HomeMy Public PortalAbout10561 DANBURY ST_Plumbing__ TBA B6 T,-C ER01T 5/63
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ER BU cess 10561 Danbury
JOHN A. LAMBIE. COUNTY ENGINE
WILLIAM A. JENSEN. SUPT OF SUI EDING
LOCALITY Temple
FOR APPLICANT TO FILL IN [NEAREST
rNUMBER FIXTURE OR ITEM EACH FEE R Noel Baldwin
3 WATER CLOSET $1.25 3 75 MAIL
1 BATH TUB 1.25 1 25 ADDRESS
CITY TEL. NO.
SHOWER 12 2 50
3 LAVATORY 1.253 75 CONTRACTOR Owen Bros Plumbing
1 SINE 1.25 1 25
ADDRESS 4265 No, Baldwin b
1 DISHWASHER 1.25 1 2. CITY E1 Monte STATE
NO. -00 8
LAUNDRY TUB 1.25 - CONTRACTOR'S
ION NO. 1971eµ COUNTY ❑
CLOTHES WASHER 1.25 ,1. 25 DISTRICT NO. GROUP FONEPROCESSED BY
1 WATER HEATER 1.50 1 50 /
1 50 1 5Q INDUSTRIAL a
GAS SYSTEM 5 OUTLETS WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 U
INSPECTION RECORD
w
A n Q
1 k O a
402 AZ
n
APPROVALS DATE INSPEC OR
sI GNATVRE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 2) 00
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THATHATTHE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANDIOR 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 ABOV ESC ED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE // �`l ll 1/"q1- p,�1
FINAL (G In ..T{,�C�✓c`
/i1 UDATION ROBERT A. WOOD U
l/c/R/ M.0, CASH SUPERVISING MECHANICAL ENG'R
Lituo9223� r'Wl22 5 0 2 0.0 0
WORKERS'COMPENSATION DECLARATION rsnss>A ^
I hereby affirm that 1 have acertificate of consent to self .15 .17 (2-..I APPLICATION FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or
a ertified copy thereof(Sec. 3800, Lab. C.)
fC I51232Z� l COUNTY OF LOSANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
�erfified copy *6 filed with the unty building inspection NUMBER FIXTURE OR ITEM O FEE ADDRESS
e WATER CLOSET LOCALITY � \e– Ut
Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' It
COMPENSATION INSURANCE SHOWER OWNER EkA&)0, !,,oL( M A.+,�
I� /�
(This section need not be completed if the work involved LAVATORY MAIL
ADDRESS �s�� C— t���t� (24 a
by the permit is for one hundred'dollars ($100) or less.) SINK O
CITU l,e �� /2 .' TEL. NO. 9 U
I certify that in the performance of the work for which this DISHWASHER �–Icc
permit is issued, 1 shall not employ any person in any manner CONTRACTOR O
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER 'ADDRESSCAMORM Y u. U
Date Applicant ps e n _n . W
SWIMMING POOL RECEPTOR r a� d
NOTICE TO APPLICANT: If, after making this Certificate of CITY SAN GABRIEL, CALIF®Rt=::ND'. :B Z!$– to
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATEQ' /`"� LIC. Z
Compensation provisions of the Labor Code, you must forth- LICENSE NO. � U o� CLASS –S�
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. I GAS SYSTEM OUTLETS ��_ oils ICT NO. PROCESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OV ER ,I , �
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 `'7 VALIDATION
ness and Professions Code, and my license is in full force and DATE – wC p .�
effect.
License Number 510 Lie. Class C —5�
I D
B)
Contractoc ,, 00pp'',, Date / — —52-
a-
pam
exempt from the licensing requirements as I am a Plan Check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). T07AL FEE 1 L+
Lie.or Reg.No. Date [Name
n check applicant
GALWIM
HOME OWNER-BUILDER DECLARATION 9506 EAST LAS TUNAS DRIVEI hereby affirm that I am exempt from the Contractor's dress BAN GABRIEL. CALWORNIA 51773'.License Law for the following reason (Section 7031.5, Busi- y Tel.No. –y
ness and Professions Code):
1, as owner of the property, am exclusively contracting .�3 6 a 5 A
with licensed contractors to construct the project
(Section 7044, Business and Professions Code). '
e o e o o rj
CONSTRUCTION LENDING AGENCY .. Z 15'15 1 Q 5 0
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is e'o o 1 6,5 65
issued (Sec. 3097,Civ.C.).
Lender's Name 0 G, 16-82
Lender's Addresses
I certify that 1 have read this application and state that the
above informtion is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances td State laws regulating Plumbing, and hereby
authorize r presentativ f us County to ente upo the
above- oned prop f inspection purpose
t u n
Peril Date