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HomeMy Public PortalAbout9307 DAINES DR_Plumbing__ LEGAL D�SCRIPTTO14-_ DLVT.UEL PEDRIMI , The. South4..x1y'. 50° of .lot 70 of 'the E 'We. McAfee Tra-c,t' in' .the, Rahcho San Franqu to', 0ounty`of Las Ar v las:. €s: , per mr�p',recorded in, B6ol '16 page 1,27-, in the -off ic 0.' of, they: C ounty recorder of- said C 4mt; �: I 76A667 (CE-817) - 1/75 .._. ;-\PPLICAT10. V FOR LUMBINft PERMIT ti COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS _;; P. T)AT TPR T1R TTF' HARVEY T.11 BRANDIT, COUNTY ENGINEER LOCALITY TMIPLE CITY CA. FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST Cloveriv CROSS ST. NUMBER FIXTURE OR ITEM @1 FEE / OWNER /! WATER CLOSET 2.0 Q CJ _ a Ij_ MAIL BATH TUB 2.0 & D ADDRESS 9307 E. Daines Drive SHOWER 2A0 CITY Tem le City, Ca TEL. NO. Ci 2 LAVATORY 2.(o Q CONTRACTOR 111\ SINK 2. 0 ADDRESS a DISHWASHER 2. 0 CITY TEL. NO. CLOTHES WASHER 2. 0 d STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 2. 0 ?' DISTRICT NO.JGROUPJ ONE (2CESSED BY LAWN SPRINKLER SYSTEM 2, 0 S�U B _T— WATER l7 l WATER HEATER 2. 0 Q INDUSTRIAL _ WASTE APPROVAL GAS SYSTEM OUTLETS 2.JO INSPECTION RECORD L. OUTLETS OVER 30` 701 '�1VLy. �/,— /�r9�"/� � � w 5 PER;SYSTEM v /�- i ��"-'� O 0 U W O. N Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE S ww TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan Check applicant UNDER SLAB WORK Name Manuel J. Pedrinl ROUGH PLUMBING • ��%�(/�`'�ie Address 9307 E. wines Drive GAS PIPING CityTemle QitiE, C Tel. Nps� 6�8 GAS VENT a. G I HEREBY ACKNOWLEDGE THAT I HAVE READ •THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH. ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. - I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR- UTILITY CO. NOTIFIED LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF - CALI FORNIA OR THAT I AM THE LEGAL OP ER OF, AND INTEND TO �7 RESIDE IN THE ABOVE DESC RE DE I L PROPERTY. FINAL -��,-��G..p'�j� c..• t SIGNATURE OF PERMITTEE' 1 PERMI ALIDATION M.O: CASH PLAN CHECK VALIDATAN K. CASH 2 31,:nrT0 5' 0 2 .5 p DB�6!6 foss APPLICATION FOR .PLUNGING PERMIT DIVISION OF BUILDING AND SAFETY Department'of County Engineer County of Los Angeles BUILDING �� JOHN A. LAMBIE, COUNTY,ENGINEER ADDRESS CASSATT D.,GRIFFIN-SUP•T OF BUILDING - _r>. .. ,: . ..s.,:- ;��.�..;. . LOCALITY 9 FOR APPLICANT O FILL IN NEAREST CROSS ST. j OWNER DISTRICT NO. GROUPS ZO Eell MAIL DY FOR INSPECTION ' ' ADDRE 1Z, INDUSTRIAL CITY jp TEL..NO WASTE APPROVAL - PLUMBER. / INSPECTION RECORD ADDRESSEl/ / 73 CI Y TEL. P7 .t LICENSE NO.'O�Z,�/e�jO/ TITEM.' ♦J ��'.� \. NUMBER YPE OF FIXTURE OR ITEM.' FEE 1 WATER CLOSET'(TOILETY @ $1.00' BATH TUB .@ .$1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 ' KITCHEN SINK .. @ $1.00 DISHWASHER @ $1.00 _ LAUNDRY TUB OR TRAY @ _$1.00 CLOTHES WASHER @ $1.00 WATER HEATER @ -$1.00 ' GAS SYSTEM @ $1.00 zj t: APPROVALS DATE INSPECTORS SIGNATURE UNDER SLAB WORK PERMIT $ 7 00 ROUGH PLUMBING GAS PIPING TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS -APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT-WATER HEATER 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 ANGELESCO ND TY A STATE OF CALIFORNIA OR i AM THE LEGAL O ER THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RES EN