLICATION FOR PLUMBING PERMIT
I hereby aff1m that I have a certificate of consent to self insure,
or a certificate of Worker's Compensation Insurance,or a certified
copy thereof(Sec.3800 Lab.C.)
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company Y
Certified copy is hereby furnished. y�
• FOR APPLICANT TO FILL IN(PRINT OR TYPE) g Fi'Certified copy is filed with the county building inspection ADDRESS :74
department. NUMBER FIXTURE OR ITEM FEE LOCALITY
Date IfillL Applicant WATER CLOSETNEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
ASSESSOR
COMPENSATION INSURANCE
(This section need not be completed If the work Involved by the SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars.($100)or less.) OWNER
1 certify that In the performance of the work for which this permit LAVATORY �j
Is issued, I shall not employ any person in any manner so as toMAIL
SINK ADDRESS �fCf�Q t
become subject to the Workers'Compensation Laws.
DISWASHER CITY TEL.NO.
Date Applicant CLOTHES WASHERCONTRACT R r �
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become subject.to the Workers'Compensation SWIMMING POOL RECEPTOR s
provisions of the Labor Code;you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY, TEL.NO.
,;v
hereby affirm that I am licensed under provisions of Chapter 9 f, WATER HEATER �� STATE �j�/ / a921 /�`�
(commencing with Section 7000)of Division 3 of the Business and + GAS SYSTEM OUTLETS LICENSE NO.J-s U 3 76 CLASS •i- 0
Professions Code,and my license is in full force and effect.
OUTLETS OVER DISTRICT NO. PROCESSED BY
,r',,_` _ 5 PER SYSTEM p
License Number ./ Lic.Clas< �C & T P
FINAL ""DATION I�
,G, DATE 2_Z3-9 Z ti ;
Contractor Date l- ACCT.s
❑ I am exempt under Sec. BY AL 3307. 39 o 3tr
B.&P.C.for this reason I ITEMS,
Date: Plan check fee
PLUMBING PERMIT ISSUING FEE$ polo. TOTAL. 39.30
Signature CHECK Sy.30
ElTOTAL FEE
SINGLE FAMILY Plan check applicant CHANGE .00
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions 'Address I�Ut3 —CC`!�1 j7f? ;u,l
Code): City Tel.No. 7223 1 App 9047
❑ 1,as owner of the property,will do the work and the structure
is not intended or offered for sale(Section 7044, Business ,
and Professions Code).
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 ordinances
and State laws regulating Plumbing, and hereby authorize
representatives o his County to enter upon the above-mentioned
props y for Ins ti u6Qose SEE REVERSE FOR EXPLANATORY LANGUAGE' ,
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Sinna rra of Parmitfaa Data