HomeMy Public PortalAbout5469 ENCINITA AVE_Plumbing__ 76Ae87 APPLICATION FOR PLUMBING PERMIT
DBS I"DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS e n
CASSATT D GRIFFIN,SUP T OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
OWNER DISTRICT,,NO GROUP Z E READY FOR INSPECTION
MAIL G..
ADDRESS J �^
INDUSTRIAL
CITY TEL NO 0 WASTE APPROVAL
PLUMBER 1 9;V,_.J P G e p INSPECTION RECORD
ADDRESS Z Q
nI
CITY A 6`� TEL NO -� pq� 4''1
LICENSE NO /S V037
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1 00 $
BATH TUB @ $1 00
SHOWER @ $1 00
LAVATORY (WASHBASIN) @ $1 00
KITCHEN SINK @ $1 00
DISHWASHER @ $1 00
LAUNDRY TUB OR TRAY @ $1 00
CLOTHES WASHER @ S100 00
WATER HEATER @ $1 00
GAS SYSTEM @ $1 00
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK /
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING _ _ •/,.n
TOTAL FEE "' GAS VENT '
- 1
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER *I �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING
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 1 AM THE LEGAL WN�E OF THE ABOVE UTILITY CO NOTIFIED 9
DESCRIBED RESIDENTIAL PR RTY U I 1
♦ 1
_ s
SIGNATURE1 A� f, _
✓P
OF PERMITTEE FINAL ul6
JOHN A LAMBIE, COUNTY ENGIIEER IDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK Id 0 CASH
UACO 6 1 1 7 L MAY 17 3 8.0 0 n
WORKERS'COMPENSATION (DECLARATION ` . 76A667A
I hereby aiffirm tlrat I have a certificate of consent to self ce ei 7 (x- o) APPLICATION FOR PLUMBING PERMIT
insure, or h certificate of Workers'Compensation Insurance,or
a certified cbpy thereof(Sec 3800,Lab C)
P28849 Zenith I COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Compi,
❑ \
Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS 5469 Enclnita
D Certified copy is filed wi he u building mspecti NUMBER FIXTURE OR ITEM O FEE
de t WATER CLOSET LOCALITY Temple City
Date Applicant NEAREST
BATH TUB CROSS ST
CERTIFICATE OF E PTION FRO R
OKERS'
COMPENSATION INSURANCE SHOWER OWNER Wesley Pack
(This section need not be completed if the work involved ILAVATORY MAIL
ADDRESS 5469 Encinita
by the permit is for one hundred dollars ($100) or less) SINK � }
CITY Temple Cit TEL NO 286_882 O
1 certify that in the performance of the work for which this DISHWASHER U
permit is issued, I shall not employ any person in any manner CONTRACTOR Bryant Heat . 8c A. C.
so as to become subject to the Workers' Compensation Laws CLOTHES WASHER 0
ADDRESS 1350 E. Las Tunas Drive
Date Applicant286t -
NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR San Gabriel —
CITY TEL NO v
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC in
Compensation provisions of the Labor Code, you must forth- LICENSE NO 221751 CLASS C 20
with comply with such provisions or this permit shall be WATER HEATER _
deemed revoked L GAS SYSTEM OUTLETS 6 ,00 DISTRICT NO PROCESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi FINAL
ness and Professions Code, and my license is in full force and DATE VALIDATION l/ �Q
effect U
221751 C20 FINAL
License Nu Lic Class gY
Contractor Date
❑ I am exempt m the licensing requirements as I am a Plan check fee
licensed archi ect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus10 150
-
iness and Professions Code) TOTAL FEE 1 16 150
2534.OA
Lic or Reg No Date Plan check applicant
- #'x000'05
HOME OWNER-BUILDER DECLARATION Name I o o 14
50
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 olo ° 1 6 5 0 v
ness and Professions Code) a `
❑ I, as owner of the property, am exclusively contracting 0 Or 1 9—8 3
with licensed contractors to construct the project
(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 agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
abov ention property for inspectio rposes
nature of P ittee Date