HomeMy Public PortalAbout10246 FREER ST_Plumbing__ .76A667.QIE#817 9/63
APPLICATION. FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUD�ss 102/6 Freer Ste
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY Temple C1ty
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER J B Weber Development
2 WATER CLOSET $1.25 2 50 MAIL
1:
BATH TUB 1.25 ADDRESS 5926 Temple City Blvd.
I SHOWER 1.25 5 CITY Temple City TEL. NO.
1 2
2 LAVATORY 1.Y5 2 5 CONTRIICTORValley Plumbing Co.
1 SINK 1.25 1 25 ADDRESS 442 W. Fleetwood�+Pl.
.1 DISHWASHER 1.25 1 2 CITY Glendora TEL. NCEd 5-12
CONTRACTOR'S 209431 STATE ❑
LAUNDRY TUB 1.25 1 REGISTRATION NO. COUNTY ❑
1• CLOTHES WASHER 1.25 1 2 DIST ICT O. GROUP ZONE P ESSED BY
1 WATER HEATER 1.50 1 50 j 1
1 GAS SYSTEM OUTLETS 1.50 1 0 WASI
TE APPROVAL
1 OUTLETS,OVER 5 PER SYSTEM .3030 -1 INSPECTION RECORD O
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-" - - APPROVALS - - .DATE- INSPECT R'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK _
ROUGH PLUMBING
TOTAL FEE 16 55 GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
ANO STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING_FIXTURES cJa () II
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST - 044- l��gy�1x,(O
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO NOTIFIED
SIGNATURE /r A
OF PERMITTEE FINAL '1 —6 k
ALIDATION ROBERT A. WOOD V
CK. M'O CASH SUPERVISING MECHANICAL ENG'R
Cleo 8 0 7 4 APP, 2 4 5 D 1 6.5 5- ,
' WORKERS'CO'dve o'c TIOicafe of corse t APPLICATION FOR PLUMING PERMIT
I hereby, affirm,that I'Fiave.a'certificafe of consent to self in- 20-0026 DPW-a/87
y sure,of a certificate of Workers'Compensation Insurance,ora 76A667ACE 817(REV 8/86) '
certified co'y th'reofSSec 3800, Lab. ,
a , i COUNTY OF LOS,ANGELES -DEPT. OF PUBLIC ,WORKS
Policy No �A/lJ Company k ,
FCertified copy is hereby furnished `
FOR APPLICANT TO FILL IN,(PRINT OR TYPE) BUILDINGd�
ertified'c pyis filed with the cou building inspection ADDRESS 4J
P rime NUMBER FIXTURE OR ITEM .@. FEE LOCALITY
Date A Licari` �M4 - WATER CLOSET(TOILET), s ` r
PP, NEAREST
+ BATH.TUB. CROSS ST
CERTIFICATE OF EXEMPTION FRC;M.WORKERS'�'
COMPENSATION INSURANCE OWNER
SHOWER EKJ
-(This section.n'eed�not be completed if,the'work in461 a by MAIL
the permit is for-one hundred dollars-,($10.0)or less.)' - -LAVATORY ADDRESS '
I rtrfy,that in)tlie performance of•the work for'which'this per-
c: �r,,,
mit.is issued,-I shall not employ any person m any manner so " SINK CITY TEL NO
3F
a's to become subject-to the Workers= Compensation Laws"
DISHWASHER, r
CONTRACTOR
Date Applicant CLOTHES WASHER
ADDRESS l ��
NOTICE TO APPLICANT If, after making this Certificate of Ex- ' _ >--
eniphon;'you should become subject to the Workers Compen- SWIMMING,POOL RECEPTOR ,
sation provisions,of the Labor Code,•you must forthwith comp, : LAWWSPRINKLER SYSTEM CITY • TEL NO f
ly with such provisions 0[,t his permit shall be;deemed revok- STATE ��,(( �uG.'
^ed WATER,HEATER - LICENSCNO sJ CLASS
"LICENSED,CONTRACTORS DECLARATION DISTRICT � PRO ED BY
I hereby affirm that-I am hcensed:under•provisions of Chapter, GAS SYSTEM OUTLETS �U(
9(commencing with Section 7000)of Division3 of-the Business OUTLETS-OVER.
and Professions Code, and my license is in'full force and ef- 5 PER SYSTEM. ' FINAL VALIDAT N'
fect "` ' DATE
a;
�j T v O
License Numb Lic Class U
FIN Q
"Contractor to �,f,�c.42 Q BY a p
�9256A
aI am exerript-under Sec l T #,o o'.o o'0 5 W
B.&P C for this reason d
Plan check fee ►
,.i o o2250 � .
Date '
, ` PLUMBING PERMIT ISSUING FEE $
Signature 0 0 0 2 2.5.0
•TOTAL FEE
- _ = SINGLE"'FAMILY `
ib W-. _ _ Plad_check a Licari
j HOME'OWNER-BUILDER"DECCARATION— -�y- - PP
I'hereby offirm'thaf I am exempt.ffom the Contractor's License - Name"
Law for the following-reason,(Section 7031 5,.Busiriess and
Professions Code) Address
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, -• - '
,Business and,Professions,Code). ;
CONSTRUCTION LENDING AGENCY''
I hereby affirm that there is a c'on'struction'Iending-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 o motion-is correct I agree to comply with all County ,w. ® µ
ordi nce and State.laws regulating Plumbing, and hereby
out nie�repre'sentatives of this' unty to enter u on the
�ab esti red prop W
tion. poses.
W:'SEE REVERSE,FOR EXPLANATORY LANGUAGE
-N'gnature of-Permittee , Dat �+