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Home My Public Portal About8856 ELM AVE_Plumbing__ D.B. 17 25M SETS 12-43 APPLICATION FOR PERS DEPARTMENT OF BUILDING AND SAFETY; H117Hd� COUNTY OF LOS ANGELES Wm. J. FOX.CHIEF ENGINEER PILUMBING NATURE OF INSTALLATION DISTRI NO. GROUP ZONE PERMIT NO. � _ ` _ �� b qa .ROUGH FIXTURES OMPLETE HEATER CESSPOOL I Voll TANK RECEIVED / BY//�J//{J READY FOR DATEISSUED Y FIRE nSPEC'�ION — /9 GAS MIBCELLANEOU (% APPLICANT FILLfIN HEAVILY OUTLINED PORTION ONLY yv JOB NAME .. I/L 1 O .lif ADDRESS B.LDR:ESy' _ LOCALITY ,�^ NEAREST SL CITY i0'f TEL.NO. CROSS ST. COUNTY CERT.No. / EXPIRES W NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL 3 ADDRESS NORTH O CITY TEL.No. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE A �jTIONf/�� PLUMBER�.,t�l! I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. 3 OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORD a Z BATH TUB FURNACE E9_ SHOWER DISHWASHER 0 LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES 1<y �� ff SEPTIC TANK ' -CESSPOOL SEPTICTANK —SEWER UTILITY I UTILITY Co.NOTIFIBD I I TOTAL FEE �' i FINAL 17 26M SUM 12-43 APPLICATION FOR PERMIT 1 DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING WM.J. FOX.CHIEF ENOiNEtR NATURE OF INSTALLATION DIST GROUPI ZONE PERMIT 7� ROUGH FIXTURES COMPLETE S_ HEATER CESSPOOLI—I FIRST INSPECTION SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED AS MISCEL NE US -C mmummimim APPLIC NT FILL IN HEAVILY OUTLINED PORTION ONLY C NAME 1'V. AJOBDDREbf W _ m ADDRESS '. LOCALITY /V tplt!e J ^^" NEAREST A, d CITY TEL.No. CROSS ST. �Y COUNTY CERT.No. EXPIRES —f4� tl NAME I LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL O ADDRESS NORTH CITY TEL.No. I AM THE LEGAL POf668fOROF OVE L08 ANGELES COUNTY CERTIFICAT FIRM N. PLUNDER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. R Y 3 M OWNHR '-I CORRECTIONS J SOUTH J DESCRIPTION OF WORK -BATHTUB FURNACE R' SHOWER DISHWASHER O LAVATORY REFRIGERATOR __KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS __WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'!HAMS WATER HEATER DENTAL LAVATORY �! ROUGH PLUMBING ETlRGAf SODA FOUNTAIN 6A8 PIPING OUTL GAS VENT I I CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I I CESSPOOL SEPTIC TANK i Qy SEWER S UTILITY CO.NOTIFIED i TOTAL FEE4,�0 ` FINAL /IT o 76A667C (CE-8176) -9/75 ( ► ) / ' ® /'� .,/ , ,� 1, ►./ ' APPLICATION FOR PLJU/MB1NG PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING �^ •� NUMBER FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET LOCALITY BATH TUB NEAREST ^�i CROSS ST. (�rJ SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL. NO / DISHWASHER CONTR M F117 fisI q - CLOTHES WASHER ,] t a ?.'- ADDRES:h ..%t-c+' i-. '•.,+s .. :)1`dD AVE. SWIMMING POOL RECEPTOR CITY TEMPLE CITY,LAWN SPRINKLER SYSTEM Y07O STATE / LIC WATER HEATER LICENSE NO. CLASS CL. GAS SYSTEM OUTLETS DISTRICT NO. GROUP ZONE RO ESE B V OUTLETS OVER d CIS 5 PER SYSTEM - INDUSTRIAL WASTE APPROVAL 1y 4. INSPECTION RECORD to Plan check fee . PLUMBING PERMIT ISSUING FEE $ 0 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. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSEDAS 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 DESCRIBED R D IA P OPERTY. UTILITY CO. NOTIFIED SIGNATU RE OF PERMITTEE It -11FINAL 12-10-7 PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION CK: M.O. CASH 6 � �7 :A 9 y 2 L-DE Ci 2 5 7.5 0 ,&',,o WORKERS'COMPENSATION DECLARATION 7ewee7w I hereby affirm that I have a' certificate of consent to self ce s» (2-80) P PU C A T�O N F®Ifs' P L U M B I N G PER Kill I insure, or a certificate of Workers'Compensation Insurance,or. a"certified copy.there'of(Sec.3800,Lab.c.) COUNTY OF'LOS ANGELES BUILDING AND SAFETY Policy No,. Company Self Insured City of Tem le Cit O Certified py is ereby fur`nis d." O'R APPLICANT TO FILL IN (PRINT OR TYPE) ' BUILDING Certif' d c f' d with the co ty d• ` spect NUM R FIXTURE OR ITEM O FEE l YYY ADDRESS Tn n WATER CLOSET LOCALITYTchple Cit Dat pp NEAREST. BATHTUB CROSS .ROSemead Blvde CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER , a a LAVATORY MAIL (This section 'need'not be'completed if the work involved ADDRESS >_ by the'.permit is for one hundred dollars ($100) or less.) aSINK CITY Tem leCit TEL.NO.28551:83 0 ' I certify that in the performance'of the work for:which'this DISHWASHER permit is issued,.I.shall'not em ploy''any'person in any manner CONTRACTOR Pacific Inst ers so as to become subject to the Workers" "Compensation Laws. CLOTHES WASHER O ADDRESS -1. 0 E. Grand Avenue Date Applicant "` SWIMMING POOL RECEPTOR U NOTICE TO APPLICANT: If, after making this Certificate of CITY,Temple City. TEL.No.442-7070 LU Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM p I STATEp LIC. Z Compensation provisions of the Labor Code, you must forth- LICENSE NO211898 CLASS with'comply with such provisions or' this permit,shall be WATER HEATER . 'deemed revoked. - GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER , �6 I hereby affirm that I am licensed under provisions o apte 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3' the Bus' FINAL VALIDATION tress and,Professions Code, and my license is in f force a d DATE [ —� effect. - .. _ License•NumberINAL 2118 8�•Lic.Clci ss l BY �. Contractor D? Date Plan check fee �� " I am exempt from the licensin requirements as I am a q licensed architect or a registered professional. engineer PLUMBING PERMIT ISSUING FEE$ Acting in`my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE 1.7 . 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. 4,3 2 2A ness and Professions Code): I, as owner of the property,, am exclusively contracting # #:,o 0 0 'o o 5 " with licensed 'contractors to construct . the ' project (Section 7044,Business and Professions,Code): 2. o o l.0 0 0 CONSTRUCTION LENDING AGENCY ° °, 0. 1 0.0 0 I hereby affirm that there•is a construction lending agency for. the performance of the .work for which this permit is 0 33 0 9—8 1 issued(Sec. 3097,Civ.C.). Lender's Name Lender's Address i u els y2F ,� I certify that I have read this application and state hat the d yTION above informatio • ect.I agree to comply with al Coun SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances State laws egulating Plumbing, an he authorize epresentatives of his Cou y _ enter p n t e above- ropert rinspec ' pos Signature of Permittee Date