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Home My Public Portal About9047 EMPEROR AVE_Plumbing__ •COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0709200014 BUILDING AND SAFETY-/ LAID DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS I ON FILE 1 9047 EMPEROR AV 1 I IFEE DESCRIPTION QUANTITY UOM AMOUNT SGAB CA 917752016 ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 15382-011-012 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H1 LOCALITY TEMPLE CITY, CI I11 CLOTHESWASHER(S) 1 00 FIX 16 20 ITENANT 125 LAVATORIES/SINKS 1 00 FIX 16 20 JISSUED ON PROCESSED BY PLAN BY EXPIRES ON I 1 1 TOTAL FEES 60 15 109/20/07 SR 03/18/08 I 1OWNER TEL NO IFINAL DATE=j--- - Jr BY CODE 1 ILI, GUO HUA (626) 363-3661- 1 19047 EMPEROR AV 1 1 ISGAB 917752016 DE CRIPTION OF WURK- IREPLACE CLOTHESWASHER AND SINK APPLICANT TEL NO ISAME AS OWNER I I ISPECIAL CONDITIONS 1 I I I I I I ICONTRACTOR TEL NO I _ (APPROVALS DATE INSPECTOR SIGNATURE I ISAME AS OWNER - I I- I I LIC NO 1 1UNDER SLAB WORK I I 1 1 I IWATER SERVICE I 1 1 IPLASTIC Y/N METAL Y/N I 1ARCHITECT OR ENGINEER TEL NO 1 - 1 IROUGH PLUMBING I I 1 1 LIC NO 1 1 IGAS PIPING I I I IGAS VENT I I I I IHOT WATER HEATER I I I 1 IPLUMBING FIXTURES 1 1 1 ILAWN SPRINKLERS I I I IGAS TEST I I I I I 11 1 1 I (UTILITY COMPANY NOTIFIED( I I I I I I I I ICWV I IGRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID DPR263 ROUTE TO BS0508 I I I 1 I I I I I I Y COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0910210009 BUILDING AND SAFETY-/ LAffD DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID FEES PAID BUILDING ADDRESS 9047 EMPEROR AV ON FILE IFEE DESCRIPTION QUANTITY UOM AMOUNT SGAB CA 917752016 (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET ROSEMEAD 15382-011-012 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H1 LOCALITY TEMPLE CITY, Cl 107 BATHTUBS/SHOWERS 1 00 FIX 16 20 1 TENANT 125 LAVATORIES/SINKS 2 00 FIX 32 40 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 1 145 WATER CLOSET/URINAL 1 00 FIX 16 20 110/21/09 SR 10/21/10 I TOTAL FEES 92 55 1 OWNER TEL NO I IFINAL`DATLE FIN Y CODE IBAUDLER, MATTHIAS (816) 234-2589- 1 1 1Ly 19047 EMPEROR AV r ISGAB 917752016 I D S RIPTIO OF WORK (PLUMBING FOR NEW BATHROOM AND KITCHEN REMODEL I � (APPLICANT TEL NO 1BAUDLER (626) 863-2531- SPECIAL CONDITIONS ICONTRACTOR TEL NO JAPPROVALS DATE INSPECTOR SIGNATURE IBAUDLER, MATTHIAS (818) 234-2589- 1 1 IGUO HUA LI LIC NO 1UNDFR SLAB WORK 19047 EMPEROR AVENUE NONE (SAN GABRIEL, CA 91775 1 (WATER SERVICE PLASTIC Y/N METAL Y/N (ARCHITECT OR ENGINEER TEL NO (ERIC ENGINEERS (310) 689-9939- TROUGH PLUMBING 1 1305 N BROADWAY #3 LIC NO 1 1 1 1 IREDONDO BEACH, CA 90277 C70392 I (GAS PIPING 1 1 1 IGAS VENT 1 1 I 1 IHOT WATER HEATER 1 (PLUMBING FIXTURES ILAWN SPRINKLERS 1 I 1 I 1I 1 (GAS TEST 1 (UTILITY COMPANY NOTIFIED( 1 1 ICWV I (GRAY WATER SYSTEM I 1 I I i I I I I I I I I I I I I I I IREPORT ID DPR263 ROUTE TO BS0508 I I I I I I + , COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1001060020 BUILDING AND SAFETY /,LANk) DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID 1 FEES PAID BUILDING ADDRESS ON FILE I 9047 EMPEROR AV 1 IFEE DESCRIPTION QUANTITY UOM AMOUNT SCAB CA 917752016 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET ROSEMEAD 15382-011-012 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H1 LOCALITY TEMPLE CITY, CI 1 107 BATHTUBS/SHOWERS 1 00 FIX 16 20 1 (TENANT 125 LAVATORIES/SINKS 1 00 FIX 16 20 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 1 145 WATER CLOSET/URINAL 1 00 FIX 16 20 101/06/10 SR 01/06/11 1 1 TOTAL FEES 76 35 1 1 1OWNER TEL NO I (FINAL DATE FIN Y CODE IBAUDLER, MATTHIAS (626) 451-6897- 1 1 19047 EMPEROR AV 1 11 ISGAB 917752016 1 1D S REQ I� OF WORK I I IPLUMBING FOR ADDITIONAL BATHROOM I I I I (APPLICANT TEL NO 1 1 1 IBAUDLER (626) 863-2531- I 1 1 ISPECIAL CONDITIONS I I I I I I I I I I I I (CONTRACTOR TEL NO I IAPPROVALS DATE INSPECTOR SIGNATURE IBAUDLER, MATTHIAS (818) 234-2589- 1 1 1 IGUO HUA LI LIC NO 1 (UNDER SLAB WORK b 19047 EMPEROR AVENUE NONE 1 I ISAN GABRIEL, CA 91775 1 IWATER SERVICE 1 1 1 I I IPLASTIC YIN METAL YIN I 1 (ARCHITECT