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Home My Public Portal About5125 ARDEN DR_Plumbing__ D.B.S. 17 25M SETS 12.44 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING Wm. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES -1-1COMPLETE HEATER CESSPOOL SEPTIC TANK RECEIVED BY READY FOR •DATE ISSUED FIRST INSPECTION GAS MISCELLANEOUS " APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY NAME Rosabell Plumbing Co. , JOB 721 Arden Dr. , ADDRESS 5039 York Blvd. , LOCALITY Temple City NEAREST CITY T.os Angel s TEL. NO.Al nll 1 CROSSST. . T.as Tunas y� r IL CERT.TNO. ?' EXPIRES =3J-� 01 NAME yl• r • Ryan LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRESS NORTH O CITY TEL.NO. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF OU LIFICATION..,_ PLUMBQR 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. PI OWNER i f CORRECTIONS i SOUTH a DESCRIPTION OF WORK -- z BATH TUB FURNACE H �HOWER DISHWASHER a' O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPQCTOR'Q NAMQ __WATER HEATER DENTAL LAVATORY ROUGH PLUMBING IMETER13 GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL 9 TOTAL NUMBER OF FIXTURES SEPTIC TANK CE98P001 SEPTIC TANK SEWER I TOTAL FEE I UTILITY CO.NOTIFIED 5 00 FINAL 76A667-CE#817 2-66 ` APPLICATION FOR PLUMBI G PERM COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 31.25 MAIL BATH TUB 1.25 ADDR C TEL. NO. SHOWER 1.25 LAVATORY 1.25 CONTRACTO SINK 1.25 ADDRESS DISHWASHER 1.25 CI Y TEL. NO. Q! STATE LIC LAUNDRY TUB 1.25 LICENSE NO. CLASS CLOTHES WASHER 1.25 DISTRI-CT NO. GpAmP zQ'V P D WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 c-')INSPECTION RECORD O U W _ Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 00 UNDER SLAB WORK ROUGH PLUMBING OTAL FEE Gas PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS RE BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR HAT [)Am THE LEG OWNER OF,AND INTEND TO RESIDE IN,THEol E IBED RE DENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMIT ' - FINAL O LIDATION JACK R. ALLEN CK. M.O. CASH SUPERVISING MECHANICAL ENG'R. Ltti �. t►�i 10 5 D 3-50- WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereb4 affirm that I have a certificate of consent to self 76A667A • iosurp, or,p 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. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS �S e� tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY / WATER CLOSET t lo/i Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER r (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS r/C I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. �`/�� /� DISHWASHER —' CONTRACTOR Date d J Applicant v ,e OG tf,144e� CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY SYSTEM OUTLETS I hereby affirm that I am licensed under provisions of Chapter 9 GAS Ss � � (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL DATE VALIDATION License Number Lic. Class v @r FI O Contractor Date ❑ I am exempt under Sec. B.&P.C. for this reason Date: Plan check fee ► PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY �C HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and 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's Address V 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-mentioned property f" i ect' n purposes. r SEE REVERSE FOR EXPLANATORY LANGUAGE r �Si gnature ermittee Date