HomeMy Public PortalAbout6050 AGNES AVE_Plumbing__ 76A667C(CE 611 A) 11/76
-APPLICATION FOR-PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING A
ADDRESS 6050 N. Agnes
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET YO LOCALITY Tempke C1t
BATH TUB d NEAREST
Lod
-
CROSS ST
SHOWER if OWNER Rosemead Construction
LAVATORY MAIL 1$16 San Gabriel Bkvd.
ADDRESS
SINK CITY an Gabriel TEL NO 573—Lll..U0
DISHWASHER CONTRALTO
Giaen Bros. Plumb3mg, Inc
CLOTHES WASHER ADDRESS 4265 N. Baldtn.n Ave.
SWIMMING POOL RECEPTOR
CITY El Monte TEL NO 443-0078
AWN SPRINKLER SYSTEM
STATE WATER HEATER LICENSE NO 231 7fes] LIC CLASS
C36-20
GAS SYSTEM OUTLETS DISTRICT NO UP E�( PRO ESSED B
t
OUTLETS OVER (J
5 PER SYSTEM INDUSTR AL
WASTE APPROVAL C
INSPECTION RECORD V
In
0
W
0.
N
Plan check fee 71-00
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE D
Plan check applicant
APPROVALS DATE INSPECTOR S SIGNATURE
Nome
UNDER SLAB WORK
Address ROUGH PLUMBING 7
i
City Tel No GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS 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 LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY UTILITYCO NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
E vk d d 11 rA
PLATCHECKVALIDA ION — CK---M O—CASH— PERMIT VALIDATIONCK O CASH
POLICY HOLDER �" 5 0 ,�,�� � 5 � 1 0 J 0 �`—�
POLICY',,"MY81M V 0 i 5 3 3 S 1—' °s
RS COMPENSATION DECL APPLICATION FOR PLUMBING PERMIT
I *c hat I have a cerii4icate of consent to self 76A667A
s Ensu or a cen ,cote of Workers Compensation Insurance CE 817(REV 10/81)
or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
P❑ol icy NoEyO/DU:Company ff�+7P Fv�v�
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ! !, /✓
Certified copy is filed with the county uildin inspec ADDRESS bV
tion department NUMBER FIXTURE OR ITEM @ FEE
LOCALITY Te✓'7 l'( C '
f
Date'Z- C!- S~Applicant WATER CLOSET
3
NEAREST
CERTIFICATE OF EXEMPaiol�tur
RKERS BATH TUB CROSS ST t t
COMPENSATIORANCE SHOWER OWNER/?06
(This section need not be completed if the work involved by 1
the permit is for one hundred dollars ($1 GO)or less ) LAVATORY MAIL
ADDRESS 6 7/-
0 /V
I certify that in the performance of the work for which this r
permit is issued I shall not employ any person in any manner SINK CITY 7 TEL NO2*G A�L-
so as to become subject to the Workers Compensation Laws DISHWASHER cS 7
CONTRACTOR J e.�yO,., / L t
Date Applicant CLOTHES WASHER 4
NOTICE TO APPLICANT If after making this Certificate of ADDRESS IDC ✓T
Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR CITY TEL NO
Compensation provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM ,/&/
v with comply with such provisions or this permit shall be STATE LIC
deemed revoked IMMIM WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO P SED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS -r
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER t
and Professions Code and my license is in full force and effect 5 PER SYSTEM d
FINAL VALIDATI O
7 /� tr t h DAT � V
License Number 2 � Lic Classy. rirtI ys
_ -4-^Z'U -d - FINA l� O
Contractor 7�/'ry � LP*,.�-� jDate BY V
S
I am exempt under Sec �
Vf
B 8P C for this reason Plan check fee �
Date PLUMBING PERMIT ISSUING FEE$ 3O ► � 1 5 5 2 A
Signature
TOTAL FEE b 5 # o o o 0 0 5
SINGLE FAMILY Plan check applicant 7 f-l'rt L ( 4650
HOME OWNER BUILDER DECLARATION Name , G L CJ
I hereby affirm that I am exempt from the Contractor s License o o o 4 65 0=
Law for the following reason (Section 7031 5 Business and Address "7 .�� C Cv d CSC
Professions Code) City T, c Tel No > (. 220-85
❑ I as owner of the property will do the work and the
structure is not intended or offered for sale (Section a
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 of this County to enter upon the
above menti ed operty for inspection purposes
` �_2d'a7
SEE REVERSE FOR EXPLANATORY LANGUAGE
ig a rmittee Date
0