OR ENGINEER TEL NO I I I (ERIC ENGINEERS (310) 689-9939- TROUGH PLUMBING 1 1 1305 N BROADWAY #3 LIC NO 1 f 1 IREDONDO BEACH, CA 90277 C70392 I IGAS PIPING I 1 I I I I I I 1 1 IGAS VENT I I 1 1 11 I IHOT WATER HEATER I I I 1 11 1 I IPLUMBING FIXTURES 1 1 1 I I I I I I I ILAWN SPRINKLERS I 1 I I I I I I I IGAS TEST 1 1 11 1 1 I (UTILITY COMPANY NOTIFIEDI I I 1 1 11 1 1 1 ICWV I I 1 I I I I I I 1 1 (GRAY WATER SYSTEM 1 1 1 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 1 IREPORT ID DPR263 ROUTE TO BSO508 I 1 I I I I I I D.B. 17 25M SETS 12-43 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ��'�� COUNTY OF LOS ANGELES WM. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE ' HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED � , / FIRST ��INSPECTION GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB NAME ADDRESS W > ADDRESS d) LOCALITY r NEAREST y CITY TEL.No, CROSS ST. COUNTY CERT.No. . EXPIRES K NAME W LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL NORTH O ADDRESS CITY TEL.No. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. a 3 i OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK _z BATH TUB FURNACE SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP GLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAMB WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METERGAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT I CESSPOOL ( I TOTAL NUMBER OF FIXTURES _. <. _ SEPTIC TANK CESSPOOI SEPTIC TANK a SEWER S �T UTILITY CO.NOTIFIED TOTAL FEE FINAL 76 A 667 - CE 817 7-69 ' � _ ��LLYY � APPLICATION FOR PLUM ING ,PER IT f I COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDINC ADORES JOHN A LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS SUP T OF BUILDING LOCALITY ` G FOR APPLICANT TO FILL IN (PR NT OR TYPE NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH -FEE O WNE WATER CLOSET 1 50 MAIL BATH TUB 1 50 ADDRE 6w-- SHOWER 1 50 CI TEL NO -7 LAVATORY 1 50 CONTRACTOR SINK 1 50 ADORES DISHWASHER 1 50 C TEL NO CLOTHES WASHER 1 50 STATE LIC LICENSE NO CLASS SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GROU ;FE PR C 5BY LAWN SPRINKLER SYSTEM 2 00 ` WATER HEATER 1 50 INDUSTRIAL WASTE APPROVAL Q GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD OUTLETS OVER 30 Q 5 PER SYSTEM32 tVA fS l_,� CLUL 7— Plan check fee 25% of above See reverse Gam( PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE 'S�t r Y AP_P_ROVAL DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel -No HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ly CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO iTd� RESIDE IN THE ABOVE DEGCRIBED RESIDENTIAL PROPERTY FINAL , / � r SIGNATURE �� C PERMIT JACK R. ALLEN, SUPER(SING MECHANICAL E G'R PERMIT VALIDATION CK M O cASH PLAN CHE�A VALIDATION CK M 0 CASH 76A667-CE#817 2-66 &:Z�7 APPLICATION FOR PLUMBI G PER COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1 25 MAIL BATH TUB 125 ADDRESS SHOWER 125 CITY TEL NO LAVATORY 125 CONTRACTOR SINK 125 ADDRESS DISHWASHER 1 25 CITY - TEL NO�86 39Z STATE LIC LAUNDRY TUB 125 LICENSE NO CLASS e CLOTHES WASHER 125 DIURICT O P ZONE P BY WATER HEATER 150 t GAS SYSTEM OUTLETS 150 S INDUSTRIAL a WASTE APPROVAL CD OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD v CD t- U W N Z APPROVALS DATE INSPECTOR S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK '( -� ROUGH PLUMBING TOTAL FEE v GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES UNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL O ER AND INTEND TO GAS TEST RESIDE IN THE ABOVE DESCRIBED RE ID TIAL PE RTY UTILITY CO NOTIFIED SIGNATURE Ell OF PERMITTEE FINAL VALIDATION JACK R. ALLEN CK M O CASH SUPERVISING MECHANICAL ENG'R LA(,0-9 3 5 3 JU14 2 9 5D 3,5 0 N r O B 17 25M SETS 15-43 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING 1 COUNTY OF LOS ANGELES Wm J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT O. GR/OJ UP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE • / / `�" HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED jo FIRST INSPECTION AS MISCELLANEOUS APPLICANT FILL JN HEAVILY OUTLINED PORTION ONLY JOBr' L® lz NAME��- ,!