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Home My Public Portal About5435 ENCINITA AVE_Plumbing__ 1 DEPARTMENT OF COUNTY ENGINEER PLUMBING 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J. FOX, COUNTY ENGINEER ADDRESS FOR APPCANT TO FILL IN LOCALITY i C BUILDING NEAREST p W ADDRESS 3 €l4 u �, CROSS ST V G DISTRICT NO GROUP ZONE PERMIT NO LOCALITY NEAREST L� ` , 1 CROSS ST ��A I> v y 141 RECEIVED BY Ready for Inspection �j DATE (ISSUED OWNER la C.r R,P. r_— L L— ! �pCIS —'sz�t- MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY /� TEL No INSPECTION RECORD PLUMBER t, A I E7 R W I Cr ADDRESS 10 � � L�t� '� L.-r.— t.,,zr— CITYNO NT 6 k S TEL.NO �Z TATE 12 91 a � J^I`I& mJ2 S fie! ��T- LICENSE NO [] COUNTY PERMIT FE S '-' _ AS �'� a v� a��-,��_ ►� 4 rt�, . _Q ? 4UM13ER TYPE OF FIXTURE OR ITEM FEE (�T-1 )j �� 1��L• _... n WATER CLOSET(TOILET) @ 080 3 BATH TUB @ 080 * SHOWER @ 080 LAVATORY(WASH BASIN) @ 080 10 KITCHEN SINK @ 080 LAUNDRY TUB OR TRAY @ 080 g® SLOP SINK @ 080 FLOOR SINK @ 080 S FLOOR DRAIN @ 080 DISHWASHER @ 080 DRINKING FOUNTAIN @ 080 URINAL @ 080 GAS SYSTEM _ _OUTLETS @ 1 00 WATER HEATER @ 1 00 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK flfl PERMIT $ 1 00 ROUGH PLUMBING R'f►`�C�1, TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THI APPLI- GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED M AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ASVE DESCRIBED ESIDENTIAL PROPERTY UTILITY CO NOTIFIED IL SIGNATURE OF PERMITTEE FINAL 1l �•l ( .(/+� 76AG67 DES 17 6 2-53 `WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT hereby'affirm that I have a certificate of consent to self 76A667A nsure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) City of Temple City or a certified copy thereof (Sec 3800, Lab C ) I COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No 201916 Company 9�IF ` 1093 Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING I`}I( Certified copy is filed with the county building inspec- ADDRESS 5435 Encinita Ave tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY � Temple Cit Date 4-1-8$ Applicant General Tn-stall WATER CLOSET NEAREST a CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB i Y CROSS ST"� Broadway COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less ) LAVATORY MAIL ADDRESS Same I certify that in the performance of the work for which this � permit is issued, I shall not employ any person in any manner SINK CITY 910p-309-9450 so as to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR General : InstallationCo Date Applicant CLOTHES WASHER ADDRESS 6558 West Blvd NOTICE TO APPLICANT If, after making this,Certificate of . Exemption, you should become subject to the Workers SW ING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- ) CITY Los Angeles TEL N LAWKLER SYSTEM 0753-2541 N with comply with such provisions or this permit shall be STATE LIC deemed revoked 1 WATER HEALICENSE NO 151839 CLASS C36 LICENSED CONTRACTORS DECLARATION r` 00 DISTRI O/y(/ PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of"the Business OUTLETS OVER >_and Professions Code, and my license is in full force and effect 5 PER SYSTEM d FINAL V IDATION O License Number 151839 Lic Class 1136 DATE / U FIN 0 U Contractor W-0- Pro4-55 BY v n Date tJ ❑ 0. I am exempt under Sec H B 8P C for this reason Plan check fee ► ;971 6 7 A Z Date PLUMBING PERMIT ISSUING FEE$ Signature # o 0 0 0 0 5 TOTAL FEE I -'o 1 650 5O o 0 0 1 6.5 0 SINGLE FAMILY Plan check applicant� 1 v HOME OWNER-BUILDER�DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Q 6,O 3 t 8 7 Law for the-following reason (Section 7031 5, Business and Address_ Professions Code) I City Tel No ❑ I, as owner of the property, will do the work and the c 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 pop.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 pro erty i pection purposes ` 7 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee! Date ` t