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HomeMy Public PortalAbout6145 HART AVE_Plumbing__ CE..B t 7 ©5 r r-,`��. �t,�pyyaa pt1I pryt,��e I� I�eG�71 EI A Il H®N R P'LU pn`��'' � LLII CI G P Lis 11 011V11 OT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE). BUILDING ADDRESS 6145 North- Hart NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple City WATER CCOSET NEAREST BATH TUB CROSS ST. SHOWER " OWNER W. A. S4nd'6rsnn LAVATORY MAIL 6145 N. Hart ADDRESS. O SINK. CITY T.em le Cit. TEL.NO.` `285-41 - 6 DISHWASHER CONTRACTOR Br yant Heat - P, AC CLOTHES WASHER ADDRESS 135b E. Las Tunas Dr. SWIMMING POOL RECEPTOR . CITY San Gabriel TEL.NO. 286-1141 LAWN SPRINKLER SYSTEM ?STATE LIC. q WATER HEATER LICENSE NO. 22175,11 C ASS 1 GAS SYSTEM OUTLETS 3 OO APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH.PLUMBING GAS PIPING GAS VENT d @3 HOT WATER HEATER PLUMBING FIXTURES ' GAS TEST" Plan check fee uTlurY co.NOTIFIED PLUMBING PERMIT ISSUING FEE$ e TOTAL FEE QO FINAL' Plan check applicant FLAN'CHECK VALIDATION Name <' Address 1 70,5A CityTel, No. . # o '0 0 0 0 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE _ THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES y AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 0 O i 000 1 HEREBY CERTIFY THAT I AM PROPERLY.REGISTERED AND/OR LICENSED AS - 0 O O 1 0,00 :S - REQUIRED BY LOS A ES CO Y AND,'SOF CALIFORNIA OR THAT.I AM THE I LEGAL OWNER OF, ND J TO ESI E IN E ABOVE DESCRIBED_RESIDENTIAL tp� Q PROPERTY, J // 0 a 1 4—8 a SIGNATURE f OF PERMIT SEE DI y TRICTNO. ' PROCESSED BY INDUSTRIAL WASTE APPROVAL 76A667-CE817 12/59 TE NTPLE CITY COUNTY OF LOS ANGELES ry DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY ]DIVISION sUILI SS JOHN A. LAMBIEe COUNTY NGINEER ADDRESS WILLIAM A JENSEN SUPT OF BUILDING _.._ LOCALITY _ FOR APPLICANT TO FILL IN CROSS ST . NUMBER FIXTURE OR ITEM OWNER _ s WATER CLOSET MAIL ADDRESS BATH TUB CITY TEL. NO. s SHOWER LAVATORY F ONTRACTOR P SINB DDRESSDISHWASHER ITY TEL. NO. ONT TO 'Sj STATE LAUNDRY TUB REGISTRATION NO. �,� � COUNTY ❑ 1 CLOTHES WASHER DISTRICT No. �I GROUP I ZONE P CESSED BY� 2 WATER HEATER ; GAS SYSTEM INDUSTRIAL / WASTE APPROVAL / INSPECTION_/RECORDf;:4-- 0 -iI1 �...,._ U $1.00 PER ITEM - i:. �5 OR FIXTURE - $ V APPROVALS s� j6AT�E� INSPECTD�2-S,SI.GNAATURE PERMIT $ 2 00 UNDER SLAB WORK /17�,�J�iot//fJlt- G TOTAL FEE ROUGH PLUMBING WI-7,-,;t'/( // 7WI-7,-,;t;'A///�') A GAS PIPINGV 0I AL HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - AND STATE THAT THE ABOVE IS'CORRECL AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER ii I HEREBY CER I2THATAM PROPERLY REGISTERED AND/OR , PLUMBING FIXTURESLICENSED AS�REQUS ANGELES CO NT AND STAGAS TESTCALIFORNIA R THHE LEGAL/ OF T BOVEDESCRIBED R IDERTY. r: UTILITY CO.NOTIFIED f >`. SIGNATURE X OF PERMITTE _�+ sale_ .. ...:,„,r;, FINAL /! �f U !9" OF / VALIDATION ROBERT A. 60D, " cK. M.0. CASH SUPERVISAG•MECHANICAL ENG'R /a �} 73 !`'i ii �_ J ( 10.00 to c?. RS'COMPENSATION DECLARATION 76 A667A I h rm that I have a certificate of consent to self CE en (z-so) APPLICATION ®� PLUMBING - insur .o o G tificateof Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) Policy NoT�?f' COU LOS AiUGELES �-LD1NG AND SAFETY `'S. rAg93'Company West AmPricnn Certified copy is hereby furnished. F.OR APPLICAN FILL-IN (P T OR TYPE) LDI ' DDRESS Certified copy..is filed with the county building inspection NUMBER FIXTURE OR ITEM.' O FEE 3fX department. LOCALITY. WATER CLOSET Date— Applicant G2orge Hu=hrevs .INEAREST Universal Plumbin BATH TUB CROSS ST. CERTIFICATE OF EXEVfJ'tw1 Y(D"i}hSHOWER OWNER COMPENSATION INSURANCE Snndprq LAVATORY MAI L (This section need not be completed if the work involved ADDRESSr9145 N U;; �. by the permit'is for one hundred-dollars,($100) or less.) SINKw O CITY TEL. NO. citI certify that in the performance of the work for which this DISHWASHER V' permit is`issued, I shall not employ any person in any manner CONTRALTO �. so as to become subject to the Workers' Compensation.Laws:, CLOTHES WASHER0 ADDRESS ' Date ApplicantSWIMMING POOL RECEPTOR V NOTICE TO APPLICANT: If, after making'this'Certificate of CITY TEL NO. a Exemption, you should become subject to the Workers' -LAWN SPRINKLER SYSTEM STATE LLC. a- Compensation provisions of the Labor Code, you must forth- LICENSE NO. CL S•-'_�,i _ with comply with such provisions or this permit shall be WATER HEATER deemed revoked: GAS SYSTEM OUTLETS. ') DISDISTRIC�"NO. ;j1R1O ESSED-BY .LICENSED CONTRACTORS DECLARATION OUTLETS OVER' Qf/ ? I hereby'affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section'7000)of'Division 3 of the Busi- FINAL . .VAI in QN ness and Professions,Cod6, and my license is in full force and DATE , effect. FINAL License Number 386678 Lic.Class �+,cC� _ �eorge 'Humphreys, InC P ontraYtor Date�7 "29 80 . pp ''''��,11'',,� U�'.gYa .e9X�'ft441iig licensing requirements as I am a Plan check fee. licensed architect or a registered professional engineer" PLUMBING PERMIT ISSUING FEE$.• �j(`J acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE, 2 ,`,� --•� r Lic.or ``7 Reg.No. Jj J� �' C' ` Date / — Plan check applicant HOME OWNERKI DER DECLARATION Name I hereby affirm that I am exempt from the Contractor's /address L. 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 with licensed contractors to construct the. project s . (Section 7044, Business and Professions Code). 1.4 9, 1 A CONSTRUCTION LENDING AGENCY # ° ° ° °r° 5 I hereby affirm that.there is a construction lending agency for the performance of the .work for which this permit is 2'o o I a 0 0 issued(Sec.3097,Civ.'C.). Lender's Name 0 0 0 O Q 0 1 Lender's Address 8 Olt —8 Q I certify that I have read this application and state that the above information is.correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the abov`-mentioned propertv for inspection purposes. ignature oj�,Frernfitfee D to