HomeMy Public PortalAbout8612 HALDEMAN ST_Plumbing__ 76A667=CE,I I7 4-67
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 SUP T OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
owNEn Ti9C.t'
WATER CLOSET $1.25
BATH rub i.25
• ADESs
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SHOWER 1.25 CITY`j�l(J �j�/j�j,� TEL. NO. '�—��Q7
LAVATORY 1,25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.l�c�lj
SATE LIC
LAUNDRY TUB 1.25 LICENSE NO CLASS �� 3
CLOTHES WASHER 1.25 DISTRICT NO GROUP ZONE PROCESSED BY
WATER HEATER 1.50 5, Z /Q/
INDUSTRIAL 0-
GAS SYSTEM OUTLETS I'50 SV WASTE APPROVAL V
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
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APPROVALS DATE INSPECTOR S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
' 7 ROUGH PLUMBING
TOTAL FEE d
O �� GAS PIPING
I HEREBY ACKNOWLEDGE THAT C 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 HOT WATER HEATER
PLUMBING '
1 HEREBY CERTIFY'THAT I AM P�tOPERLY REGISTERED AND/OR PLUMBING FIXTURES A
LICENSED AS REQUIRED BY CLOS GELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I M THE AL OWNER OF,AND E D TO �'
RESIDE IN, THE ABOVEJ��RIBRESIDEN;rOPE�� UTILITY CO NOTIFIEDSIGNATURE iJ
OF PERMITTEE FINAL lG_.G� A/�
LIDATION JACK R. ALLEN V
cK M o CASH SUPERVISING MECHANICAL ENG'R.
LALo,26 5 7"S' JAN 18 5' A 3.5 0!--
,%76A667-CE817 12/59 t
APPLICATION FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND�,SAFETY RIVISION BUILDING Tract 26026
JOHN A. IAMBI COUNTY NGINEER ADDRESS
WILLIAM A JENSEN, SUPT OF BUILDING
LOCALITY San Gabriel
FOR APPLICANT TO'FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM
MAIL MOriarC Estates
,2 WATER CLOSET
BATH TUB ADDRESS 11518 Lambert
],
CITY El Monte TEL. NO. 61 31761
sxowER
2 LAVATORY CONTRACTOR Valley Plumbing_ 66.
], SINE ADDRESS 44.2 W F
DISHWASHER CITY , Glendora TEL. NO. Ed
i 20
CONTRACTOR'S STAT
LAUNDRY TUB REGISTRATION No-160847 COUNTY ❑
CLOTHES WASHER DISTRICT NO. GROUP I ZONE PROCESSED BY
]. WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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10 @ $1.00 PER ITEM
OR FIXTURE $ /0 O"J APPROVALS DATE e INSP OR'S NIURE
PERMIT $ 2 0000 UNDER SLAB WORK-H p
TOTAL FEE ROUGH PLUMBING /1
1
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
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 THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERM,
AL
®r VALIDATION ROBERT A. WOOD,
cs.
M.0. CASH SUPERVISING MECHANICAL ENG'R
I ki"102 2 5 6 FEB 8 5 A 1 2.0 0 M
WORKERS'COMPENSATION DECLARATION 81 A 1 APPLICATION FOR PLUMBING PERMIT -
I hereby affirm"that I have a certificate of consentCE to self ce e» (z-so _
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec 3800 La .) _
COUNTY,OF LOS ANGEL ?_ 01 B ING AND SAFE
Policy No Compan f
a*ERTIFIC�ATE
hereby fur FOR APPLICANT TO FILL IN (PRINT OR TYPE) 8 DING �! 1
DRESS b
h count mg mspec 1 UMBER FIXTURE OR ITEM, • FEE
LOCALITY
WATER CLOSET
Dathcant NEARESTBATH TUBCROSSST
OF EXEMPTION FROM WORKERSPENSATION INSURANCE SHOWER OWNER
"(This section Beed not be cori►pleted if the'work involved LAVATORY- = MAIL -
ADDRESS
by the permit is for'one hundred dollars ($100) or less.) SINK a
CITY TEL.NO��.�(�� 0
I certify that in the performance of the work for which this DISHWASHER
-permit is issued, I shall not employ any person in any manner CONTRACTOR
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER
ADDRESS O @��• •
Date Applicant SWIMMING`POOL RECEPTOR )
NOTICE TO APPLICANT If, after making this Certificate of CITY TEL.NO. a
Exemption, you, should become subject to the,Workers' LAWN SPRINKLER SYSTEM ��/ STATE LIC. N
Compensation provisions of the Labor Code, you must forth- LICENSE NO lij9 CLA z
with comply with.such provisions or this permit shall be WATER HEATER
deemed revoked. DISTRICT NO iPR C SED
GAS SYSTEM OUTLETS
LICENSED CONTRACTORS DECLARATION; AA
OUTLETS OVER
I hereby affirm that I am licensed-under provisions of Ch ter 5 PER SYSTEM p
9 (commencing with Section-7000) of Division 3 oft usi- FINAL `r� / VALIDAT N
ness and Professions Code, and my license is•m full rce and DATE IVC /T/L
effect
n Number i lass FINAL
BY
ate 71I am exempt from the licensing requirements as I am a Plan Check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ '
acting in my 'professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg No Datel Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
A hereby' affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031 5, Busi- City Tel No
ness and Professions Code)
I, as owner of the property,'am exclusively contracting 2 2 2 R
with licensed. contractors to construct the project # 0 0 0 0 0 5
(Section 7044, Business and Professions Code)
20 ° 10,00
CONSTRUCTION LENDING AGENCY
I hereby affirm that there 'is a construction lending agency o 0 0 1 0,00 v
for the performance of the work for which this permit is /s so
issued(Sec 3097,Civ, C.). BUD FOR FINAL INSPECTION' o 1 ,6-8 , .,
Lender's Name
Lender's Address
I certify that I have read this application and state that he
above information is correct I agree to com with all C my SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances tate regulating Plum mg, an ereby
author representatives o this C n t enter Pon th
ned pcopert or ms ti pose `
Signa ure of
Da Permittee /