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Home My Public Portal About9830 FLAHERTY ST_Plumbing__ • i 76AGG7-CE#817 4=64 APPLICATION FOR PLUMBI G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING FNEAREST ESS 9830 E. Flaherty JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LITY Temple City, California FOR APPLICANT TO FILL IN T. Goldenwest Avenue NUMBER FIXTURE OR ITEM EACH FEE OWNER HenryChalmdler WATER CLOSET $1.25 MAIL 9830 E. Flaherty HATH TUB 1,25 ADDRESS SHOWER 1.25 CITY Temple City, CaMoFiRia LAVATORY 1.25 CONTRACTOR Bryant Heating & Air Cond. SINK 1.25 ADDRESS 1350 E. Las Tunasrive DISHWASHER 1.25 CITYRan TEL. NO.AT 6-1141 CONTRACTOR'S STATE LAUNDRY TUB 1.25 REGISTRATION NO. 221751 COUNTY p CLOTHES WASHER 1.25 DISTRICT N G E PAOCE/S�� -- WATER HEATER1.50 GAS SYSTEM • .QUTLETS 1'� INDUSTRIAL 0 WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD A V > 2.. � l� - APPROVALS DATE INSPECTOR'S SIGNATURE P 'RMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TO'T'AL FEE 3 0 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. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ^� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST' CALIFORNIA OR THAT I AM THE LEGAL O R OF,AND INTEND TO RESIDE IN, THE ABOV ESCRIBED RESID Tl PROPERTY. UTILITY CO. NOTIFIED .1 SIGNATURE OF PERMITTE FINAL 7/ 0.- ALIDATION ROBERT A. WOOD M O CASH SUPERVISING MECHANICAL ENG'R Ll1�sv 0 �� ! 3 v r`'I�#t 5 0 3.50 n WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I°hereFjy,_affirm.that I have a cert1.ificate of:consent to self in- 76A667A20-0026 DPW 4/87 ' sure,br a certificate of-Workers'Compensation Insurance,or a CE 817(REV. 8/86) Certified copy thereof (Seca 3800, Lab. C.)* Policy No.* CompanyCOUNTY OF LOS ANGELES, DEPT. OF PUBLIC WORKS . , -Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS. S"T NUMBER FIXTURE OR ITEM FEE department. @ LOCALITY Date Applicant WATER CLOSET(TOILET) L NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB O CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This (This section need not be completed,if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY D ADDRESS, l,certify'that in the performance of the work for which this per- SINK' ' mit is issued, I shall not employ any person in any manner so CITY eZa/ ` TEL. N as to become subject to the Workers Compensation Laws. DISHWASHER L CONTRACTOR Date Applicant . CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of.Ex- SWIMMING POOL RECEPTOR erription,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,.you must forthwith comp- LAWN SPRINKLER SYSTEM ly'with such provisions or this permit shall be,deemed revok- STATE UC. ed. WATER HEATER LICENSE NO, CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS. D� Gam- 4C� 9(commencing with Section 7000)of Division'3 of the Business %OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL / p VALIDATION >_ fect. DATE !t�[ � Q License Number Lic. Class U FINAL Contractor Date BY O ❑' I am exempt under Sec. W �a o IM B.&P.C. for this reason Plan check fee. Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY ' r 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 ai)6 )ssions Code): Address. ? •i•s 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, T Business•,and Professions Code). CONSTRUCTION LENDING AGENCY ` , _•ss Al £ � 50 I hereby affirm that there is a construction lendingagency for s`• __, i r 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 ► '6 'ir 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 Sign re of P mit a Date WORKERS' COMPENSATION DECLARATION ?0-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT *her.eby, affirm that I have a certificate of consent to self in- f� sure,o •i certificate�of Workers'Compensation Insurance,or ?6A667A �ILJII r! P CE 817(REV. 8/86) certified cdpy thereof (Sec. 3800, Lab..C.) Policy No.. ' Company, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished' FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS o NcT department. NUMBER FIXTURE.OR ITEM @ FEE WATER CLOSET (TOILET) Date Appl,icanT LOCALITY n�NEAREST CERTIFBATH TUB CROSS ST. COMPENSATION OF EXEMPTION FROM WORKERS' "- COMPENSATION INSURANCE OWNER �►a/ S SHOWER /7�Y (This section need not be completed if the work involved by MAIL the permit is for one be dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work" cir,which this per- SINK mit is issued, I shall not employ any person in any manner so CITY !'T EL N as to become subject to the Workers' Compensation Laws: DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of.Ex- SWIMMING POOL RECEPTOR emption, you should become subject to-the Workers'Compen- CITY TEi. NO, sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such proyi'sions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY 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 fed Profess iohs,Code, and my license is in full force.and ef- 5 PER SYSTEM FINAL VALIDATION _ DATE S License Number Lic. Class 0V FINAL 99 Contractor Date BY O F71 I am exempt under Seca LU BAP.C. for this reason rA Plan check fee � Date: PLUMBING PERMIT ISSUING FEE $ 1.9 Signature . _ • _ .. TOTAL FEE. SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATIONacecaPP . I,hereby affirm that I am exempt from the Contractor's License Name Law for.the following reason(Section 7031'.5, Business and Ans Code): Addresss owner of the property, will do the'work and.the City Tel. No.cture is not intended or offered for sale(Section 7044, e..i.miness and Professions Code). Poo. s hL" " _ CONSTRUCTION LENDING AGENCY Ali t1; I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued ; =f":;K (Sec. 3097, Civ. C.). Lender's Namef,iiij: ".i Lender's Address. a_1� '= I.certify that I have read this applicatio6 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 fo inspection purposes. Z� SEE REVERSE FOR EXPLANATORY LANGUAGE Sicyature 64 Permittee Date .,.