HomeMy Public PortalAbout10715 GRAND AVE_Plumbing__ 76A667-CE4817 6-65
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER ol
WATER CLOSET $1.25
BATH TUB1.25 ADDRESS Q 5
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.2S CONTRACTOR
SINS 1.25 ADDRESS �G�j
DISHWASHER 1.25 CITY TEL. NO.
STATE ��� LIC
LAUNDRY TUB 1.25 uCENSE NO SS
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE "SCLESSED BY
WATER HEATER 1.50 -4L
INDUSTRIAL
GAS SYSTEM--,/—OUTLETS— 1.50
WA °
STE APPROVAL O
OUTLETS OVER S PER SYSTEM 30 INSPECTION RECORD V
O
F-
U
W
N
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE j
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER '
1 HEREBY CERTIFY THAT I AM PROPERLY RE ISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED - LOS ANGELES CO Y ANDSjATE OF GAS TEST, _
CALIFORNIA OR THAT 1 THE LEGAL OWN F,AND INTEND TO
RESIDE IN,THE ABOVE CRIBED RESIDE ROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERM ITTE FINAL
VALIDATION
CASH
1.11,07 7 7 9:^ DE'C 3 5 D 350- a
J OOUNTY OF Loa ANGELES APPUCAT1ON FOR PERMIT
Y Department of Conan Engineer
DIVISION OF BUILDING & SAFETY
PLUMBING 1
WILLIAM I FOX, 0o[oty Emil low
FOR APPLICIA�M TO FILL IN S ]
PLUMBSVALLEY �'`IARD I 1f n R=D[rylm WY READY FUR DAT[ ISSUED
M FIRST INSP[0T113N
ADDgmm OO EA A C
arnTE
r ROSEMEAD L.No. AT. 2-27119
BADloaui O �
COUNTY 93MIREN Fi-3a,S� LOOALITY -
NE"[ST
PERMIT FEES CRD>tn NT.
Numown TYPO OF rrXTIJ1II OR ITCM FEE DWN CR
MAIL
WATER OL.DSET(TUI 0.50 III ADDRESS
OATH TL■ 0.50 CITY TEL No.
NHOW[R 0.513 1 HERESY ADKHOWLCDSK THAT I HAVE READ THIS
LAVATORY (WASH BASIN) 0.513 APPUQATI13N AND STATE THAT THE ABOVE 10 OORREOT
AND AOREI TO COMPLY WITH ALL COUNTY ORDINANDIM
KrrO EN OINK 40 0.513 AND STATE LAWS R[DULATINO PLUMNINO.
I RTIF
OEY THAT I P13ENUME THE ASOV[ VALID LDS
L
LAUNDRY TB OR TRAY 0 0.50 AND[LES COUNTY LICENSE- OR I AM THE -LKDAL OWN[I!
m" SYSTELTTLIT7 0 0.513
OT THE RESIDENTIAL P OPERTY DQORINK9 ASDV
el 010NATURE Df
WATER HEATER •O Moo FERMI
SLOP OINK 0.NO INgPECTION RECO 601
FLODR SINK 0.50
FLOOR DRAIN 0.00
DISHWASHER 13.50
DRINKING FOUNTAIN A D.BO
URINAL ! 0.NO —I
t
HOLIN[ ■EWER D.SO _Z
M160ELLANEUW 2
APPSOVAI..S
DATE INIM[OTOw•■ NANO
ROUGH PLUMBING
OAS PIPINO
OAS VENT
DESBPOOL O 1.00 C[S*POOL
■EPTIO TANKS SEPTIC TANK
DRAIN ( ) PIT ( O 1.013 SEWER
PERMIT 1.00 OAA TEjT
LITILITY 00.NOTIFIED
TOTAL FEE • �"
k I
I TEAS" DBS#1T "
f WORKERS'COMPENSATION DECLARATION /APPLICATION FOR PLUMBING PERMIT
I here{oy affirm that L have a certificate of consent to self 76A667A �-
flnsure, or a certificate of Worked' Cgmpensotlon IrsuraAce„ CE 817(REV.10/81)
or a certified copyy ttborr�e��of (Sec, 3800, lab. C,) COUNTY OF LOS ANGELIES vvv BUILDING AND SAFETY
policy No. +��T+�{ompany Select IIID. Co.
