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Home My Public Portal About9034 BROADWAY_Plumbing__ ' CITT OF TIMPLE CITY °BABBr Be9�17 10 55 APPLICATION .FOR PLUMBING PERMIT 1 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles $-Z 2, BUILDING D.. JOHN A. LAMBIE• COUNTY ENGINEER ADDRESS 9034 E-Broadway Broadway CASSATT D.GRIFFIN.SuF-T OF BUILMN.. Temple City LOCALITY 1 V FOR APPLICANT TO FILL IN I NEAREST Roeemead CROSS ST. OWNER Wm. Griffith I ° IST�J T�10. GROUP ZONE R FOR INSPECTION MAIL "CT ADDRESS Some INDUS RIAL CITY TEL. NO. WASTE APPROVAL PLUMBER GENERAL INSTALLATION CO. INSPECTION RECORD ADDRESS 6558 West Blvd. CITY L.A. 43 TEL. No. PLeasant 3-2541 LICENSE NO. 787 C-36 151839 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ BATH TUB @ 51.00 SHOWER @ SI.00 LAVATORY (WASH BASIN) @ S1.00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRYTUB OR TRAY .@ S1.00 CLOTHESWASHER @ $1.00 WATER HEATER @ $1.00 _ GAS SYSTEM @ 51.00 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT 5 00 ROUGH PLUMBING GAS PIPING _ TOTAL FEE OD GAS VENT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST q LI ENSED S REQUIRED I0 6 CALIFORNIAORTHAT 1AL0ANGELES ECOUNTY DSTATE MHE LEGAL OWNEROF THE ABOVE - UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL P SIGNATURE OFPERMITTEE FINAL JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A:WOOD. CHIEF PLBG. INSPECTOR, CK. Y.9. CASH 9"f 4 2 f/u1R 15 5 D 3 .0 0 M � 0 2 k r WORKERS'at I hays a* ION DECLARATION CE ) APPLICATION FOR PLUMBING PERMIT..--, /7 I kereby affirm that I have a certificate of consent to self es an(r-eo h f in sure, or'acerfifiL•ate of Workers'Compensation Insurance,or 'ul a certified copy thereof(Sec. 3800,Lab.C.) ' COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) - BUILDING^ Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM O -FEE ADDRESSD department. LOCALITY A-1C � WATER CLOSET - Date Applicant � NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNERMAIL �G /J p LAVATORY AD DR ESS 9Q3 - L.�� ) d (This section need not be completed if the work involved by the permit is for one hundred dollars ($I00) or less.) SINK �( CITY LIQ TEL. NO. W � U I certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CO NTRACTO �J �� O so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS U Date Applicant SWIMMING POOL RECEPTOR a NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO. N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Z Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO. CLASS with comply with such provisions or this permit shall be deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PRQCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER S, d 1 hereby affirm that I am licensed under provisions of Chapter 5 PE R SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL �!�(,� VALIDATION ness and Professions Code, and my license is in full force and DATE O effect. FINAL License Number Lie.Class Bim_ C21Z Contractor Date 0 I am exempt from the licensing requirements as I am a Plan Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- _ iness and Professions Code). - TOTAL FEE- Lie.or Reg.No. Date Plan check applicant , , a O A Name 5 HOME OWNER-BUILDER DECLA RA /� A!tas 1 hereby affirm that em exempt fr the Contra is Address 300 License Law for Ih ollo_Ing reaso Sectio n.7031 Busi- City Tel. No. ` ness and Professi Code): o a e 3, 006 �Iu�sof the pro ty, am exclusi y contractingpd conte ors to constr the project O 7,,�tQ—(jQ 4, Bu ass and Professi s Code). CONSTRUCTION LENDING AGENCY - 1 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.). - Lenders 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 SEE REVERSE' FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this F-ounty to enter upon the above-mentioned property fori action purposes. Pem t . r Signature of rttcee Date ,