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Home My Public Portal About10420 DAINES DR_Plumbing__ �. 76A887A (CE 0178) -4/'77 APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE( BUILDING O ^ NUMBER FIXTURE OR ITEM ® FEE ADDRESS N WATER CLOSET LOCALITY 70 NEAREST BATH TUB CROSS ST Qt Q / SHOWER OWNER S r Q r n LAVATORY MAIL ADDRESS 4a Ste rra SINK CITY r a d TEL NO A DISHWASHER CONTRACTOR p S CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL NO (�(F(y t�L LAWN SPRINKLER SYSTEM STATE rce WATER HEATER LICENSE NQSTA__ S, S. 3 dC,,#zbUN(h GAS SYSTEM OUTLETS � ISTfjIC NO G U ZONE P D BY OUTLETS OVER vh CD 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL CD INSPECTION RECORD t ,�4• / N U � z Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant Name APPROVALS DATE INSPECTOR 5 SIGNATURE UNDER SLAB WORK Address , p, ROUGH PLUMBING y, , City Tel No GAS PIPING IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT - THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER IHEREBY CERTIFY THAT PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIREDBY LOS ANGELES OU TY AND STATE CALIFORNIA OR TH IAM THE GAS TEST LEGAL OWNER OF,AND I ND O RESIDE IN ABOVE DESC RIB ESIDE NT PROPERTY .' UTILITY CO NOTIFIED `SIGNATURE OF PERM ITTE C FINAL ,PLAN CHECK VALIDATION CK M o CASH PERMIT VALIDATION CK M o cAs�Hf Z5 3 9 r--JUL 7 5 0 1 5.0 0 ,&:3�, .r "D s s-i, 25M SETS 12-45 APPLICATION FOR PERMIT DEPARTMENT-OF'BUILDING AND SAFETY COUNTY OF LOS ANGELES PL j WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO" GROUP ZONE PERMIT NO ROUGH FIXTURES COMPLETE ' 4,9 HEATER CESSPOOL SEPTIC TANK E RCEIVED BY READY FOR DATE ISSUED —I FIRST INSPECTION GAS MISCELLANEOUS I / ! y / APPLICANT FILL IN HEAVILY OUTLINED PO{RTIO,N, ONLY JOB NAME,fJ'(�/ L &-,e- /7��P/y�I,QQ� ADDRESS p �` O Q�G.C�y�C/./ " ADDRESS .,!]� �„(��,/,/yilr(,/ thJ 4 LOCALITY �- D � � NEAREST ' a CITY TEL.No. CROSS ST. COUNTY—� CERT.No. EXPIRES W I NAME � ,( w LOCATION OF SEPTIC TANK, OR-CESSPOOL 3 MAIL ADDRESS NORTH 0 CITY TEL No. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER _ 'I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. 3 m OWNER p �! CORRECTIONS SOUTH a DESCRIPTION OF WORK ATH TUB FURNACE ' H —SHOWER DISHWASHER 1 —LAVATORY - REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP LOP SINK FLOOR DRAIN -T o / WASH TRAY URINAL APPROVALS F WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING ETER -� GAS SODA FOUNTAIN GAS PIPING j OUTL GAS VENT f • CESSPOOL TOTAL NUMBER OF FIXTURES 5'Q SEPTIC TANK CESSPOOI _l8EPTIC TANK _7 � SEWER I TOTAL FEE 1 $ UTILITY CO.NOTIFIED FINAL y / f D B.S.-1T 25M SETS 6-46 APPLIc."nul ��a = DEPARTMENT OF BUII.DING E SAFETY - �� r �� - COUNTY OF LOS ANGELES WM.J. FOX.CHIEF ENGINEER NATURE OF INSTA TIO _j DI 1 GROUP ZONE PERMIT O. ROUGH FIXTURES COMPIWETE Ise, , !// '*l/ 7 �� HEATER CESSPOOL H SEPTIC TANK RECEIVED BY READY FOR DATH ISSUED FIRST INSPECTION � a�� rY AS, MISCELLANEOUS 1 \{ APPLICANT FALL IN HEAVILY-OUTLINED PORTIY/3' JOBON ONLY/�{A A C NAME �tI mI ADORE" Gqf'�®9) "Iv �orN6�IN g ADDRESS 5�r�_ w��I � LOCALITY T !1�)&Ae V/I ,¢ NEAREST `I CITY ✓ ({ - TEL.No. CROSS ST. d COUNTY 6✓" _ /�p� i /��A ,9�r�q CERT.N [rJ(PIREB m NAME /"� ®I `� LOCATION OF SEM- C TANK, OR CESSPOOL 2 MAIL e I �� /�� 3 ADDRESS -ter NORTH O �, CITY .� TEL.No. i� { IAM THE LEGAL P1688MBSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. _ � PLUMBER ,f 1 AM THE LEGAL"OWNER OF HE PROPERTY DESCRIBED ABOVE. �� ' OWNER CORRECTIONS Fla A� SOUTH J DESCRIPTION OF WORK z BATH TUB FURNACE Q' HOWER DISHWASHER D AVATORYI/ REFRIGERATOR ::�v ITCHEN SINK WATER SOFTENER r• FLOOR SINK BAND TRAP `'�'��/�✓4 1 SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPUCTOR'S NAMQ-J _WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I ETER__�_GAS -_SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES .