HomeMy Public PortalAbout9558 WORKMAN AVE_Plumbing__ 76A667 (CE-817)-8-71 ��
APPLICATIC N FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY L I,
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
m LQS J
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
�
WATER CLOSET 1.75 OWNER AgRA�-&
MAIL
BATH TUB 1.75 ADDRESS
SHOWER 1.75 CITY Z,4, TEL. NO.M_1
LAVATORY 1.75 CONTRACTOR A-0 F l ��
SINK 1.75 ADDRESS
DISHWASHER 1.75 CITY-TELL ( TEL. NO. Q 0
CLOTHES WASHER 1'75 STATE LIC LICENSE NO. �� / (� � CLASS 6 �
SWIMMING POOL RECEPTOR 1.75
DISTR11,1 . GROUP N ROC ESS B'Y
LAWN SPRINKLER SYSTEM 1.75 U
/ WATER HEATER 1.75 / 12 INDUSTRIAL
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.750
INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM .30 Z
V
W
9,
W
z
Plan check fee See reverse.
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE 7�
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO. GAS VENT
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LE OWN OF; AND INTEND TO
RESIDE IN THE ABOVE DE RI ED RE (DENT L PROPERTY. FINAL.
S144ATURE
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH IN
I AU0 7 724 94, AuG 25 5 .D 4.75
)BS-17,o.ss APPLICATION FOR PLUMBING PERMIT 1
Bs.t�
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
County of Los Angeles r
UILDING
JOHN A.LAMBIE,COUNTY ENGINEER DDRESSCASSATT D:GRIFFIN,SUPIT OF BUILDINGCALITY !moi Gam/
FOR APPLICANT TO FILL INI NEAREST C
CROSS ST. L(v
OWNER C DIST NO., I GRO I ZONE I READY FOR INSPECTION
MAIL
ADDRESS
INDUSTRIAL
CITY TEL.`' ,�LNO. f WASTE APPROVAL
� 10
PLUMBER � p.!A I�L.,�lViINSPECTION RECORD
ADDRESS 0 Q
CITY �' �jTEL.NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
2. WATER CLOSET (TOILET) @ $1.00 $ O O
BATHTUB~ @ $1.00 OO
SHOWER @ SI.00
LAVATORY (WASH BASIN) @ $1.00 1.00
KITCHEN SINK @ $1.00 00
DISHWASHER @' $1.00
LAUNDRY TUB OR TRAY @ $1..00 0
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00 4 00
1 GAS SYSTEM @ $1.00 100
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ Z 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE co GAS VENT
1 D HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT We1TER HEATER
AND
NSTATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
i HEREBY CERTIFY THAT I AEA PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED B16 LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR TH T M THE LEGAL 0 NER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED RESIDE A ROPERTY.
SIGNATURE
OF PERMITTEE FINAL
IOHIV A.L4MBIE,COUNTY ENGINEER ALIDATION ROBERT A.WOOD,.CHIEF PLBG. INSPECTOR
M2 5 U AUG
5 2 3 3 116.0 0 ID
• 11
ION
2D-0
WORKER'S I have
a certificate
of consent to 76A667 DPW 9189 APPLICATION FOR PLUMBING PERMIT
75A867A
1 hereby affirm that I have a certificate of consent to self insure,
or a i.ertific&tebf Worker's Compensation Insurance,or a certified
COPY thereof(Sec.3800 Lab.C.)
Policy No. Company COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
❑ Certified copy is hereby furnished.❑ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE ADDRESS
Certified copy is filed with the county building inspection _
department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY _
Date Applicant WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed If the work Involved by the ISHOWER MAP BOOK PAGE PARCEL
permit Is for one hundred dollars($100)or less.) LAVATORY OWNER
I certify that in the performance of the work for which this permit MAIL
Is issued, I shall not employ any person in any manner so as to SINK ADDRESS yy�
become subject to the Workers'Compensation Laws.
f / Applicant
DISWASHER CITY TEL.
Da Applicant 1 CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code,you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION H[ACITY J ��v� TEL.
I hereby affirm that I am licensed under provisions of Chapter 9 T ?STATE /+ a
(commencing with Section 7000)of Division 3 of the Business and `GAS SYSTEM OUTLETS LICENSE NO.Iic'7 t G CLASS
Professions Code,and my license is in full force and effect.
OUTLETS OVER DISTRICT NO. PROCESSED BY
5 PER SYSTEM
License Number" C Z Lic.Class ��
FINAL W
Contractor Date DATE /—!Z VALIDATION d
❑ FINAL Z
I am exempt under Sec, BY
B.&P.C.for this reason
Dale:
Plan check fee 001.
Signature
PLUMBING PERMIT ISSUING FEE$
ElTOTAL FEE
Plan check applicant
C
SINGLE FAMILY o
HOME OWNER-BUILDER DECLARATION Name ACCT ®r
I hereby affirm that I am exempt from the Contractor's License Law J�(j qe �
for the following reason(Section 7031.5, Business and Professions Address
Code): 1 ITEMS
❑ City Tel.No.
I,as owner of the properly,will do the work and the structure TOTAL 4p 1.515is not intended or offered for sale(Section 7044, Business 41.&
and Professions Code). , CHECK
CONSTRUCTION LENDING AGENCY CHANGE o0 j
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.)
130-10-13001 12/15/93
Lender's Name * 19 1
Lender's Address
I certify that I have read this application and state that the above 001.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 above-mentioned
proper a inspurposes. / //�� SEE REVERSE FOR EXPLANATORY LANGUAGE
l l
ftnature of Permittee Date