HomeMy Public PortalAbout10243 FREER ST_Plumbing__ 76A667C (CE-8178) -975 I '
APPLICATION FOR PLUMBING PERMIT
-4��4
BUILDING AN SAFETY DIVISI
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
NUMBER FIXTURE OR ITEM @ FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNER r
LAVATORY MAIL
ADDRESS e C--
SINK CITY `1 TEL NO � 0
1 Ao
DISHWASHER
CONTRACTOR
CLOTHES WASHER
ADDRESS
s SWIMMING POOL RECEPTOR
CITY` , TEL NO,4 e
LAWN SPRINKLER SYSTEMSTATE
Q-
WATER HEATER LICENSE NO Q CILASS
a
` GAS SYSTEM OUTLETS DISTRICT NO G OUP NEI PROC SE BY O
o �J v
D
OUTLETS OVER _. pi �
5 PER SYSTEM U
INDUSTRIAL
s WASTE APPROVAL ly
dO �" INSPECTION RECORD GO
Z
Plan check fee
PLUMBING PERMIT ISSUING FEE $ 'J?�
TOTAL FEE
Plan check applicant
NameAPPROVALS DATE INSPECTOR 5 SIGNATURE
'� UNDER SLAB WORK
Address ROUGH PLUMBING
CItY ' Tel NoClf_SGAS PIPINGIg' i
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
I 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 TH EGAL OWNER-O F, AND �NE0 TO _
RESIDE IN THE ABOVE DESCRI REST NT 9Cy L �F�O PER UTILITY CO NOTIFIED'
SIGNATURE (/TJX,/l 7
7 f`a ��--
OF PERMITTEE -,FINAL
PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION M,O CASH
6 2.7 r QCT i2 5 13.6 0 Arc
76A88P•CE9817 9/63
APPLICATION ICOR PLUMBING • PERMIT,
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS 10243 Freer St.
JOHN A LAMBIE, COUNTY ENGINEER
WILLIAM A JENSEN, SUP 7 OF BUILDING LOCALITY Temple City ,
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE '
3 WATER CLOSET s1.25 3 75 OWNER J B Weber Development
MAIL
1 BATH TUB 1 25 1 25
ADDRESS 5926 Temple City Blvd.,
1 SHOWER 1 25 1 25 CITY Temple CitV TEL. NO
3 ILAVATORY 125 3 75 CONTRACTORValle P
1 SINK 125 1125 ADDRESS 442 W. Fleetwood
1 DISHWASHER 12S 1 25 cITYGlendora TEL N
LAUNDRY TUB 1 25 CONTRACTOR'S I REGIS RAT ON NO. 209 COUNTY p
1 CLOTHES WASHER 1 25 1 25 -DISTRICT NO GROUP NE CESSED BY
1 WATER HEATER 1.50 1 50
i
1 GAS SYSTEM OUTLETS 150 1 50 INDUSTRIAL I a
WASTE APPROVAL 0
1 - OUTLETS OVER 5 PER SYSTEM 30 30 INSPECTION RECORD U
Ix
,0.
H
U
W
t -
Z
APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT s 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 05 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
I 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 1 AM THE LEGAL OWNER OF,AND INTEND TO [S
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE A w
OF PERMITTEE FINAL
VALIDATION ROBERT A WOOD 1
cK M O CASH SUPERVISING MECHANICAL ENG R
�� a 0 0 7 3 APR24 5 Q 1 S-1.0 5
ION
WORKER'S I have
a certificate
of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT
76A667A
I hereby affiNn that I have a certificate of consent to self insure,
• or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec 3800 Lab C)
�(o N,7 3 �7'�' � ��,, COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV.
Policy N Company _ T _^ }w •. ,
I�L�JI Certified copy is hereby furnished _ ' ` --1 t
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified•copy is filed with the county building inspection ADDRESS
department NUMBER FIXTURE OR ITEM ® FEE
LOCALITY
Date _Z`Ct Z- Applicant WATER CLOSET NEAREST
� _
CERTIFICATE OF EXEMPTIO FROM WORKERS' CROSS ST
BATH TUB� ASSESSOR COMPENSATION INSURANCE -
(This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less-)- OWNER Je_� �/J/J� '±) 1
1 certify that in the performance of the work for which this permit - LAVATORY i i o ry
is issued, I shall not employ any person in any manner,so as to ` SINK / J MAIL
ADDRESS
become subject to the Workers' Compensation Laws
/ DISWASHER =-JY CITY T�' g - T &3 70 _
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT If, after making this Certificate of C T ��
'Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS/ f �S, ,5 J
provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM J' y
LICENSED CONTRACTORS DECLARATION CIT 9/V r� Lv (�S a
I hereby affirm that I am licensed under provisions of Chapter 9 ` ' WATER HEATER
STATE LIC 0
(commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS 'LICENSE NO 0 $ {7 0 C ASS /rte
Professions Code, and my license is in full force and effect / V
PROCESSED BY
DISTRICT NO
` OUTLETS OVER ` 7
5 PER SYSTEM �'DO /�, ����LL'-�i°•�
License Number 6 V I Lic Class 0
FINAL
DATE /7—!` —�jZ VALIDATION a
'ac..(/ �IJ�/�jd/0�✓ � /
Contractor Date
❑ FINAL " Z
I am exempt under Sec BY
B RP C for this reason
Date G —� Plan check fee
4 PLUMBING PERMIT ISSUING FEE$
Signature
❑ �, TOTAL FEE �j?� C�/ _ ;y =f
f C 1}nj_
Plan check applicant ,
SINGLE FAMILY L�Eys;
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law t.c.F�FjtL f j
for the following reason'(Section 7031 5, Business and Professions Address
Code)
r_1f City Tel No
I, as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business
and Professions Code) ,
5-H, )
_ A,t _
CONSTRUCTION LENDING AGENCY i
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) t
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 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 Permittee ate