HomeMy Public PortalAbout9972 DUFFY ST_Plumbing_09/12/1951 ?IM667 17 g=so ® APPLICATION FOR PERMIT
'DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING I
WILLIAM J. FOX,'CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I ZONE PERMIT NO.
FONTgNA PLUMBING CONTRQf"'�"� REC VED BY READY FOR DATE ISSUED
PLUMBER FIRST INSPECTION _
ADDRESS 44 W. Garvey Montere Park-
laritic 2.4654 _ BUI-L E',
CITY TECU�berlarld 3-77[},? ADDRESS
COUNTY 78 m � LOCALITY J
LICENSE NO. �+ �` EXPIRES X� /115-311a.
NEAREST w
' PERMIT FEES cRoss sT.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
1 WATER CLOSET (TOILET) @ 0.50 $ J ADDRESS
BATH TUB @ 0.50 I \� CiTY TEL. NO.
SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LAVATORY (WASHBASIN) @ 0.50 7- AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
1 KITCHEN SINK @ 0.50 1 STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
ILAUNDRY TUB OR TRAY @ 0.50 I 15-6ANGELES COUNTY LICE;....OR I AM THE LEGAL OWNER
—, +Q OF THE RESIDENTIAL OPERTY IE
ABOVE.
GAS SYSTEM
OUTLETS @ O.SOI 4� � �
t_ PAER
SIGNM ITTEE
✓' 1 WATER HEATER @ 0.50 I D l_
SLOP SINK @ o.so INSPECTION RECORD
FLOOR SINK @ 0.50
1 FLOOR DRAIN @ 0.501
DISHWASHER @ 0.501
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50
HOUSE SEWER @ 0.501 1
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MISCELLANEOUS I 0
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APPROVALS
DATE INSPECTOR'S NAME
I.ROUGH �PLUMBINGA f
1 GAS PIPING I 1 .
GAS VENT
CESSPOOL a 1.00 1 - CESSPOOL
1 SEPTIC TANK: E
a SEPTIC TANK �I
DRAIN ( ) PIT ( ). @ 1.001 I SEWER
PER MIT.. , 1.00 - GAS TESTf
. ® UTILITY CO. NOTIFIED /-p/`,C n!&g
TOTAL FEE
$ I FINAL
WORKERS'COMPENSATION DECLARATION C A667A p P P L I C�7 1®rte p FOR P L U (,��I B �l�II G P E R I��1 0 T
I hereby affirm that I have a certificate of consent to self ce ev (z-ao) /YUy\ III�'ILI� �`�I y�y� u� ��y�
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab.C.)
549301 State Fund COUNTY OF LOS ANGELES— BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS 9972 Duffy
Certified copy is filed with the ount buildin inspection NUMBER FIXTURE OR ITEM O FEE
de artrrient. ), LOCALITY Temple City •
WATER CLOSET
Date Applicant NEAREST
BATH TUB CROSS ST. Baldwin'
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER Greer
LAVATORY MAIL
(This section- need not be completed if the work involved ADDRESS 608 Vague ro Rd }
by the permit is for one hundred dollars (S I00) or less.) SINKa
_ CITY ArcadiaX TEL.NO. O
I certify that in the performance of the work for which this DISHWASHER 1U
permit is issued, I shall'not employ any•person in any manner CONT•RACTORBen Walker Plumbing.
so as to become subject to the.Workers' Compensation Laws. CLOTH yES WASHER
ADDRESS O
Date Applicant SWIMMING POOL RECEPTOR. U
�r�/ L'
NOTICE TO APPLICANT:If, after making this Certificate of CITY TEL. NO.Z � V 4 Ir a
Exemption, 'you should' become subject to the Workers' LAWN:SPRINKLER SYSTEM STATE LIC. C N
e you must forth- /` / Z
Compensation provisions of the Labor Cod y LICENSE NO. x"�� CLASS _
with comply with such provisions or -this permit shall be WATER HEATER
PY
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PR CESSED /�
BY �J
LICENSED CONTRACTORS DECLARATION OUTLETS OVER a v '
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
I. ness and Professions Code, and my license is in full force and DATE (DATION
effect.
Y 82665.. C-36 FIN
1!
License Number Lie.Class BY. . '
Ben Walker PlumbinV 11_23-82
Contractor Dat n
I
Plan check fee
El I am exempt from the licensing requirements as I am a v r
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ Q
acting in my professional capacity'(Section 7051, Bus-
iness'and Professions Code). TOTAL FEE' -
f
Lie.or Reg.No. Date Plan check applicant
1' t
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. +/ $0 CT p
ness and Professions Code):
1, as owner of the property, am exclusively contracting
with licensed -contractors to construct the project k
(Section 7044,Business and Professions Code). 3.
2 °_ 3.S
CONSTRUCTION LENDING AGENCY c o o 1 'S O v
I hereby affirm that there is a construction lending agency r 2 0.1 —82
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-m Pntioned roperty for inspection purposes.
-
ature o rmittee Date