HomeMy Public PortalAbout10539 BOGUE ST_Plumbing__ 76A667 E#817 5/63 �y k- ' 4
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B
UILDING
10539 Bogue
JOHN A. LAM IE. COUNTY ENGINEER
WILLIAM A. JENSEN. SUPT OF BUILDING
CALITY Temple C'ty
FOR APPLICANT TO FILL IN OSSST. /
NUMBER FIXTURE OR ITEM EACH FEE
OWNER Noel Baldwin
3 WATER CLOSET $1.25 3 75 MAIL
1 BATH TUB 1.25 1 25 ADDRESS
2 SHOWER 1.25 2 50 CITY TEL. NO.
3 LAVATORY 1.2S 3 75 CONTRACTOR Owen Bros Plumbing
1 SINK 1.2S 1 25 ADDRESS 4265 No. Baldwin
]. DISHWASHER 1.2S 1 25 CITY El Monte TEL. NO. 443-0078
CONTRACTOR'S1 STATE
LAUNDRY TUB 1.25 REGISTRATION NO. 197184 COUNTY ❑
CLOTHES WASHER 1.25 1 25 DISTRICT NO. GROUP ZONE PfIOGESSED BY
WATER HEATER 1.50 1 0 � ) i 1_ 1
i s i
1 GAS SYSTEM 5 OUTLETS 1.50 1 5o wasT WASTE APPROVAL STRIALO
OUTLETS OVER 5 PER SYSTEM .30 V
INSPECTION RECORD 0�
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT j 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE0 00 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READLICATION
AND STATE THAT THE ABOVE IS CORRECT AND COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE ULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY RAND�OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNSTATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER TEND TO RESIDE IN, THE ABOVE SCRI RESIDENTIAL PUTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
LIDATION ROBERT A. WOOD
CK. W O. CASH SUPERVISING MECHANICAL ENG'R
WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A T,
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a certifi copy thereof (Sec. 3800 b. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy N . 7 Company
Certified copy is hereby furnishe
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 0 ��
Certified copy is filed with the co my building inspec- ADDRESS
tion department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Date d Z Z Applicant WATER CLOSET NEAREST '
CERTIFICATE OF EXEMPTI 39 FROM W -ERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER U,(IC.II_'
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars(S100)or less.) LAVATORY 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
CONTRACTOR
Date Applicant 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. ��o
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATEy--�� LIC.
deemed revoked. WATER HEATER LICENSE NO. 4, a 7 Z CLASS
LICENSED CONTRACTORS DECLARATION DISTRIei-4�10. P ED 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 FINAL VALIDATIO @'
eyL�� , p DATE
License Number " "P— Lic. Class U
�
C-46A,, FINAL 99
Contractor sz`^"'�- Date 041_Z7_ BY
I am exempt under Sec.
r�
BAP.C. for this reason
Plan check fee 3 2 G,4 A
Date: PLUMBING PERMIT ISSUING FEE$ 1111111. ;ESignature � � # o 0 0 0 0 5
TOTAL FEE
SINGLE FAMILY Plan check applicant 0 . 3 0,50
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address `3 5
o 0 0
Law for the following reason (Section 7031.5, Business and Q 0
Professions Code): City Tel. No.
❑ I, as owner of the property, will do the work and the a 2 2_$5
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
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 S to laws regulating Plumbing, and hereby
authorize repr tatives of this County to enter upon the
abov enti d property for inspection purposes.
` SEE REVERSE FOR EXPLANATORY LANGUAGE
9�c /P/ " �
Sig a re of Permi a Date