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Home My Public Portal About9040 BROADWAY_Plumbing__ 76AS67A (.L CE 617IIREV.6/]BI LI'll] APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS '9040 LI BR7ALWAY NUMBER FIXTURE OR ITEM ® FEE LOGAuiv . 1EIViPLE CITY WATER CLOSET NEAREST BATHTUB CROSS Si. Irl d� SHOWER OWNER MY R LAVATORY ADDRESS 9040 E.- BROADWAY ADD SINK CITY SAIYE TEL.NO, DISHWASHER CONTRACTOR Tt41YLi LL P� NL E FT�L CC CLOTHES WASHER ADDRESS I034 N. PECK SWIMMING POOL RECEPTOR CITYS'OUTH EL M), p TEL.NO. LAWN SPRINKLER SYSTEM STATE1 5797982 �T f C WATER HEATER LICENSE NO. 4 CLASS C-20 ]_ GASSVSTEM ]_ OUTLETS 3.Q0 I APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING ' GAS PIPING 0 0 GAS VENT U HOT WATER HEATER F0F PLUMBING FIXTURES W GASTEST 11.tT,fJ '•,t.:.4i19A�r�. 0. Plan check fee UTIUTYCO.NOTIFIED Z PLUMBING PERMIT-ISSUING FEE$ TOTALFEE 10.0 FINAL /kuXo 1.�7 Vfea : I C..._. Plan check applicant -LAN �.CHECK VALKJ IDATN" . Name • • `�� (10-7 0— Address _ City Tel.No. _ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION I HEREBY CERTIFY THAT 1 AM.PROPERLY REGISTERED AND/OR LICENSED AS p A 7 23 L 11 A REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE G. Y V LEGAL OWNER OF.AND INTEND TO RESIDE IN TME AB VE DESCRIBED RESIDENTIAL PROPERTY. # O 0 0 0 O'S ". SIGNATURE2 0 0 1 Q 00 OF PERMITTEE 1 ll DISTRICT NO. PR SSED BY o O 6 1.Q 0 0 0 JJ 6 0604'-79 INDUSTRIAL - WASTE APPROVAL 76AS67-CE817 12/59 �"�•�4-L.V (�- APPLICATION FOR PLU4BING PERMIT �] COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY ]DIVISION - BUILDRNc JOHN A. LAMBIE, COUNTY NGINEER ADDRESS 90l�0 Eanst Brwgdwny WILLIAM A. JENSEN, Sur•T of BUILoiNo_ LOCALITY Temple City,ty, Calif. FOR APPLICANT TO FILA. IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM Owxea Mr. Lloyd Dyer WATER CLOSET MAIL ADDRESS O O R HATH TUB SHOWER c1TYTemnle City, TEL. NOAt- 69458 LAVATORY cONTRACToR ARCO PLUMBING CO SINK ADDRESS 527 West Garvey Ave. DISHWASHER CITY Monterey Par NO. AT- 29 188 CONTRACTOR'S STATE a LAUNDRY TUB REGISTRATION NO. 113206 C36 COUNTY Cl CLOTHES WASHER DISTIR ICTNQj GROUP ZO1JEE PR ESSED BY 1 WATER HEATER U JJ( ✓/�j�.J 7 GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD Yh O U m O U 6 0 $1.00 PER ITEM 1 OR FIXTURE S 1.00 APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTAL FEE 3VO-O-' ROUGH PLUMBING GAS PIPINGIEREBY ACK AN DH RSTATE TH TN THE ABOVEH EAD IS CORRECT I HAVEAT THIS AGREEA ICATION TOL COMPLY GAS VENT PWITH ALL LUMBING. COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER IIID/E.I /i A.G� I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES I/ I7 / LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST J CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE Y• ( ( 1 1✓. �• OF PERMITTE FINAL 1 C( "iI ®• OVALIDATION ROBERT A. WOOD, c[. 8.0. CASH SUPERVISING MECHANICAL ENG'R LACI 2 2 9 9 SEP 7 5 D 3 .0 0 WORKERS'COMPENSATION DECLARATIONP9��l�v�PYY B®� -�®� �6VItlE�'��, ��ItlO�g I hereby affirm that 1 have a certificate of consent to self yyA667.q svu eve I `,inure;-qr a certificate of Workers' Compensation Insurance, CE BV(REV. 1WBI) or a certified oapy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES - - BUILDING AND'SA FET.Y - 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 inspec- ' ADDRESS"''' tion department. NUMBER FIXTURE OR ITEM Cb FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. - COMPENSATION INSURANCE / OWNER (This section need not be completed if the work involved by SHOWER r• Aiii - _. _ _ ... .. _. _ MAIL .a the permit is for one hundred dollars($100) or less.) LAVATORY . . •� ADDRESS--" - 4 P IF I certify that in the performance of the work for which this - - - permit is issued, I shall not employ any person in any manner SINK CITY 7� TEL NO. o 79 so as to beco a su jeer to the Worker Compensati n Lo s. DISHWASHER 7 CONTRACTOR Date/O Z pplic CLOTHES WASHER ADDRESS NOTICE O A LICANT: If, after king this Certificate of ' Exemption, you should became subject to :the Workers' SWIMMING.POOL RECEPTOR --- -- — - Compensation provisions of theLaborCode, you must forth- QTY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE- _ LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO: P OCEsSED BY Thereby affirm that I am licensed underprovisions of Chapter 9 GAS SYSTEM. OUTLETS •� - �� O (cothmencing with Section 7000) of Division 3 of the Business OUTLETS OVER o and Professions Code,and my license is in full force and effect. 5 PER SYSTEM• FINAL VALIDATION ' — DATE-/;7 } J License Number Lic. Class 0 - _ O U. Contractor Date , I am exempt under Sec. 0 B.SP.C. for this reason W Plan check fee - - a• Date: PLUMBING PERMIT ISSUING FEE$ D Z Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name . . 1 hereby affirm that I am exempt from the Contractor's License Address — - Low for the following reason (Section 7031.5, Business and _ Professions Code): I City Tel. No. 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section .. .. . .D 7044, Business and Professions Code). - CONSTRUCTION LENDING AGENCY _ _ _ 9 5 8 Z 0 A I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued -' - — - — - - - -- --- # e e s,o,e 5 (Sec. 3097, Civ. C.). t) ° ° 4 Q*5 0 Lender's Name - __ `.' "— '—e�e-e.4-Q 50.ii Lender's Address - I 029-86 1 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 laws regulating Plumbing, and hereby authorize representatives of this County to an r u in the ' 4a, mentioned pty 1 r inspection perp es. SEE-REVERSE FOREXPLANATORY LANGUAGEre of Permittee D to --' •- - -- - - _ _... _.. __ .. ..