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Home My Public Portal About9028 EMPEROR AVE_Plumbing__ 17 APPLICATION FOR -P�� II�� PERMITDBS- .1 DBS-17 10-55 DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 902G Ttiporor CASSATT D,GRIFFIN, SUPT OF BUILDING LOCALITY Temple City FOR APPLICANT TO FILLmgrmm—I NEAREST CROSS ST. OWNER DISTRICT NO. GROUP Zn-ONE READY FOR INSPECTION MAIL ADDRESS 9024 MPoror _ I "' CITY Tom lou City TEL. NO. WADUSTRIAL- STE APPROVAL PLUMBER DUCEPLU1e:BING 64 Ht;'�TING INSPECTION RECORD i ADDRESS 3232 No San G-abriel Blvd o 51 CITY S San Gabri0j, TEL. NO. AT=04031 ` LICENSE NO. 104970 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ I BATH TUB @ $1.00 l SHOWER Pala @ $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 APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING ' GAS PIPING TOTAL FEE 2 00 GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING a PLUMBING. PLUMBING FIXTURES I 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 OWNE OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RE ENTI PR PERTY. SIGNATURE n OF PERMITTEE FINAL JOHN A. LAMBIE, COUNTY GINEER VALIDATIO]NOBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. M.0. (C CASH 1648 AUG26 3 2.00 9 WORKER'S COMPENSATION DECLARATION 6DPW 9/89 APPLICATION FOR PLUMBING PERMIT IJ 76A66 I hereby affirm that I have a certificate of consent to self insure, 76A667A or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec. 3800 Lab.C.) D� gig L�,�yyrjgZ _P COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. 7 Company ��`� ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM @ FEE 1 '13 Applicant�0"\�00A,5 LOCALITY Date 5 WATER CLOSET � NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE ;?9/971PARCEL�o�� permit is for one hundred dollars($100)or less.) OWNER LAVATORY I certify that in the performance of the work for which this permit MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers' Compensation Laws. DISWASHER CITY TEL.NO. Date Applicant CLOTHES WASHER CONTRACTOR , NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. AWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY 0V 1 TEL.N0.3 3 I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC. IL (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM Z_-OUTLETS LICE SE NOM CLASS C 3(P O Professions Code, and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY jr Z G 3 5 PER SYSTEM D� Q License Number s ✓ Lic.Class U FINAL _ VALIDATION W DATE �( CLContracto3Q N Date l ❑ FINAL _ Z I am exempt under Sec. U v BY B.&P.C.for this reason Plan check fee Date: Signature PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE �} 1 ITEMS Plan check applicant €I-I i � -100 - 65 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name `s.` ;I t ) I hereby affirm that I am exempt from the Contractor's License Law + i- for the following reason (Section 7031.5, Business and Professions Address !.HI'IIt E Code): ❑ City Tel. No. I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business I ;�f �)f and Professions Code). , CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency 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 ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned erty for inspectio, pur osks., d SEE REVERSE FOR EXPLANATORY LANGUAGE (i(Jl gnature of Perini tee if Date