PROPERTY. - SIGNATURE C• OF PERMIZA� FINAL JOHN A..LAMBIE, COUNTY ENGINEER ALI TION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR CK. t J,M. CASH1 1��F� r i,_:VLL�7 4 , ' i�, JtJ1%2 6 3 2.0 0 'I�) 76APPLICATION FOR PLUMBING PERMIT 1 DBS-1710'55 DIVISION OF. BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDINGD JOHN A. LAMBIE, COUNTY ENGINEER ADRESS CASSATT D,GRIFFIN,SUPT OF BUILDING LOCALITY FOR APPLICANT 22 FILL.IN . NEAREST' CROSS ST. DISTRICT IVO. GROUP I ZONE READY FOR INSPECTION a MAIL 1—/ pn ) I at- 11 . ." t? 1 ���III � ,����� INDUSTRIAL CITY TEL..N WASTE APPROVAL PLUMBER INSPECTION RECORD ". ADDRESS CITY - TEL. NO. , 5 ' LICENSE NO. - NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @_ $1.00 »: BATH TUB @ $1.00 r SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1:00 - 1: KITCHEN SINK _@ $1.00 DISHWASHER •@ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ $1.00 WATE HEATER @ .$I.00 e_. S SYSTEM @ $1.00 Oo APPROVALS DATE INSPECTORS SIGNATURE UNDER SLAB WORK q PERMIT $ } OO ROUGH PLUMBING :� GAS PIPING TOTAL FEE �/ ` ��-� GAS VENT v v 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ HOT WATER HEATER WITH ALL COUNTY ORDINANCES. AND STATE LAWS REGULATING PLUMBING FIXTURES -� PLUMBING. .� 1 Y C IFY I AM PROPERLY R_E TERED AND/OR GAS TEST NSED AS RE D BY LOS ANGELES CO Y AND STATE OF - o CALIFORNIA THAT I AM THE LEGAL O��iTO•'THE ABOVE UTILITY CO.NOTIFIED - DESCR R ENTIAL PROPERTY. 9 SIGNAT OF R � FINAL Ll JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION i-1 ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. M.O. ASH a'z o 7 6 9 8•L° JUL 3 2.0 0 1 . 76A667 (CE-817)-4/72 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY- j- FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST. .. � J WATER CLOSET 1.75 OWNER > L MAIL BATH TUB 1.75 ADDRESS C' e SHOWER 1,75 CITY r TEL. LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS. DISHWASHER 1.75 CITY �. TEL. NO. C• CLOTHES WASHER 1.75 STATE /� LIC 5 r LICENSE NO—. S� CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP ZOfyE PRO SSED BY LAWN SPRINKLER SYSTEM 1.75 � WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL 4 GAS SYSTEM OUTLETS 1.75INSPECTION RECORD V OUTLETS OVER 5 PER SYSTEM 30 C F V W 0- h Plan check fee See Reverse PLUMBING PERMIT ISSUING FEES zo TOTAL FEE S APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. NO. GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING-FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING J PLUMBING. .GAS TEST I HEREBY CERTIFY T AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUI BY LO ANGELES COUNTY AND STATE OF CALIFORNIA OR T I AM THE EGAL OWNER OF, AND INTEND TO RESIDE IN THE OVE DESCRIBED ESIDENTIAL PROPERTY. j a FINAL SIGNATUR / OF PERM( PERMIT VALID IO CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH �: 7.5 0 7 1 '5 r SrEP 12 "5 h A ® APPLICATION FOR PERMIT 13E x—&ivlENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMITNO. t 0 PLUMBEFfl)rt 1 ANA P; i i MBING CONTRACT nRc RECEIVED BY FIRST INDY FOR SPECTION DATE ISSUED ADDRESS344 W. Carvey - Monterey Park, Calif. BUILDING ATlantic 2-4654 - CUmberland 3.1040 ADDRESS CITY TEL. NO. - p^ o P LICENSE NO. Y ftll EXPIRES �' ��� : .1,•�.