HomeMy Public PortalAbout10115 BOGUE ST_Plumbing__ 9 r+3Ae�r iy I�-as APPLICATION FOR PERMIT
p DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES ' ;
WILLIAM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. I GROUP ZONE PERMIT NO.
$
PLUMBER VALLEY BOULEVARD PLUMBING C0: ` s ��DTE �
RECEIVED BY E
READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS ann EAST VALLEY BLVD,
CITY ROSEMEAD 'TEL. NO. AT. 2-2719 ADDREISS /F/' 0,.COUNTYV�
LICENSE NO. 93 t-A EXPIRES ��SO�/� LOCALITY
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
�I
WATER CLOSET (TOILET) @ 0.50 S �O ADDRESS ��
"al-, _
�1BATH TUB a. 50 sod CITY �1A/71.16A YY�.��.5.
�I SHOWER 0.50Io I HEREBY ACKN WI_EDGE THAT 1 HAVE READ THIS
/ LAVATORY (WASH BASIN) @ 0.50 (� APPLICATION AND S ATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ 0.506 STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OF TRAY @ 0.50-I � ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
OF THE RESIDE NTIALR PERTY DESCRIBED ABOVE.
j I GAS SYSTEM OUTLETS @ O.SOI -!94;11SIGNATURE OF
LWATER HEATER @ O Sol _ PERMITTE _- �J
1 SLOP SINK @ 0.50 I INSPECTION RECORD
FLOOR SINK @
0.50
_ FLOOR DRAIN @ 0.50
DISHWASHER @ O 501
IDRINKING FOUNTAIN @ 0.501
URINAL @ 0.501
HOUSE SEWER @ 0.50 I Q
MISCELLANEOUS I 1 0
0
1 APPROVALS
DATE INSPECTOR'S NAME
i
ROUGH PLUMBING A �I �
GAS PIPING
GAS VENT
CESSPOOL @ I.00 I CESSPOOL
SEPTIC TANK: I 1 SEPTIC TANK
DRAIN ( ) PIT ( ) @. 1.001 I SEWER
PERMIT I 1.00 GAS TEST i/^.L!f+flL �- -
y UTILITY CO. NOTIFIED/ 1 11 /
i TOTAL FEE � �
FINAL
I
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING -PERMIT
l I hereby affirm that I have a certificate of consent to self 76A667A
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_Co'm pany
Certified copy is hereyfurnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
aCertified copy.is filed with the county building Inspec- ADDRESS
tion department. NUMBER FIXTURE OR ITEM r@ FEE LOCALITY
WATER CLOSET
Date ApplicantNEARECROSSST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH rue
COMPENSATION INSURANCE SHOWER OWNER �� Z
(This section need not be completed if the work involved by
the permit is for one hundred dollars ($100)or less.) LAVATORY MAILO
ADDRESS
I certify that in the performance of the work for which this
permit is Issued, I shall not employ any person in any manner SINK CITY TEL. NO ��
so as to become subject to the Workers Compensation Laws. DISHWASHER
�f e/ !� ��. CONTRACTOR
Da12 / pplicant tJ/� l // CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL NO.
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9
GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is In full force and effect. 5 PER SYSTEM
DATE
FINAL Zb7 VALIDATION
License Number Lic. Class t;
FINAL 99
Contractor Date
BY 0
U
I am exempt under Sec tL
CL
B 8P C. for this reason Plan check,fee
Date-
PLUMBING PERMIT ISSUING FEE$ ez
Signature
TOTAL.FEE �►
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License
Law for th iillowing reason (Section 7031 5, Business and Address
Professi s Code) City Tel No. '9 6, 2 A
I, as owner of the property, will do the work and the Z�l
structure Is not intended or offered for sale (Section 0 0 0 0 0 5
7044, Business and Professions Code) 2,0 o 6.5 Q
I ,
CONSTRUCTION LENDING AGENCY o 0 0 •�•� _
`I hereby affirm that there is a construction lending agency for + c�
Len'der's
he performance of the work for which this permit is issued Q 6. 1 3—81'4
Se3097, Civ. C.).
Name
Lender's Address
.11 certify,that I have read this application and state that the
above information is correct. I agree to comply with all County
lordinances and State jaws regulating Plumbing, and hereby
taut. nze repre tatives of this County to enter upon the
ov - �odpertyfor inspection pur ses
SEE REVERSE FOR EXPLANATORY LANGUAGE
'S nature ofP' tee Date