The URL can be used to link to this page

Home My Public Portal About4932 WILLMONTE AVE_Plumbing__ 76A667-CE817-8-57 APPLICATION FOR .PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS a JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET C 4 J v n� • MAIL BATH TUB JL L ,, ADDRESS SHOWER CITY TEL.NO. LAVATORY t- CONTRACTOR SINS 'y ADDRESS A DISHWASHER CITY •�'� Q TEL.NO. LAUNDRY TUB CONTRACTOR'S 6f STATE Ll REGISTRATION NO. COUNTY ❑ • CLOTHES WAS Y DISTRICT NO. GROUP I =R.ADY FOR INSPECTION WATER.H1ATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL f INSPECTION RECORD e n 1 / ly z APPROVALS @ $1.00 PER ITEM T INSNSIATURE OR FIXTURE $ �� UNDER SLAB WORK ROUGH PLUMBING PERMIT $1. Oo GAS PIPING TOTAL FEE GAS VENT � � i 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES'. PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST 'O-erOL c-w LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF r CALIFORNIA OR THAT I AM THE LEGAL OWNER OF T E OVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL P E SIGNATURE OFPERMITTE FINAL VALIDATION ROBERT A. WOOD, SUPERVISING MECHANICAL ENG'R CK. N.4k. CASH ;3 E v' jUL 1 5 A 1 3.0 0 Ir WORKERS'COMP€NSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self .76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified ,,copy thereof('See. 38 b. C.) COUNTY OF LOS ANGELES BUILDING AND,SAFETY ai I ICC&P pZob Company Certi 'ed copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspec- tion dep7rtm�enft.. NUMBER FIXTURE OR ITEM FEE LOCALITY Date 1—�Appli4ant �� o WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER r<L `A A07171's (This section need not be completed If the work Involved by MAIL � the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 93fMId I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY �`� /' TEL.NO O�j so as to become subject to the Workers'Compensation Laws. DISHWASHER [�G C.� CONTRACTOR 9 &&6pe s Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of r �I Exemption, you should become subjectto the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY �0 TEL.NO 7131-1 131 with comply with such provisions or this permit shall be STATE `' LIC. y� deemed revoked. WATER HEATER LICENSE NO.( J ?r� CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division.3.of the Business OUTLETS OVER >_ and Professions Code,and m` �y�license is in full force and effect. 5 PER SYSTEM FINAL , e' VA DATION less .License Number -4- `t7 f Lic.Class_ ✓OL- P DATE -Z_ 6 . 0 Mon /�/Q� �,��* 1//(� "FIN&hloC ntraiT�� 1 �0' �� O Om ❑ I am exempt under Sec. ;130'28A -� B.BP.C. for this reason # 000,005 Z • Plan check fee � Date: ® ( ° ° 3 Q 5 0 PLUMBING PERMIT ISSUING FEE$ AD Signature TOTAL FEE. 50 S o o 0 3 0.5 0 5 . SINGLE FAMILY 9 Plan check applicant 2 7 8 5 • � Q - HOME OWNER-BUILDER DECLARATION Norzz I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section address 7031.5, Business and LRL-ID Professions Code): City Tel. No. ❑ I, 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'sAddress I certify that I have read this application and state that the ► above information is torr I agree to comply.with all County ordinances and St ws r gulating Plumbing, and hereby , authorize repre n Lives his County to enter upon the C7 e-rnentio d rop r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnatureermittee Date (