- LOCALICOUNTY �� r NEARESIT CROSS ST. G , ! PERMIT FEES �� �/ • / J `� NUMBER I TYPE OF FIXTURE OR ITEM FEE OWNER _ MAIL WATER CLOSET (TOILET) C O.50 I$�I t7 ADDRESS BATH TUB a 0.501 _� CITY TEL. NO. �ryry_I SHOWER •@ 0.501 I � 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS Ota i LAVATORY (WASH BASIN) @ 0.50 / APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND I/ I • (�� STATE LAWS REGULATING PLUMBING KITCHEN SINK @ 0.501 . 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.501 � ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PR'OPER-'I'Y-DESCRI.BED ABOVE. GAS SYSTEM OUTLETS @ O.50 _ -- r ' WATER HEATER @ 0.50 SIGNATURE OF I J'`] PERMITTEE SLOP SINK o 0.501 1 INSPECTION RECORD FLOOR SINK [@i 0.50 1 ' 4 FLOOR DRAIN c+ 0.501 ��xlVa-A (f�'_ oqlv a Z,—,,r 7-z�"S7— DISHWASHER @ 0.501 DRINKING FOUNTAIN 0.50 ..�CL•'r r a.. IURINAL t± 0.50 �� L�v ��G,r��� ..I Q I HOUSESEWER (3( 0.50I 1 3'y3-�' e oo Z MISCELLANEOUS I I. a 3r I I� x �f✓ I I �`�;� o I IV I� APPROVALS DATE INSPECTOR'S NAME I ROUGH PLUMBING 1 GAS PIPING �y��iC� F '�'�f�--�•. GAS VENT CESSPOOL@ 1.00 I CESSPOOL SEPTIC TANK: I I SEPTIC TANK DRAIN ( ) PIT ( ) t@i 1.001 I SEWER PERMIT . . . . I 1.00 GAS TEST /I TOTAL FEE UTILITY CO. NOTIFIED15 /_ I '� FINAL . 76A667A ICE 8178)- 11/76 APPLICATION ry PLUMBING BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS 9307 DATNES WATER CLOSET LOCALITY TEMPLE CITY BATH TUB NEAREST CROSS ST. HILTON SHOWER OWNER alp LAVATORY MAIL ADDRESS <�`a, SINK 40 CITY TEMPLE CITY TEL.128,55001 DISHWASHER „j 1ocl CONTRACTOR J&D PLUMBING CLOTHES WASHER ADDRESS 41 90 . SAN GABRIEL BLVD, SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM CITY SAN, GABRIIEL TEL.N028 STATE LIC. WATER HEATER LICENSE NO.307 7 6 CLASS r, ° GAS SYSTEM OUTLETSDISTRICT NO. GROUP ZONE PROCESSED BY OUTLETSOVER r 'q, 4'-) 5 PER SYSTEM y INDUSTRIAL EL WASTE APPROVAL INSPECTION RECORD gm u Plan check fee PLUMBING PERMIT ISSUING FEE$ .S'a TOTAL FEE S[� Plan check applicant APPROVALS. DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK �w Address ROUGH PLUMBING City Tel. No. GAS PIPING IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING, HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GA,STEST LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE CRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTE -'�`"�`� FINALW ` ' PL'AN'tHE�K VALIDATION _ d y` cK�s'ra `- CASH PERMIT VALIDATION CK. M.0. Pal s 6 �� 3.5 G lig+- 76AS07 n 0-50 K5 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING 1 WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL INI:T DISTRICT NO. GROUP ZONE PERMIT NO. ly— ft pp�� ply p I I 5-k /3 PLUMBEF ONT�A�'.I'} PI jhfigjNG CONTRACTORS RECEIVED BY READY FOR DATE ISSUED �-�,�- I F FIRST INSPECTION ADDRES 4 W. (;arvey MonteTeY Park, p�- 3-ATlantic 2-4654 - met aABUILDING CITY TEL. NO. ADDRESS v COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) @ 0.50 $I I ADDRESS BATH TUB @ 0.501 CITY TEL. NO. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN) @ 0.50 AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. KITCHEN SINK @ 0.50 1 CERTIFY THAT 1 POSSE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LICENSE. E LEGAL OWNER OF THE RESIDENTIAL PROPE Y DESC B BOVE. GAS SYSTEM OUTLETS @ 0.50 I_ SIGNATURE OF WATER HEATER @ 0.501 1 PERMITTEE 1 SLOP SINK @ O.50 I1- INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.501 DISHWASHER @ 0.501 J DRINKING FOUNTAIN @ 0.501 URINAL @ 0.501 -J I HOUSESEWER @ 0.501 1 Q Z MISCELLANEOUS O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING 1 L-� GAS PIPING GAS VENT CESSPOOL @ 1.00 I�. CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.001 1 SEWER PERMIT I 1.00 GAS TEST I / UTILITY CO. NOTIFIED I +I TOTAL FEE $ FINAL v 76A667C I,CE-8178) -9/75 ' APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING S 9307 E. 1)1_IiV�S DIVE NUMBER FIXTURE OR ITEM @ 'FEE WATER CLOSET LOCALITY T.I�aTLE CIr1TY 9 CA. NEAREST }-Tilton BATH TUB CROSS ST." SHOWER OWNER ' ..A T 'R'.?il TTTT LAVATORY MAIL '—"�-`-- - ADDRESS ' 9307 E. DaineS Drive, SINK CITY r� l� P, r 'I;V a,�, TEL. NO 6481 DISHWASHER CONTRACTOR C LOTHES WASHER ADDRESS& Q SWIMMING POOL RECEPTOR .a.rr�c _ CITY ¢� � TEL. N O.� _�4 U- LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LICENSE NO. 0-7 CLASS DISTRICT NO. IGROUP ZON PR S D BY GAS SYSTEM OUTLETS ea U-0 �....y' OUTLETS OVER r CP 5 PER SYSTEM INDUSTRIAL V WASTE APPROVAL LLI INSPECTION RECORD Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE T'" n-��_^• UNDER SLAB WORK AddreSS O'� 7 T, -Daineq D ROUGH PLUMBING C tY Temple City, Ca. Tel. No. 285 6485 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 ORDINANC ES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LRLESIDEN REQUIRED BY LOS ANGELES COUNTY AND STATE OF R THAT I THE LEGAL OWNER OF, AND INTEND T,O GAS TEST E ABOVE D 5 RIBE ��SIDNTIAL PROPERT UTILITY CO. NOTIFIED ITTEE FINAL •�d' ���1 _y� �=_ _ PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK. M.O. CASH 9.7 3'r'MkR 3 7.5 0 ,&S�6 WORKERS'COMPENSATION DECLARATION a Sf A A P P L I C 4T 10 N FOC PLUMBING PERMIT I hereby affirm that I have certificate of conse'stt to self, CE ce sty (2-SO) r insure, or a certificate of Workers'Compensation Insurance,or T a certified copy thereof(Sec. 3800, Lab C.) ° a �pL2,-1�-cls/fv i ,/ COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company/ e eG Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 3o,7 ' ADDRESS ,J Certified copy is filed with the county build/in�to ectio NUMBER FIXTURE OR ITEM • FEE depart �� `,.may LOCALITY Date Applicant (� 01 -WATER CLOSET �'�° NEAREST BATH TUBCROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' v /�� COMPENSATION INSURANCE SHOWER OWNER MAIL �r ,__ ' (This section need not be completed if the work involved LAVATORY L ADDRESS O W�+'�-"`� a- by the. permit is for one hundred dollars ($100) or less.) SINKO CITY TEL. NO. O I certify that in the performance of the work for which this DISHWASHER IF !�' permit is issued, I shall not employ any person in any manner CONTRACTOR CC so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS �` U Date Applicant tr SWIMMING POOL RECEPTOR , W NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO����" Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM Compensation provisions of the Labor Code, you must forth- STATE !fLIC. with comply with such provisions or this permit shall be WATER HEATER C� LICENSE NO. (JamV CLASS DISTRICT NO. PROCESSE BY deemed revoked. GAS SYSTEM OUTLETS �`v ��� Q LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL �6 ness and Professions Code, and my license is in full force and DATE � VALIDATION effect. 