HomeMy Public PortalAbout9509 BROADWAY_Plumbing__ BA°^TAPPLICATION -FOR PLUMBING PERMIT
DeB.IT 3DIVISION OF BUILDING AND SAFETY
Department of County.EngineeE
County of Los Angeles
WM.J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
OA£BATT D. GRIFFIN, BOP'T of BUIIOING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST..
_OWNER YW✓r✓Wf/`�o� D CT NO. GROUP ±0=E REAUYPORINSPECTI-
MAIL
_ADDRESS
♦� INDUSTRIAL
CITY TELTwNO. WASTE APPROVAL
PLUMBER IG9 INSPECTION.RECORD
ADDRESS
CITY NSS TEL.'N- 71 F 3V
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) g
BATH TU B
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER - -
TOTAL_ NO, (a O.BO' : APPROVALS
DATE INSPECTORS SIGNATURE
GAS SYSTEM-OUTLETS (a 1.00 _
WATER HEATER 0 1.00 1 Dv UNDER SLAB WORK
PERMIT 7 00
ROUGH PLUMBING
s - - '
- � 1 � GAS PIPING
- TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER t2
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES'
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF '
CALIFORNIA OR THATqM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED .
DESCRIBED RESIDENTI PROPERTY. �y /
SIGNATURE
OFPERMITTEE� Jr FINAL
WILLIAM J. FOX COUNTY ENGINEER VALIDATION I R.A.WOOD, CHIEF PLBG. INSPECTOR
X07.8 6 GuSEP 12 3 2.0 0 ID
COMPEN
,WORKERS' IhoveaSATIOc.leofDECLARATION APPLICATION FOR PLUMBING PERMIT
20-WP6 DPW'4/87 n
by:affirm that I have a certificate of consent to self,in- 76aa67n '�IL.III
sure,ora certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified copy thereof (Sec. 3800, Lab. C.) il -
Policy No. 989449 CompanyRenubTic Indemnity COUNTY OF LOS ANGELES
Policy DEPT.�OF PUBLIC WORKS
❑-Certified copy is hereby furnished. BUILDING
1 FOR APPLICANT TO FILL IN (PRINT OR TYPE) '
® Certified copy is filed with the county building inspectionA
_� DDRESS 9509 `Broadwa
department. NUMBER FIXTURE OR ITEM rd�_.�FEE LOCALITY ,TempleCity
Date 6/89 Apolicon� WATER CLOSET(TOILET) IF _ —_ �
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ��_ _�j CROSS ST.
COMPENSATION INSURANCE SHOWER ~ OWNER Rocco Sanello
(This section need not be completed if the work involved by "=? MAIL ,
the permit is for one hundred dollars ($100) or less.) LAVATORY a _ ADDRESS 1010O
La Rosa Dr
• ('certify that in the performance of the work for which this per- SINK � y
mit is issued, I shall not employ any person in any manner so _ �'-` `� �1(? CITY TEL NO.
as to become subject to the Workers' Compensation Laws. _ � . --. -._ \
DlsnwnsHER /o _ 1� -- '? 5777
CONTRACTOR FxankTem le Cityane_& —
_MA.r_rSons, Inc.
Date Applicant I CLOTHES WASHER \ _ ` —
- _---
� ADDRESS �_'"�" 9860 Lower Azusa Rd.
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption, you should become subject to the Workers'Compen-
sation provisions of the Labor Code, you must forthwith comp- CITY El Monte. TEL. No 444 2548
LAWN SPRINKLER SYSTEM �r-� _
ly with such provisions or this permit shall be deemed revok- STATE g97886 CL C/36
ed'. WATER HEATER _(� �, -. � � LICENSE N CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
tJ Q
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUT
O
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �/Sb —_ -•.. ! �J
and Professions Code, and my license is in full force and ef- 3 5 PER SYSTEM /• - •- t FINAL VALIDATION Y
fed. Z- -�__� DATE '00-3IM
License Number 3978E4 Uc. Class C/36 /81 O
U
Contractor
F. Marrone & Songote 12/89 — - —� e� p
t. U
am exempt under Sec �^ ` W
B.SP.C. for this reason - I> - N
Plan check fee o o mac! z
Dole PLUMBING PERMIT ISSUING FEE$
S'gnature� ,S G�FAMILV at ._ �- .: ..-. .__.__--_ .....__ _._. .. .._ .__..._._....
. ...__ . .
TOTAL FEE (It ,•• �)
HOME OWNER-BUILDER DECLARATION Plan check applicant �--- 1
_ 5.
I hereby affirm that I am exempt from the Contractor's License Name `'- •�� - -
Law for the following reason (Section 7031..5, Business and -- -- -p:
Professions Code): Address 0.� _ ,,. ACCT.a3307 � '"sGo
F1 1,I, as owner of the property, will do the work and the City Tel. No. .0 .-. _ 1
.. L Gt I .... -
structure isnot intended or offered for sale(Section 7044, r•,
Business and Professions Code). TOTAL 99 . 1130[vnr
CONSTRUCTION LENDING AGENCY - �� CHECK
rC 99.011
1 hereby affirm that there is a construction lending agency for CHVG ,sCu
the performance of the work for which this permit is issued
(Sec. 3097, Civ, C.). .___.._. .
Lender's Name
OdOD-00o1 6/ 1/089
Lender's Address 371-1 1 MUM
I certify that I have read this application and state that the - - D -
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 enter upon the
bove-mentioned property
,.for
for inspection purposes.
,-{p,�L—�• SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig ature Por 'kufiee�;e1 Date (