HomeMy Public PortalAbout10568 BOGUE ST_Plumbing__ 76A667-CE#617 5/63 �'�//%'�/ `•% / ` /
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 10568 Bogue
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
} WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY Temple Ci
FOR APPLICANT TO FILL IN NEAREST /
CROSS ST. 1
NUMBER FIXTURE OR ITEM EACH FEE OWNER Noel Baldwin
2 WATER CLOSET $1.25 2 50 MAIL
1. BATH TUB 11.25 1 25 ADDRESS
], SHOWER 1.25 1 25 CITY TEL. NO.
LAVATORY 1.2S 2 50 'CONTRACTOR Owen Bros Plumbing
1 SINK 1.25 1 25 ADDRESS h265 No.
1 DISHWASHER 1.25 1 25 CITY El Monte TEL. No. 4 3-00 8
CONTRACTOR'SSTATE
LAUNDRY TUB 1.25 REGISTRATION NO. 19718 COUNTY
1 CLOTHES WASHER - 1.25 1 25 DISTRICT NO., GROUP
_- ZONE I PROCESSED BY
1 WATER HEATER 1.50 1. 50
1.50 INDUSTRIAL 1 a
1 GAS SYSTEM OUTLETS 1 WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 U
INSPECTION RECORD �
0
LUZ
APPROVALS DATE INSPE OR' SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 16125
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 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
LESDE
CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
THE ABOV ESC D RESIDENTIAL PRO ERTY UTILITY CO. NOTIFIEDE ITTEE
FINAL
VALIDATION ROBERT A. WOOD
cK M O CASH SUPERVISING MECHANICAL ENG'R
Li'I.Lck
9 0 7 i!A`f 5 Q
16.25- t;
WORKERS',COMPENSATION DECLARATION
ereby,
certifiaffirm that I have a certificate of consent to self .n 76��A PW 4,87 APPLICATION FOR PLUMBING ' PERMIT
sure.or a certificate of Workers'Compensation Insurance,or a 'CE 817(REV 8/86)- City Of 1 ernpl•e City'
ed copy thereof (Sec 3800, Lab C )
-COUNTY,OF LOS ANGELES DEPT. OF PUBLIC WORKS .
Fohcy:Na. 6969-O0. m`0any NMIC;:
1 1, . . - 1850& -
Certified copy is,hereby furnished '
'" BUILDING
t � ' �' - •,'-- •FOR APPLICANT TO FILL IN (PRINT OR TYPE) ' • �
1-1 'Certified copy is filed with the county building inspection ADDRESS '+
4� NUMBER FIXTURE OR ITEM FEE LOCALITY
department. @ „-
(�` (TOILET) .
Date_, ^4 1 2 Applicaneneral 'InstalWATER CLOSET'
l. NEAREST "
I "
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB'.-• - -. , CROSS ST,
- COMPENSATION INSURANCE SHOWER -OWNER'
(Thls:section=ne6d'no't be completed if the work involved by MAIL
"the permit is for orie hundred dollars ($100)or less.) LAVATORY - ADDRESS;
I certify.that in,the performance of the work for which this per- �` eii�- -
SINK: CITY .TE
mit is issued„I shall not employ any person many manner so r "4 _ 0 _
OS to become subject to the Workers' Compensation Laws DISHWASHER
CONTRACTOR1, DiStaktation co
`Date-- 'Applicant ' r CLOTHES WASHER , ADDRESS
NOTICE TO APPLICANT: If, after making this'Certificate of Ex- SWIMMING POOL,RECEPTOR j
emption,you'shou ld become subl'ect to the Workers'Compen-- CITY• TEL NO Fr
sation provisions of the Labor-Code, you must forthwith comp- LAWN SPRINKLER SYSTEM2541
•,ly with such provisions-.or,this permit shall be deemed-revok- .i; - STA AngelesU ;, '
ed.,.L -WATER HEATER7” 5 LIC SE^NO CLASS
-LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED�BY,/,.�
";I'he�eby affirm that I am licenied under provi•sioris of,Chapter GAS SYSTEM „ OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER U f/
fed Professions Code, and my license is-in full force and ef- 5 PER SYSTEM FINAL., VALIDATION ,.
DATE ,
License Number -tri 1.8 3 9 Lic Classy C'-1h O
- FINAL
- Contractor�T.��=vein Date / 1 BY O
H
E• I amexemptunder Sec W
B 8P C::;for this reason
Plan check•fee \ ,Z,,4/- f`� N
poll.
�,
Date PLUMBING PERMIT ISSUING FEE$ 1 3 00
Signature
TOTAL FEE
20
SINGLE l
-HOME OWNER-BUILDERPlan check appicant-
bECLARATION -
I hereby affirm that I am exempt from the Contractor's License Name
Law for the, following reason, (Section 7031.5, Business and. i_ .` as
Professions Code) Address - -
--- -DIJ
Da. l,'as owner of tFe-property will.do the'work'-and the Gty' . Tel No
structure is not intended or offered for sale(Section 7044, _
Business'and Profession`s,Code) •`t -
t _ .rii_ -,�
- ? - • - - —
r CONSTRUCTION LENDING-AGENCY
I heieby affirm tfiat there is a construction,lending agency for t - -
tfie performance of the work forvvhich'this permif-is issued -'ri s`yiji�
(Sec %3097;`Civ `C ) w
Lender's Name
Lender's Address - . . - •• - ` «,"f_t- f. . •a•il'',:�'E'_r ,
I cert fy that I•have read this application and state that the
above information is correct;I agree to complywitholl-County
ordinances and,State laws'regulating Plumbing, and hereby.
authorize representa s f this.Gounty to-enter'upon•the ;
above,m a ''_ open lfor inspection purposes
��i ;, /- SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Per tt ate