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HomeMy Public PortalAbout9038 EMPEROR AVE_Plumbing__ 76A607-CE617 10-60 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A AMBIE. COUNTY ENGINEER ADDRESS fJ 3 6 E' EI�PO/Z Ott /4 WILLIAM A JENSEN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FML IN cHo sr' NUMBER FIXTURE OR ITEM OWNER 4-R A' WATER CLOSET MAm BATH TUB ADDRESS CITY TEL NO. SHOWER /�-� LAVATORY A CONTRACTOR ��k'Je / SINS ADDRESS -52_,o Z LV . 1di S If C-jW DISHWASHER CITY L/� I� TEL NO.t 0-118 CONTRACTOR'S STATE LAUNDRY TUB REGISTRATION NO. /0 Z.C 8 Z— COUNTY CLOTHES WASHES DISTRICT O G5 pYP ZONE PR CESSED BY WATER HEATER / GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD D_ O V O G w a N Z $100 PER ITEM OR FIXTURE $ APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY GAS VENT. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING / PLUMBING HOT WATER HEATER 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DOOR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND TE OF CALIFORNIA OR THAT 1 EEG R OF ABOVE GAS TEST DESCRIBED RESIDENTIAL R UTILITY CO NOTIFIED SIGNATURE I OF PERMITTEE FINAL _ -OVALIDATION ROBERT A WOOD K M o CASH SUPERVISING MECHANICAL ENG R Cleo 9 8 8 7 JUL 2 5 D 3 .0 0 �t v 76A687A ICE 817Ej)-11/78 t - APPLICATION FOR PLUMBING PERMIT BUIL G AND SAFETY DIVI FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGf., NUMBER FIXTURE OR ITEM ® FEE ADDRESS WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST SHOWER OWNER LAVATORY MAIL ADDRESS SINK 3 CITY TEL NO,2�' 7�� DISHWASHER CONTRACTOR CLOTHES WASHER a ADDRESS SWIMMING POOL RECEPTOR CITY TEL NO LAWN SPRINKLER SYSTEM STATE � LIC WATER HEATER LICENSE NO CLASS GAS SYSTEM OUTLETS DISTRIC-TTNN GROUP NEESSED BY OUTLETS OVER (2r )5- 5 PER SYSTEM INDUSTRIAL g. WASTE APPROVAL O INSPECTION RECORD v 09 O 16d M z Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check pllcanT APPROVALS DATE INSPECTOR S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT IHAVE READ'T44S APPLICATION AND STATE GAS VENT THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WIT LL 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 GAS TEST LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY > UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE � ! ti"" FINAL PLAN CHECK VALIDATION CK M Q CASH PERMIT VALIDATION CK Mo 4 8 9 r MAY 25 5 © 7.5 0,&V' 76A667C (CE-8178) -975 �� 4ogr-? FaIB PLUMBING PERMIT POLICY HOLDER: 'S g vp POLICY NUMBER-, BUILDING At40.3AFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS 9038 Emperor NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET LOCALITY Temple City BATH TUB NEAREST CROSS ST SHOWER OWNER Ferlo Bressan LAVATORY MAIL ADDRESS 9038 Emperor SINK CITY Temple City TEL NO 285-4991 DISHWASHER CONTRACTOR Bryant Heat. & Air Cond. CLOTHES WASHER ADDRESS 1350 E. Las Tunas Drive SWIMMING POOL RECEPTOR CITY San Gabriel TEL NO 286-1141 LAWN SPRINKLER SYSTEM STATE WATER HEATER - LICENSE NO 221751 CLIC ILASS C20 a O DISTRICT NO GROUP ZONE R C SSIED BY V 1 GAS SYSTEM OUTLETS 3 00 OUTLETS OVER 5 PER SYSTEM INDUSTRIAL LI-1 WASTE APPROVAL N INSPECTION RECORD z Plan check fee PLUMBING PERMIT ISSUING FEE $ 4 50 TOTAL FEE 7 50 Plan check applicant Name APPROVALS DATE INSPECTOR 5 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 1 LICENSED AS REQUIRED,05t LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I /A THE LEGAL OWNER OF, AND,l1TEND TO , RESIDE IN THE ABOVE DE IBED RESIDENTIAL OPE UTILITY CO NOTIFIED SIGNATU RE OF PERMITTEE FINAL PLAN CHECK VALIDATION CK M o ' CASH PERMIT VALIDATIO cK M o CASH 7 3 3 iz JUL 2'1 5 D I.5 � � S WORKERS' COMPENSATION DECLARAT � hereby affirm that I have a certificate of cons nI.(L.eIf{ 76A667A APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/8)) or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company ❑ Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING^ 0 38 Certified copy is filed with the county building inspec- ADDRESS f ( S tion department NUMBER FIXTURE OR ITEM Q FEE LOCALITY Date Applicant WATER CLOSET NEAREST T OS e CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS COMPENSATION INSURANCE SHOWER OWNER F rk — lar eSU (This section need not be completed if the work involved by MAIL " the permit is for one hundred dollars (;100)or less) j LAVATORY ADDRESS p lr A Sp I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY S a V1 C Q` TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL NO LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ,(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect 5 PER SYSTEM FINALa DATE I �� �'�3 VALIDATION u License Number Lic Class QS FINAL O Contractor Date BY V ❑ I am exempt under Sec 0. Vf B &P C for this reason Z Plan check fee Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 4 Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and 22 1 1,2A Professions Code) City Tel No #ro 0 0 0 0 5 ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® 2 8 5 0 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY °t° ° 2 a 5 O ux I hereby,affirm that there is a construction lending agency for ' the performance of the work for which this permit is issued 0 5 1 9—8 3 (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 entioned propertyA, inspection purposes I SEE REVERSE FOR EXPLANATORY LANGUAGE / 0 44 to 1 5 I I-S3 ignoture Wftermittee Date / ri