��J �,�+ SEPTIC TANK I I CESSPOOI EPTIC TANK SEWER +�} S UTILITY CO.NOTIFIED I I TOTAL FEE • FINAL ✓� iF 76A667-CE817-8-58 APPLICATION FOR - PLUMBI G PER IT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY EkGMEER BUMDING AND SAFETY DIION BE&I G JOHN A. LAMBIE, County Ener ADD RE33 CASSATT D. GRIFFIN,Supt of ding LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS _ SHOWER CITY ! ♦ TEL. NO. LAVATORY CONTRACTOR SINK ADDRESS / DISHWASHER CITY NO. LAUNDRY TUB CONTRACT08 STATE TY REGISTRATION NO. O COUNEl CLOTHES WASHER DISTRICT NO GR P ZONE P O S� BY WATER HEATER (J GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD APPROVALS / $1.00 R PER $ 1,p p DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK � j I PERMIT $ 2 OO ROUGH PLUMBING TOTAL FEE 3 d D GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL PROPERTY. SIGNATUREFINAL /le/61 OF PERMITTE ®P VALIDATION ROBERT A.WOOD. SUPERVISING MECHANICAL ENG'R ' CK. B.0. CASH' Lpfo 1 9 3 4 FE3 5 D 3 .0 0 e WORKERS'COMPENSATION DECLARATION 7GA667A I hereby'a rm that I have a certificate,of consent to self ce e17 (2-e0) APPLICATION F O PLUMBING PERMIT ingure,''or�Y ertlficate of Workers',Compensation Insurance,or ) a curtified Ppy thereof(Sec. 3800,Lab C.1 G tOUEWING AND SAFETY 94.0357CpanyAetna Ins .- Co. 0,Certified copy is hereby furnished FOR APPLICANT TO FILL IN (P I T OR TYPE) G -ADD RE SN 10420 Daines Ave r-1 Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE department WATER CLOSET LOCALITY Date 7 1 9oApplicantOWQn Bros Plumhi ng U� NEAREST BATH TUB O CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' - COMPENSATION INSURANCE SHOWER OWNER D Chll LAVATORYMAIL ' (This section need not be completed if the work involved ADDRESS 180 W.. ive Oak a by the permit is for one hundred dollars ($100) or less.) SINK O 00 CITY Arcadia TEL No4.45-188 U I certify that in the performance of the work for which this DISHWASHER �y tE !/ �V CONTRACTOR Q.wen Bros. Plumbing, Inc. permit is issued, I shall not employ any person in any manner .O so as to become subject to the Workers' Compensation Laws / CLOTHES WASHER Q ADDRESS- 4265 N. Baldwin Ave. Date SWIMMING POOL RECEPTOR d UJI NOTICE TO APPLICANT If, after making this Certificate of CITY El Monte TEL "0443-00 8 Z Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM _ Compensation provisions of the Labor Code, you must forth- STATE LIC WATER HEATER LICENSE NO. CLAS with comply with such provisions,,or this permit shall be C —20 deemed revoked. GAS SYSTEM OUTLETS .1 DISTRICT NO SSE Y, , d LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of-Chapter, - 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- - FINAL ALIDAT ON ness and Professions Code, and my license is in full force and DATE " r effect �f License Number��74� Lic Class C*16-9 " BY AL CoAtracto lArg - 7179/80 Q,:I'am exempt from the licensing requirements as I am a Plan check fee SCS licensed architect or'a registered professional-engineer PLUMBING PERMIT ISSUING FEE$ J acting in my professional capacity (Section 7051, Bus- O iness and Professions Code). TOTAL FEE Lic.or Reg.No Date Plan check applicant ' HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's I Address ` License Law for the following reason (Section 7031 5, Busi- City Tel No ness and Professions Code) I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY 1 0'0 A I hereby affirm that there is a construction lending agency # 0 0 0 0 0 5 for the performance of the work for which this permit is issued(Sec. 3097,Civ C.). Lender's Name 2 0 04600 Lender's Address o46, ppM I certify that I have read this application and state that the 0 El 0 .1 —80 above information is correct I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby , au horize representatives of this County to enter upon the property for inspection purposes 00 - entioned Sigliature of Permittee Date.