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HomeMy Public PortalAbout9840 BROADWAY_Plumbing__ APPLICATION FOR PLUMBING PERMIT BBs IT (DIVISION OF BUILDING AND SAFETY Depoziment of County Engineer County of Los Angeles BUILDING U' !� JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS p / CASSATTD P GRIFFIN, SUPT of BURBW6 LOCALITY C/ FOR APPLICANT TO FILL EAREST a CROSS ST. OWNER DISTRICT GROUP ZONE I READY FOR INSPECTION MAIL l ADDRESS INDUSTRIAL CITY TEL. NO. WASTE APPROVAL PLUMBER / ZZIvwL;�cP pll�Y,-�—� INS�P'ECTION RECORD ({ ADDRESS . CITY � L`L�®'•"' 3 2 41 I1IR:.") Y�1 h.YY , 4�Sri:�L�na�t` F^.I.Q C1 y✓(.�.�_. - L TEL. NO.a e` 93tI�0iS7 1\1{s syn \t�fiwG� tido 1..L LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ C7 O BATH TUB @ $1.00 SHOWER @ $1.00 99 m D C9 LAVATORY (WASH BASIN) @ $IOO � 6 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 QO - CLOTHESWASHER - @ SLOO ��pp WATER HEATER @ $1.00 V GAS SYSTEM @ $1.00 ©Q APPROVALS DATE IN ECTOR'S•<SIGNATURE UNDER Sl-WORK Q ':A PERMIT $ 1 00 ROUGH PLUMBING / dJO GASPIPING TOTAL FEE GASVENT i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER i AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST e LICENSED AS REQUIRED BY LOS ANGELES COUNTY STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER (AND THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIAL �ROPPERTY. SIGNATURE OF PERM ' F'LZ� /" {� ?a ..11 nF �.tr•^� ITTEE �'t1"� FINAL y JOHN A. LAMBIE, COUNTY ENGINEERVIALIDATION ROBERT A. WOOD. CHIEF PLBG, INSPECTOR 11.'0. CASH L,�Co6695,� APR 2 2 700 in 76A667C ICE-BIJBI -9/TS APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TVFE) BUILDING aE NUMBER FIXTURE OR ITEM @ FEE ADDRESS rC WATER CLOSET LOCALITY' BATH TUB NEAREST i CROSS ST. SHOWER jaa OWNER q LAVATORY MAIL ADDRESS c i SINK CIT TEL. NO r DISHWASHER h CONTRACTOR > CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL. NOII _ LAWN SPRINKLER SYSTEM STATE LIC _ >. WATER HEATER LICENSE NOr - ''\ CLASSCIII O DISTRICT NO. GROUP I(ZApNE CESSE BV GAS SYSTEM OUTLETS , VU I y N`—� t CD OUTLETS OVER IINV� 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL h INSPECTION RECORD Z Plan check fee PLUMBING PERMIT ISSUING FEE $ f TOTAL FEE \ Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. NO. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE OES CRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE PLAN CHECK VALIDATION CK. M.O. - "CASH PERMIT VALIDATION � M,0. CASH . 6r6..8&APR 13 o5 0D 3 1/50 .e-�� wffirm that COMPENSATION DECLARATION20 APPLICATION FOR PLUMBING PERMIT hereby, affirm that I jiave o certificate of consent to self in- 76A666 DPW 4/87 E 817( sure,or a cer�ficate of Workers'Compensation Insurance,,ora CE 817(REV. 8i86) ' certified copy thereof (Sec. 3800, Lab. C.)' • Policy NcF."C'975g52 CompcmKePubliC Indemnity COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS © Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the my building i cfion ADDRES department. NUMBER FIXTURE OR ITEM (d FEE LOCA`5T 9 WATER CLOSET(TOILET) I em le CIOt Date 101 21187 Applicant NEAREST CERTIFICATE OF EXEMPTI FROM WORKE BATH TUB CROSS 5 COMPENSATIO NSURANCE SHOWER OWNER r (This section need not be completed if the work involved by MAIL Dennis OLeary- the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 9840 Broadway I certify that in the performance of the work for which this.per- SINK CITY Temple City, CA TEL. NO. htit is issued, I shall not employ any person in any manner so - 286-4347 as to become subject to the Workers' Compensation Laws, DISHWASHER coNTRAcittryant Heating and Air Conditionin Inc. Dote Applicant CLOTHES WASHER ADDRESS 1350 E. Las Tunas Drive NOTICE , y APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR sation n,.you ns of the come Code,too the tforthwithco p- CITY San Gabriel, CA 91HIENo. 286-1141 lotion provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE 221751 LIC. C20 -,ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT Np PR CESSED B I hereby affirm that I am licensedrunder provisions of Chapter GAS SYSTEM OUTLETS (•(/!l/ 9(commencing with Section 7000)of Division 3 o the Business OUTLETS OVER fed Professions Code, and my license is in full ftyce and ef- 5 PER SYSTEM FINAL ,_� VA ATION a O' License u ber / Lc loss i D U FIN Q Contract ate 7 - B '� O f m exempt and c. W a B.SP.C. for this reason Plan check fee D 2 Date: PLUMBING PERMIT ISSUING FEE $ - r' Signature 10 50 / TOTAL FEE SINGLE FAMILY 8S�tf'L A HOME OWNER-BUILDER DECLARATION Plan check applicant •- I hereby affirm that I am exempt from the Contractor's License Name - # e e o e'e 5 Low for the following reason (Section 7031.5, Business and - Professions Code): Address I a - 1650 .F] I, as owner of the property, will do the work and the City - Tel. No. o e �1 Jr 060structure is not intended or offered for sale(Section 7044 e, - Business and Professions Code). - CONSTRUCTION LENDING AGENCY 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 D ans and $tate laws regulating Plumbing, and hereby - auth ri p e tatives of this County to entet upon the abo of roperty for insp tion purpose . - . 6 • SEE REVERSE FOR EXPLANATORY LANGUAGE r ign reteof Per Dafe _