QCertified copy Is hereby furnished.
CerHfled Copy Is filed with the c n Ildlnq I FOR APPLKUANT TO FR11N(PRINT OR TYPE) BUI�N6 C715 F. Ave.
tion department. (}e0 �g. &r Stg• mss
NUAA882 FIXTURE 012 rrEAA Q FEE
IIT Temple City
Date^ � ,Appll,a. WATER CLOSET
CSRTIFIQATE(>F EXEMPTION-FROM WORKERS' BAS TUB (ROSS ST. Santa Am Ave. & Lower AzuBa
COMPENSATION INSURANCE(ThIlSFIOWERow by � bardelli
tFre�n *need"hu dbe�dpi'�Ib If Are
work
l�} AVArorrY MAIL
10`f1g E. (t'bLnt Ave
I certify that Ih the perfdrmance of the work for which thls.
permit it Issued, I shall not employ any Person In airy maAner SJ NX CITY Temple City TEL_ 110 444-0963
so as to become subject to the Workets Compensation Laws.
. aISfIW.tiStfER
T Geoign BpMg plb . '& Heating
Date A +llcant dOT111E5 WASF®t
NOTICE TO APPLICANT: ff after making this Certificate of AmRESs 1740 $O. Broadway
Exemption, you should become subject to the Worker' SWLMMIN6PO0LRECEPTOR
Compensatlon pFovislbns of the Labor Code, you must froth- �(iElydenas Calif. Ta- N$15-0404
P
with comply With such Fovlslons or this Rermlt shall be LAWNSPRINIQERSYSIEM STATE
deemed revoked. WATER HEATER Np. 441678 G 36
LICENSED CONTkACTORS bECLARATION No.
BY
I hereby affirm that I am licensed unci r provislbns ofChppter 9 5 1 OUnETS Q�
(commenclN With Sectlgn'7000) of Division 3 of the Business OvbR
and Professions Coda,and my license Is In,full force and effect. 5 PER SFINAL YSTEM VALIDATION
_
441678 C 36 1 Yater Service 6. DATE
License NUmloer Ilc. Class
Plumbing515-0404FINAL
CPhtrattor, . Dpte - - 5y O .
El �am exempt udder Sec.
B-$P.C. for thio reason
Plan check fee _
Date:
PLUMBING PERMIT ISSUING FEE 10.50
Slgnaturo-,.
TOTAL FH -16.50
Plan check.appllcapt1 8 1, A
SINGLE FAMILY
HOME OWNER-BUILDER DFCIAJI AT10N. Name
0,0 oo
1 hereby affirm that 1 cam exempt from the ContraeWs License # tt +0 5
Law for the following reason (Section 7031.5, Business and
Professlons Code): city
. Tel.No. 2,o'-r 5
I, as owner of the property, will do the work and the �o o a•1 a 5 0.6
structure Is not Intended or offered for sale (Section '
7044,Business and Professions Cade} 0 6 0 7—8 4
CONSTRUCTION LENDING ACAC Y
J hereby affirm tEat there Is a gonstruction lending agency for 1
the performance of the work foF whlCh this Permit Is IoUbd
(Sec, 3097, Cly. C.).
-Lender's Name
Lender'sAddress
f certify that I have read this application and►tate that the ►
above Informatlon U correct. I agree to comply with all County
ordlhances and State lows regulating Plumblhg, and hereby
authorize rppresentativet of this County to enter upon thb
above Honed property for Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
s -Tf
Slgntrture of Permlttee Date