7f/4 V � FINAL License Numbe Lic.Class ¢ BY , Contractor Date V I am exempt from the licensing requirements as I am a Plan check fee )) �/ licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ` (� �rs� / / acting in my professional capacity (Section 7051, Bus- 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 Address License .Law for the following reason (Section.7031.5, Busi- City Tel.No. ness and Professions Code): 25 1 9.2A ElI, as owner of the property, am exclusively contracting with licensed contractors to construct the project # 0 0 0 0 o 5 (Section 7044,Business and Professions Code). ' ' '2 ° ° 3650 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency i°i° ° 3 65 0 25 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). 07,27-82 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of t Vs ounty to enter upon the abov nti a property for rogi6ection purposes. lt,�, �;_ Z� . Signature of Permittee Date WORKERS'COMPENSATIONDECLARATIOSI- N CE ^ APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have ,a certificate'of cgnsent to self ce erg iz-aolM -APPLICATION insure, or a certificate of Workers'CoWensation Insurance,or rl a certified copy'thereof'(Sec. 3800,Lab.C.) � v REPLUBLIC INDEMNIT3 COUNTY OF LOS ANGELES i BUILDING AND SAFETY Policy No.�G 96 St�L(+'oany 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 • FEE ADDRESS 9� DAINES Datede t qt. WATER CLOSET LOCALITY CITY Applicant AD PLUMBING NEAREST ` CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. HILTON COMPENSATION INSURANCE 1 SHOWER OWNER (This section need not be completed if the work involved 3. LAVATORY MAIL >ADDRESS by the permit is for one hundred dollars ($100) or less.) ©' SINK CITY TEMPLE CITY TEL. NO. 0 1 certify that in the performance of the work for which this DISHWASHER permit is issued, I shall not employ any person in any manner CONTRACTOR J 0 0 so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS Date Applicant 414 SO , SAN SWIMMING POOL RECEPTOR ry h T U W NOTICE TO APPLICANT: If, after making this Certificate of CITY SANUABg IF..L TEL. NO. N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM 877832 STATE LIC. Z Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE N CLASS ;v� with comply with such provisions or this permit shall be deemed revoked. DISTRICT NO. PROCESSED BY GAS SYSTEM OUTLETS p� LICENSED CONTRACTORS DECLARATION OUTLETS OVER 0 0 , 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 VALIDATION effect.ness and Professions Code, and my license is in full force and DATE effect. FINAL License Number3077166_ Lic.Class 0*36 BY ContractonT D PLUMBINCbate ryf/6/81 ElI am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer acting in my professional capacity (Section 7051, Bus- 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 Address License Law for the following reason (Section.7031.5, Busi- City Tel.No. ness and Professions Code): 0 2 1.Ll A 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project 0 0.0 0 0 5 (Section 7044, Business and Professions Code). 2 ° ° 14,00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency o 0 0 1 9,00 H for the performance of the work for which this permit is �r issued(Sec. 3097,Civ.C.). O,:/F 0 6 -8 1 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-m io rope for inls�ion purpose . V • Signatu of Permittee Date