HomeMy Public PortalAbout5634 BALDWIN AVE_Plumbing__ (2) YBAG67 17 $-s°. '® APPLICATION FOR PERM
DEPARTMENT OF BUILDING AND SAFETY
r ' COUNTY OF LOS ANGELES
PLUMBING
WILL:IA•M J. FOX.. CHIEF ENGINEER'
DISTRICT NO. GROUP ZONE' PERMIT 1V0:
FOR APPL1Ci4NT`TO FILL IN.
PLUMBER: VALLEY BOULEVARD PLUMBING CO. RECEI D BY READY FOR .._. DATE ISSUED
FIRST INSPECTION
ADDRESS 8340 EAST VALLEY BLVD. ` _
pA q BUILDING
CITY_ ROSEMEAD TEL. NC. AT.Z'2719" ADDRESS V
COUNTY. 93M 630 Locni_ITY . Xi
LICE SENO. EXPIRES
NEAREST
PERMIT FEES CROSS ST..
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER •/ awCi(„,.
MAIL
WATER+CLCSET (TOILET.). 0.50 ADDRESS slg
/ BATH TUB O.'S0' .0. �11.WL...m
EL. NO(� �
SHOWER Q o.-so 1 HERE .THAT I' HAVE READ THIS
LAVATORY (WASH BASIN)' O..50 (� APPLICATION AND,STATE THAiT'THE ABOVE IS CORRECT AND
AGREETO COMPLY WITH ALL COUNTY,ORDINANCES AND
STATE LAWS'REGULATING PLUMBING.
KITCHEN SINK Q. .O.50 0 I CERTIFY THAT I P.CSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY (� 0.50. D ANGELES COUNTY LICENSE,. OR I' AM' THE LEGAL OW ER
' OF THE'RESIDENTIA PERTY DESCRIBED ABOVE.
GAS.SYSTEM OUTLETS Q 0.50 D
SIGNATURE OF
WATER HEATER 0.50 PERMITTE
SLOP SINK. @ o.s0 INSPECTION.RECORD
FLOOR SINK, Q o.So '
FLOOR DRAIN Q 0.50
-DISHWASHER @ 0.50 ..
-DRINKING FOUNTAIN @ o.50
i
URINAL Q 0.50
J
HOUSE SEWER'.. Q. .U.So Q
MISCELLANEOUS ZZ
0
I
APPROVALS.
' I DATE INSPECTOR'S NAME
ROUGH PLUMBING �-
GAS. PIPING I nw5��pn�e
GAS VENT Al
CESSPOOL. @ •I.Oco) I CESSPOOL
SEPTIC TANK: SEPTIC TANK
I DRAIN ( ) PIT ( ) Q 7•.00 SEWER
PERMIT . -7-Iq
1:06 GAS TEST'
TOTAL. FEE
UTILITY CO, NOTIFIED All
$. �-�. "
FINAL
i
`_CORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
t�',z eby'affirm theft 1'have a certificate of consent to self 76g667A
insure, or a certificate 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
Policy No. Company
❑ Certified copy is hereby furnished. BUILDING
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS ✓lJ,`� � Jv� C,�ii.—SL—�
Certified copy is filed with the county building inspec-
tion department. NUMBER FIXTURE OR ITEM Qa FEE LOCALITY �~
Date Applicant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE OWNER
SHOWER
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 66
I certify that in the performance of the work for which this )�
SINK CITY TEL.NO.
permit is issued, I shall not employ any person in any manner
so as to become subject 10 the Work r Compensation Laws. v
� DISHWASHER CONTRACTOR _
Date o✓C 'L" Applican CLOTHES WASHER T/O �, ADDRESS
NOTICE TO APPLICANT: If, after making ti Certificate o
Exemption, you should become subject the Workers' SWIMMING POOL RECEPTOR CITY U TEL. NO.
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PVC EDB Y
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �� O
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER B.
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALID ION
L t,.Vct< 1.ff DATE
License Number Lic. Class e
FIN �
Contractor Date BY / U
EN
❑ 1 am exempt under Sec.
B.BP.C. for this reason V Plan check fee ,
Date: PLUMBING PERMIT ISSUING FEE$
Signature n �\
TOTAL FEE
Plan check applicant '3069A
SINGLE FAMILY z
HOME OWNER-BUILDER DECLARATION Name
1 hereby affirm that I am exempt from the Contractor's License # 0 0 0 • 0 5
Address
Law for the following reason (Section 7031.5, Business and rI 2250
P?o essions Code): Cit Tel. N
City o. o o ® 22,50
JQJ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section , 10,04—85
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
abov -menti o d property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of P ittee V Ir Date