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Home My Public Portal About8603 WORTHINGTON DR - Plumbing - 1979-09-25 76AG67A CE 6 17(REV.6/76) ®S APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING .� a NUMBER FIXTURE OR ITEM @FEE ADDRESS 3,q WATER CLOSET LOCALITY NEAREST //fy BATH TUB CROSS ST. U O SHOWER OWNER 8FC14p MAIL LAVATORY ADDRESSWO�2%/�IfVGT� SINK CITY -Qv 61W iEL TEL.NO. DISHWASHER CONTRACTOR L UI /711 -�U CLOTHES WASHER ADDRESS 1 SWIMMING POOL RECEPTOR CITY TEL.TEL.NO. LAWN SPRINKLER SYSTEM STATE ,} WATER HEATER LICENSE NO. ,�.�lJ I/ CLASS GAS SYSTEM OUTLETS APPROVALS D�TEj INSPECTO 'S SIGN U E OUTLETS OVER UNDERSLABWORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS-VENT- HOT ASVENTHOT WATER HEATER PLUMBING FIXTUR _ GAS TEST r c Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ '� o TOTAL FEE 1 (] FINAL-6) INAL Z Tr Plan check applicant PLAN CHECK VALIDATION Name � � Address City Tel.No. I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE L A n THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES E7 a 8 9 AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS O O O O O REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL / n n PROPERTY. 1 D D O'0 0 SIGNATURE0 L O C O 1 0. U OF PERMITTEE 1 • DISTRI NO. MOCESSfpFBY 09,25-79 INDUSTRIAL WASTE APPROVAL � 76A667-CE817-8-58 &:"op c9 eu 41 ®Ai=lP C 6 �;_i -f/ple—C/ Sj APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT .OF COUNTY ENGINEER BUILD= AND SAFETY DIVISION BUUMING ADDRESSa� CASSATr D:GR>FFIN?Wt of Scolding LOCALITY FOR APPLICANT TO FILL IN NEAST CROSS ST. /�a� -.Aj NUMBER FIXTURE OR ITEM OWNER WATER CLOSET nLtAIL BATS TUB ADDRESS 1 SHOWER CITY TEL NO. LAVATORY CONTBSCrOfONTANA PLUMBING CONTRACTORS ansa ADDRESS -13329 E. Ector Street DISHWASHER Crr r City of Industry,mmaRb. ED. 7-7226 CONTRACTOR'S 96496 STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY CLOTHES WASHER DISTRICT NO. GROUPZONE P SEED BY WATER HEATER - GAS SYSTEM INDUSTRIAL WASTE APPROVAL DWECTION RECORD APPROVALS / ( OO PER $ I DATE INSPECTOR'S SIGNATURfi $IRITEM GO / UNDER ORK• PERMIT $ 2 00 ROUGH PLUMBING TOTAL FEE L120 GAS PIPING IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND..STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS:I ES 1• �1v0 LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF 91, 07 CALIFORNIA OR THAT 1 TH -LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDEN IA PE SIGNATURE FINAL OF PERMIT TE ROBERT A.WOOD. ®pOVALIDATION SUPERVISING MECHANICAL ENG'R M.0. CASH CK. LAC08 9 5.3 m APR 7 5 A 1 3.0 0 WORKERS'COMPENSATION DECLARATION 76AG67A I hereby affirm that 1 have v: certificate of consent to self cE 617(z-ao) APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or) a certified copy thereof(Sec.3800,Lab.C.) / COUNTY OF LOS ANGELES , BUILDING AND SAFETY Policy No. Company 0 Certified copy is hereby furnished. KFORPLICANT TO FILL IN (PRINT OR TYPE) BUILDING opeCertified co y is filed with the c ty build' FIXTURE OR ITEM • FEE ADDRESSp g inspection tmeryt. LOCALITY Datea2Applicant ER CLOSET NEAREST BAH TUB CROSS ST. CERTIFICATE OF EXEMPTION F M WORKERS' COMPENSATION INSURANCE SHOWER OWNER ef TORY MAIL (This section need not be completed if the work involved LAVAADDRESS } by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.N t�_ I certify that in the performance of the work for which this DISHWASHER U permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER Q ADDRESS Date Applicant SWIMMING POOL RECEPTOR U NOTICE TO APPLICANT: If, after making this Certificate of CITY TELIrc .N U_ �� aW Exem tion, you. should become subject to the Workers' LAWN SPRINKLER SYSTEM p STATE LIC. to Compensation provisions of the Labor Code, you must forth- r t�- z with comply with such provisions or this permit shall be WATER HEATER LICENSE NO. / CLASS deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR EBBED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER �OO I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINALVALIDATION effect.ness and Professions Code,and'my license is in full force and DATE t_• l effect. d License Numbe Lic.Class a• _ , r t � BY BY -' Contractor Date El I am exempt Prom the licensing requirements as I am a Plan Check fee U licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic,or Reg.No. Date Plan check applicant U� HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the. Contractor's Address License Law for the following reason (Section 7031.5, Busi- City Tel..No. ness and Professions Code): I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044,Business and Professions Code). o c+ o 0 o f CONSTRUCTION LENDING AGENCY [ o o 2 c.Q V 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.). 0 0 o Lender's Name 0 3,0 1 —i,2 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- ed property for inspection purposes. Signature c&Afe7rmittee Date