� /.r.�( �,i� / ADDRESS ' ADDRESS y j/ /� y'�Yl^t e,& t*- LOCALITY � �L�i,, �E�"�`'�� 1/1 LL CITY / -E� TEL No >;0 //;� CERT NCOUNTYO//1$ /fY/ V EXPIREB��'T� 7'f� Z NAME /(y 4"4 41 LOCATION OF SEPTIC TANS, OR CESSPOOL 3 MAIL NORTH O CITY �:% TEL No IAM THff oLEGAL POSSESSORr 01�_THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION.,, PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE PI a .= I OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK _z BATH TUB J�JI 'FURNACE 6 SHOWER DISHWASHER E3� O -LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR BINK SAND TRAP LSLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY - _O GAS SODA FOUNTAIN ROUGH PLUMBING ETERS 1 OUTL GAS PIPING V i GAS VENT / CESSPOOL TOTAL NUMBER OF FIXTURES (p SEPTIC TANK I I CESSPOOI SEPTIC TANK SEWER $ G1 U UTILITY CO NOTIFIED TOTAL FEE �I�`� FINAL 1d Y� D 8 17 2SM SETS 12-43 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY , PLUMBING COUNTY OF LOS ANGELES WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT GROUP ZONE PERMIT ROUGH FIXTURES COMPLETE 1.5— /p 81 a � 99 1-1 HEATER CESSPOOL SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED +r� ��y FIRST,INSPECTION � AS MISCELLANEOUS �j/` t/V 4L APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY t q � - ADDRESS P. `Y �/i•YYJ'Y�' m ADDRESS LOCALITY g 7 _ NEAREST h IL CITY�\ _ ,�,.�/� TEL NO C OSS ST COUNTY v . CERT NO EXPIRES X NAME LOCATION OF SEPTIC TANK, OR CESSPOOL x MAIL ADDRESS NORTH O CITY TEL No I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. V WINA APLUMBHR 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. m D 3 VI OWNER i CORRECTIONS SOUTH �2•��2 �i�L//...�.��t7� %�1�"'� Q DESCRIPTION OF WORK z BATH TUB FURNACE O L7 4i SHOWER DISHWASHER 0 LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR BINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S MAMA WATER HEATER DENTAL LAVATORY ' ROUGH PLUMBING I I METER—GAS SODA FOUNTAIN OUTL GAS PIPING GAS VENT CESSPOOL TOTAL NUMBER OF FIXTSEPTIC TANK CESSPOOL--------SEPTICK SEWER UTILITY CO NOTIFIED I ) t f } TOTAL FEE l O"r] FINAL D S 17 25M SETS 12-43 ,APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFIETY ' s COUNTY OF LOS ANGELES Wm J. FOX. CHIEF ENGINEER NATURE OF INSTALLATIONISTRI,, .N GROUP o PERMIT o. Y I ROUGH y FIXTURES L COMPLETE HEATER CESSPOOL I—I SEPTIC TANK E /VED Y READY FOR `DATE ISSUED FIRST INSPECTION d AS ml mmmlgmffi� 23 APPLICANT FILL IN�}_ H-�EAVI Y OUTLINED PORTION ONLY Joe C NAME t B e 1 �C. -� ADDRE80 W C ADDRESS w) +I.+I LOCALITY r O NEAREST 1 -1 CITY ' - .Nt_. TEL NO ! CR088 ST.IL �9 COUNTY r - EXPIRES —;i - CERT NO � NAME 11 �9' LOCATION OF SEP'T'IC TANS, OR CESSPOOL 2 MAIL - 3 ADDRESS NORTH O CITY TEL NO I AM THE LEGAL POSSESSOR OF THE ABOVE LOB ANGELES COU TY CERTIP_ICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRI BD ABOVE. V/ OWNER i CORRECTIONS SOUTH W DESCRIPTION OF WORK a L) BATH TUB FURNACE -i IL SHOWER DISHWASHER :1 cl LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK BAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR 8 NAME WATER HEATER DENTAL LAVATORY k ROUGH PLUMBING I METER GAS pODA FOUNTAIN GAS PIPING OUTL GAS VENT � j CESSPOOL J TOTAL NUMBER OF FIXTURES , SEPTIC TANK I CESSPOOI RIEPTICTANK SEWER I S UTILITY CO.NOTIFIED e TOTAL FEE _ - FINAL D B S-17 25M SETS 12-45 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES o PLU 1 Wm J FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO GROUP I ZONE PERMIT (NO ROUGH FIXTURES COMPLETE 1.5- / le?/ 1,5p 5 T �+ _ HEATER CESSPOOL I—I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED gyp FIRST INSPECTION / GAS MISCELLANEOUS SEM LICAN LL�IN EA Y OUTLINED PORTION NLY JOB K NAME ADDRESS O /fAy ADDRESS r LOCALITY J NEAREST v J a CITY TEL No CROSS ST COUNTY /1 J, CERT No 6/ EXPIRES `C/�� X NAME Ifi— LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL 3 ADDRESS NORTH O CITY TEL No AM THE EGAL POSSES 1 R THE�,AB V LOB ANGELES GOON CERTIFICA F UAL.FIC,A • PLUMBUR I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE � m OWNER CORRECTIONS SOUTH l DESCRIPTION OF WORK yyy� ATH TUB FURNACE rr SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP LOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE�J[ INSPECTOR''B NAME, —WATER WATER HEATER DENTAL LAVATORY ROUGH PLUMBING ETERj__GAS aODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL \ LTOTAL NUMBER OF FIXTURES S5 SEPTIC TANK SSPOOI +SEPTIC TANK SEWER UTILITY CO NOTIFIED TOTAL FEE I FINAL ¢� WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 1 hereby, affirm that I have a certificate of consent to self in- 76A6667A PW 4/67 sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) e COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy Nol't l tCompany 7 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 15{ Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE ADDRESS department. R �a LOCALITY WATER CLOSET(TOILET) Date " T: Applicant rs: NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL NO as to become subject to the Workers' Compensation Laws. DISHWASHER CONTRACTOR DateApplicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS SWIMMING POOL RECEPTOR em tion,you should become subject to the Workers'Com en- p y I p CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC ed. WATER HEATER LICENSE NO. / CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM { OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER IL and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. DATE License Number Lic. Class UJ FINAL U„ Contractor - Date f- BY I am exempt under Sec. B.&P.C. for this reasonO Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address 0 I, as owner of the property, will do the work and the City (, Tel. No. structure is not intended or offered for sale(Section 7044, Business 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 `moi t.f 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date r —� WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/87 n sure,or a certificate of Workers'Compensation Insurance,or a CE 817(7( P CE 81 `IUI REV. 8/86) certified copy thereof (5 c. L8800, Lab. C.) r f41-,5 C `- (( COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS . Policy No�WflLut.]i� - Company V1_ Certified copy is hereby furnished. BUILDING ti FOR APPLICANT TO FILL IN (PRINT OR TYPE) c¢7 Certified copy is filed with the county building inspection ADDRESS Ip1 department. Y NUMBER FIXTURE OR ITEM Ca FEE LOCALITY c Date L' 1T Applicant '' d`�iL�C�cC! WATER CLOSET(TOILET) 4 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. r, 'COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK A mit is issued, I shall not employ any person in any manner so CITY w TEL. NO2 as to become subject to the Workers' Compensation Laws. DISHWASHER •• CONTRACTOR Date Applicant CLOTHES:WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS MING emption,you should become subject to the Workers'Compen- SWIMPOOL RECEPTOR CITY TEL. NO. 7 sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this-permit shall be deemed revok- STATE !i LIC. /a ed. WATER HEATER LICENSE NO. `y CLASS L✓ J LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY / I hereby affirm0 ,that I am Licensed under provisions of Chapter GAS SYSTEM OUTLETS %} 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER v fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL �l� VALIDATION ,/��.� _, � - DATE "lj� �C/ License Number M46 e7 C' Lic. Class �- � � o fl AL V Contractor"XON to Date O ElI am exempt under Sec. / B.&P.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 0 8 8 5 8 A SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check-applicant .0 0 0 0 0 5 I hereby affirm that I am exempt from the Contractor's License Name 0 0 1 6.50 Law for the following reason (Section 7031.5, Business and1 Professions Code): Address / `� �f�rbty'2 0 0 61650.5 F I, as owner of the property, will.do the work and the City Tel. Nom' -14.7 4 '(, Q 1,2 b=8 8 structure is not intended or offered for sale(Section 7044, Business 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 agrbe.to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the a ove-m ntioned property for inspection purposes. •� ' Z - e r SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date