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Home My Public Portal About4847 HALLOWELL AVE_Plumbing__ 76A667 -CE#817 2-62 ,APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FC JOHN A. LAMBIE. COUNTY ENGINEER e WILLIAM A. JENSEN, SUPT OF BUILDING G' �� FOR APPLICANT TO FILL'IN L�I ' / NUMBER FIXTURE OR ITEM EACH FEE OWNER �w t3 /� WATER CLOSET $1.25Z 5r MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 ! CITY i TEL. NO. G-T 1 r LAVATORY 1.25 J CONTRACTOR W` �, SINK 1,25 ADDRESS s h-MA;: DISHWASHER 1.25 CITY TEL. NO. LAUNDRY TUB 1.25- CONTRACTOR'S STATE ❑ REGISTRATION NO. COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P ESSED BY WATER HEATER 1.50 )�� - - �( GAS SYSTEM 2- OUTLETS 1.50 INDUSTRIAL R WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 c INSPECTION RECORD 0 f ACL Ul Z.-4' APPROVALS JDATE INSPESYQR_'S StG MATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING I A 1,-� ..11 _ TOTAL FEE CJ GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS A PLICATION GAS VENT ' AND STATE THAT THE ABOVE IS CORRECT,AND AGREE TO COMPLY - WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. - I HEREBY CERTIFY THAT 1 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 .AND INTEND TO RESIDE IN,THE ESCRIBED RESI L ERrr. UTILITY CO. NOTIFIED SIGNATURE ' _ OF PERMITTEE FINAL -1 ' VALIDATION ROBERT A. WOOD M O CASH SUPERVISING MECHANICAL ENG'R LA(�3 8 8 4% SEP 4 , 5 •D 8_50- Q 76 A CE 817 8/68 n APPLICATION FOR PLUMBINeP& COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FNEAREST BUILDING AND SAFETY DIVISION 4847 Ha11oWe11. JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING Temple City FOR APPLICANT TO FILL IN (PR NT OR TYPE) . NUMBER FIXTURE OR ITEM EACH FEE OWNER WilliamHadley WATER CLOSET 1.50 MAIL BATH TUB 1.50 ADDRESS D 818 E. Camino Real SHOWER 1.50 CITY ETcadia TEL. NO. 446-4920 LAVATORY 1.50 CONTRACTOR Dalen Bros. Plumbing, Inc. SINK 1.50 K 0 ADDRESS 4265 No. Baldwin Ave. DISHWASHER 1.50 Q CITY El Monte Y17-31' TEL. NO. 443-0078 CLOTHES WASHER 1.50 STATE `231 741 LIC C 36 LICENSE NO. CLASS SWSMb1ING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE I PROCIES.SED.2Y a I.AWN.SPRINKLER SYSTEM 2.00 moi-co WATER HEATER 1.50 INDUSTRIAL Zo WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD v W OUTLETS OVER h 30 ci) 5 PER SYSTEM � Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING F'EE S 2 00 TOTAL FEE ST APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING — Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDE NTIA OPE RTU. FINAL �.. SIGNATURE JACK R. ALLEN, SUPERVISIOHANICALPERMITTEEOF EPERMIT VALIDATIONM.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH J'A�nI 6 a.'6�.- >i G 2 6 - 5" o 6.5 0 WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ebY affirm that I hive a certificote,r,f consent to self 76A667A suce,'or a certificate 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 Ng. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING EJ Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITP—� WATER CLOSET ry►' ,As Date Applicant �/^ " NEAREST , CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNE(-=��> (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) j LAVATORY ADDRESS ® . I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Com a Laws. DISHWASHER �- CONTRACTOR VV D ^ L _Npp �_ CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of you subject, Exem tionshould become suect to the Workers' SWIMMING POOL RECEPTOR P Y I CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS v, f (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER 5Jt and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL�� VALI ATION DATE CL' License Number Lic. Class Q FINAL Contractor Date BY ❑ I am exempt under Sec. 0 U B.&P.C. for this reason LU Plan check fee ® N, Date: Y� PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE U Plan check applicant SINGLE FAMILY 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 6:.8 A Profe ins Code): City Tel. No. •#,o,o,o 01 o'5 LJ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® it o o405;0 7044, Business and Professions Code). o a o 4.0,'6'0 5 CONSTRUCTION LENDINGAGENCY O 2 O=81 1 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 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-me�P'operlction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE gnatureDate