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Home My Public Portal About9222 BLACKLEY ST_Plumbing__ 76A667A CE 817(REV 6/78) , Os APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 9222 Blackley St. ADDRESS NUMBER FIXTURE OR ITEM ® FEE �+ WATER CLOSET LOCALITV YTem le it NEAREST BATH TUB CROSS ST SHOWER OWNERMr- and s . Goya MAIL ADDR9222 Blackie St. LAVATORY �r Q . SINK cTOmple City ` TEL NO 283-177 DISHWASHER CONTRACTOR /AAA CONDITIONED AIR CLOTHES WASHER ADDRESS 10160 Valle SWIMMING POOL RECEPTOR CITY El Monte TEL NO 579-18 LAWN SPRINKLER SYSTEM �j Q WATER HEATER LIC NnSE NO -a9-35-29 CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER 1®9 PLUMBING FIXTURES GAS TEST 1_7,4* I�-'� �oD07�,Gur? L ,� Plan check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINALZ— Plan check applicant PLAN CHECK VALI ATIO,N Name /�TynZ �-7q Address City Tel No I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE 0 31 7.7 A THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION O O O O 0 ,5 1 HEREBY CERT THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS GEL COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE ,. O O 1 Q O O LEGAL OWNER OF AND INT NO TO RESIDE IN_THE.A80VE�DESCRESIDENTIAL PROPERTY O O,O 1 Q //�� SIGNATURE 0 L/U OF PERMITTEE 0,112-79 Z 1 2-7 9 DISTRICT NO � P OCES BY J, G I Y ` 0 INDUSTRIAL WASTE,APPROVAL 76A667A CE 817(REV 6/78) 0P s APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BWILDING ADDRESS NUMBER FIXTURE OR ITEM ® FEE LOCALITY WATER CLOSET NEAREST BATH TUB CROSS ST SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY = (, TEL NO f-6 - l DISHWASHER CONTRACTOR F �� CLOTHES WASHER ADDRESS l SWIMMING POOL RECEPTOR CITY � TEL NO LAWN SPRINKLER SYSTEM STATE LIC p WATER HEATER LICENSE NO CLASS o 10/ ! GAS SYSTEM OUTLETS 3 APPROVALS DATE INSPECTORS SIGNATURE OUTLETS OVER _ UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING (' GAS VENT v @9 HOT WATER HEATER PLUMBING FIXTURES GAS TEST Plan Check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ , TOTAL FEE FINAL —3-77 <, ,Plan check applicant PLAN CHECK VALIDATION Nametk - Address 4 0, "(1/ a� ��✓ City Te o � �` 0 I HERE ACKNOWLEDGE T AT I HAVE READ THIS APPLICATION AN STATE '�—�?-- ? 9 THAT THE ABO E IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING i PERMIT VALIDATION �y {� I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 40 3 16 cJ A ^ 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 O O d O O"g PROPERTY 0 01000 SIGNATURE OFPERMITTEE J ^^^•/ o Q Q DISTRICT 11a00t^' ), O /�PROC S BY Ou12d79 INDUSTRIAL IZ WASTE APPROVAL a � DEPARTMENT OF COUNTY ENGINEER PLUMBING 1 LVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING X22 WILLIAM J FOX, COUNTY ENGINEER ADDRESS FOR APPLICA O F IN LOCALITY C� BUILDING NEAREST ADDRESS CROSS ST DISTRICT NO GROUP I ZONE PERMIT NO LOCALITY NEAREST c 00 CROSS ST RECEIVED Y Ready for Inspection D T ISSUED OWNER 2 MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY TEL NO INSPECTION RECORD PLUMBER VALLEY BOULEVARD PLUMBING CO. `� L ADDRESS 8300 EAST VALLEY Bl VD_ CITY R("--FAD TEL:NO ' AT_ 2-2719 LICENSE NO25 ❑,$TATE COUNTY J PERMIT FEES a _z `Ur EER TYPE OF FIXTURE OR ITEM FEE Vr WATER CLOSET(TOILET) @ 080 $ A411 Ix O BATH TUB @ ,0 80'`ti SHOWER @ 080 LAVATORY(WASH BASIN) @ 0 80 KITCHEN SINK @ 0 80 LAUNDRY TUB OR TRAY @ 0 80 SLOP SINK @ 0 80 FLOOR SINK @ 080 FLOOR DRAIN @ 080 DISHWASHER @ 0 80 DRINKING FOUNTAIN @ 080 URINAL @ 080 GAS SYSTEM OUTLETS @ 1 00 C� WATER HEATER @ 1 00 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT 1 00 ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED �y AND/OR LICENSED S REQUIRED BY LOS ANGELFS COUNTY GAS TEST AND STATE OF C 0RNIA OR Tj4AT M THE LEGAL 0 , w .+ 7 ER OF THE ABOV ESCRIBE SI IAL' PROPERTY UTILITY CO NOTIFIED Q SIGNATURE v / A OF PERMITTEE FINAL / S 7GA667 DBS 17 1/53 WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compe tion Insurance, CE 817(REV 10/81) or a certified copy thereof (Sec 3800, La ) COUNTY OF LOS ANGELES , �' BUILDIN N SAFETY Policy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING F� ��Certified copy is filed with the county buDIdinspec- ADDRESS tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applica WATER CLOSET NEAREST CERTIFICATE OF EXEMPTI FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less) LAVATORY ADDRESS e;Ze7?� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CIT TEL N 3 J„ so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTO Date Applicant CLOTHES WASHER ADDRESS �y NOTICE TO APPLICANT If, after making this Certificate of �� Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL NO LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC / deemed revoked WATER HEATER LICENSE NO -/(f' r CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BIG Q� I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 1 Q >.(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER CL and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION V G 6 �''�� License Nu bet Lic Class DATE CK/ FINAL V v O Contra r Date &Z BY U ud ❑ I am exe t r c B 8P C for this reason 7/ Plan check fee Date ��f� PLUMBING PERMIT ISSUING FEE$ �Q �? �� Signature ®� TOTAL FEE SINGLE FAMILY Plan check applicant 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 0-re I Nor°,° 1 b,5 0 ❑ j, as owner of the property, will do the work and the °'00,165006 structure is not intended or offered for sale (Section + 7044, Business and Professions Code) 0 1,24-83 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 jaws regulating Plumbing, and hereby authorize represents es of this County to enter upon the above-m boned p op yrs for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE SiVurdf of ermittee D ite