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Home My Public Portal About5319 GLICKMAN AVE_Plumbing__ 76A667-CE817-8-57 APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. t NUMBER FIXTURE OR ITEM OWNER v WATER CLOSET MAIL .t Y BATH TUB ADDRESS SHOWER CITY }. TEL.N09.,t C4 Z' LAVATORY CONTR TO SINK ADDRESS f I DISHWASHER CITY TEL.NO. � LAUNDRY TUB CONTRACTOR'S �' ' STATE REGISTRATION NO. COUNTY CLOTHES WASHER DISTRO. GR ZONE READY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD A. O jtw s APPROVALS @ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE V\ OR FIXTURE $ D UNDER SLAB WORK PERMIT $ 100 ROUGH PLUMBING - C- GAS PIPING TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING. IHEREBY 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 OWNER OF TH ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIA PR RTY. �} SIGNATURE OF PERMITTEE v FINAL ROBERT A. WOOD, VALIDATION SUPERVISING MECHANICAL ENG'R CK. M. O. CASH ! 2860 x- 16 5A 3.00 a 76A667C (CE-81713) -9/75 APPLICATION FOR PLUMBING PERMIT {� LI BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TY PEI BUILDING 5319 Glickman NUMBER FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET 60LOCALITY Te e City NEAREST BATH TUB CROSS ST. SHOWER l' OWNER Rosemead Construction LAVATORY ADDRESS 52S.s• AtlantlC SINK CITY Monterey ParkTEL. NO. 3_9513 DISHWASHER CONTRACTOR Owen Bros. Plumbing CLOTHES WASHER ADDRESS 26 No Baldwin SWIMMING POOL RECEPTOR CITY TEL. NO. Ayes--- LAWN SPRINKLER SYSTEM MonteSTATE C WATER HEATER LICENSE NO. 231 141 CLASS 036-20 O DISTRICT IN GROUP CESSED 8 vGAS SYSTEM OUTLETS OUTLETS OVER JTE� ( v 5 PER SYSTEM INDUSTRIAL LLJ d WASTE APPROVAL N SPECTION RECORD Z Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Plan check applicant Name APPR DATE INSPEC,.IOR'S SIGNATURE UNDER 'WORK Address ROUGH PLUMBING City Tel. No. 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 A STATE OF GAS TEST CALIFORNIA OR THAT I THE GAL OWNER OF, d INTEND TO RESIDE IN THE ABOVE D CRIBED IDENTIAL ROP RT?Y. UTILITY CO. NO SIGNATURE // OF PERMITTE /�.-.. IN PLA rQ0M0tN6ATc10FJ PERMIT VALIDATION CK.` M.O. CASH POLICY HOLDER: Tfc CH J o 04S V4 t-- y 4 7 4 i--3G"i 13.5C) •` POLICY NUMBER: CA 6 5 0,�7C`j �j7 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT whereby i6ffirm that I have a certificate of consent to self 20-0026 DPW 6787 in�,,ire, or aecertificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No, Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Com^ Certified copy is filed with the county building inspec- ADDRESS 5 . tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY I Date W-1-1 Appli4ant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER 1� i tia' the permit is for one hundred dollars $100 or less. MAIL p ( ) ) LAVATORY ADDRESS t I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY Tr t TEL. NO.A(C(3 so as to become subject to the Workers'Compensation Laws. DISHWASHERvC S CONTRACTOR Date 2. • Applicant CLOTHES WASHER ADDRESS 1 QQ NOTICE TO A PLICANT: If, after aking this Certificate of \�3O JO V�f�2 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR �/►� Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO.3S>S-3I with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. ® CLASS 2—Q3 LICENSED CONTRACTORS DECLARATION DISTRICT NO. P CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /0 ", (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER C1 and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION r ^ x ✓iQ�(, DATE � Q License Number CG_� Lic. Class ^ � 1 ` �• FIN Contractor V� Date 1 BY ❑ �� ILLI I am exempt under Sec. ILLI B.&P.C, for this reason � n fL Plan check fee U) Date: ® -® PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE S Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address AXT.# Law for the following reason (Section 7031.5, Business and ,f.en Professions Code): City Tel. No. -.•-, 16 50 ❑ I, as owner of the property, will do the work and the 1 IVIS structure is not intended or offered for sale (Section f 7044, Business and Professions Code). TOTAL 1$.5O CONSTRUCTION LENDING AGENCY 1650 ��4�r I hereby affirm that there is a construction lending agency for r �ry the performance of the work for which this permit is issued � -00 (Sec. 3097, Civ. C.). Lender's Name 1 7/21/89 L'ender's Address 4,604 1 AM 9:N 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 �7 2[ Cj qgnature of Permittee to WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have P certificate of consent to self 76A667A insure, or a certificaT6 of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company ' Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS 6319 "AA/ tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET Date Applicant CROSS NEARESTT . ®Lri VC CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE OWNER SHOWER. 6--LaS E AIA-P_pTP—I C—1< (This section need not be completed if the work involved by MAILe, the permit is for one hundred dollars(;100)or less.) LAVATORY ADDRESS 5-3// fes/ U/C4iit-M.4 I certify that in the performance of the work for which this SINK CITY^ TEL. NO. permit is issued, I shall not employ any person in any manner /� -& so 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 qq Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITYTEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS L^` ,�"j (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER J (f and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDA ION DATE License Number Lic: Class FINAL Contractor Date BY U X6 U I /�__ - / tie ❑ I am exempt under Sec. 1 34L8A t� B.&P.C. for this reason Plan check fee ► # ® e o o ® 5 Date: PLUMBING PERMIT ISSUING FEE$ 0S-0 ( ® s 1 6 5 0 Signature TOTAL FEE ® ® ® 1 &5 0 v Plan check applicant SINGLE FAMILY 0 1. 1 5-85 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. 14 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). 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 lop.above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby outhorizg,,Irepresentatives of thi County to enter upon the a nti ed pr per or .sp`ect' n purposes. _ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per,ttee Date