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Home My Public Portal About10770 FAIRVIEW AVE_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer PLUMBING DIVISION OF BUILDING & SAFETY WILLIAM J FOX, County Engineer DIS R T NO. GROUP ZONE PE�RM O. FOR APPLICANT TO FILL IN T -4- 1 D 1op— aO PLUMBER Jack's Plumbing & Su lies 1ne RECEIVED BY READY FOR DATE ISSUED ADDRESS A, .cw.tFIRST INSPECTION li26 , h BU OITY l Monte TEL No. Fo-87666 ADD EISS 10770 Fairview COUNTY LICENSE NO. M 4U EXPIRES 6-30-53' LOCALITY Temple City NEAREST PERMIT FEES CRDs ST. persimmon NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER Geo. Metz MAIL� s�lme-_WATER CLOSET(TOILET) 0.50 $ 0 ADDRESS BATH TUB Q 0.50 CITY TEL No. SHOWER 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK Q 0.50 AND STATE LAWS REGULATING PLUMBING. 1CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O 5O AND LES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER GAS SYSTEM OUTLETS @ O 50 I THE RESIDENTjAI�_QF30 •C S Innq j4estlnZ SIGNATURE OF rd�C/tl/�JLSG[�JS .f�sr'��7, .Ll WATER HEATER @ 0.50 PERMITTEE SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ O 50 URINAL @ O 50 Z MISCELLANEOUS L7 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING i GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK i _ DRAIN ( ) PIT ( ) @ 1 00 SEWER PERMIT I 1.00 GAS TEST 'Ln UTILITY CO. NOTIFIED _ TOTAL FEE $ • FINAL 76A667, DBS$R li 6-52 DECLARAT WORKER'S COMPENSATION certificate of consent to ' 76A666OPV,J,69• APPLICATION FOR PLUMBING PERMIT I hereby.affrrmai.,it I Piave a certificate of consent to serif insure, 76A667A or a certificate of Worker's Gompensatibn Insurance, or a certified copy tnereof(Sec 3800 Lab C) i Policy No ti Company ST�FFC� uND COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑ Certified copy is hereby furnished ( _ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING O O I `L�_ �` 'U-- Certified copy is filed with the county building inspection ADDRESS V (/�/ �J department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST v, -,w COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL f permit is for one hundred dollars($100)or less) OWNER `� I certify that in the performance of the work for which this permit LAVATORY V is issued, I shall not employ any person in any manner so as toMAIL •, become subject to the Workers' Compensation Laws SINK' ADDRESS 0 Ivt DISWASHER CITY 1 TEL NO Z- 2011VV Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after.making this Certificate of CONTRACTOR S �— Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER CIN LOS S CCS TEL � �� >- I 1 hereby affirm that I am licensed under provisions of Chapter 9 LIC a (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO 13 CLASS Professions Code,and my license is in full force and effect () OUTLETS OVER DISTRICT NO PROCESdL6 BY 5 PER SYSTEM O License Numbs t Lic Class I . FINAL Contractor R� '.Date L s DATE - VALIDATION 0YCLW ❑ I am exempt under Sec FINAL Z BY 8 RP C for this reason Date Plan check fee _ Signature r PLUMBING PERMIT ISSUING FEE$ (' - ❑ TOTAL FEE a fir-y e r SINGLE FAMILY Plan check applicant ;I` �t a f n 2E r HOME OWNER-BUILDER DECLARATION Name i N F PIs_ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Professions Address j j- A4I H7 0 Code) - HL ❑ ,'i: �c f ,r� I, as owner of the property,will do the work and the structure City Tel No is not intended or offered for sale (Section 7044, Business �• t f and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the ,:1_11)j.-1141131 7120;4`, performance of the work for which this permit is issued (Sec 3097, Civ C) °j�14 1 Ar,11:1: Lender's Name Lender's Address I certify that I have read this application and state that the above r 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