HomeMy Public PortalAbout5011 HELEO AVE_Plumbing__ 76A667 (CE-817) - 5/73
APPLICATI NFO ' PLUMBI G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT.OF_COUNTY ENGINEER Ael
BUILDING AND SAFETY DIVISION BUILDING
nlnhe cHscKs PnrncBcs TO: ADDRESS 5011 Heleo Ave.
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Temple i y
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM @ FEE
WATER CLOSET 1,75 V OWNER John Marshall
BATH TUB 1.75 ADDRESS 592 Temple City Blvd.
Temple City .46
SHOWER 1,75 �� CITY TEL. NO,
LAVATORY 1,75 .� CONTRACTOR 5� • Owen Bros. Plumbin Inc.
SINK 1.75 ADDRESS 4265 N Baldwin Ave.
DISHWASHER 1.75 CITY El Monte TEL. NO. _00 8
CLOTHES WASHER 1.75 7� STATtNO.
'237 741 LIC C 6�
LICECLASS 3 20
SWIMMING POOL RECEPTOR 1,75
DfiROUP ONE CESSED BY
LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1.75 I INDUWASTL y
a
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD U
OUTLETS OVER ,30 � [r
5 PER SYSTEM
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Plan check fee See Reve,se
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE a
APPROVALS DATE PcEC{TDR's sIGNAruRE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING ey��✓
City Tel. NO. GAS VENT
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE CTHATOUNTY
THE DINAE IS CORRECT AND AGREE E COMPLY PLUMBING FIXTURES
[RESIDE
ITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING / , ^7 /
L UMBING. GAS TEST
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
CENSED AS REDOI REO BY LOS ANGELES COUNTY AND STATE OF
ALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
IN TL
D RI D RESIDENTIAL PROPERTY. FINAL
SIGNATU OF PER
PERMIT VALIDATIONcK. M.O. CASH
PLAN CHECK VALIDATION CK. M.D. CASH
7 6 4�JUL 30 5 0 _2 2_,5 5 .
WORKERS'COMPENSATION DECLARATION 76N667N ^
I hereby affirm that I have a certificate of consent to self CEa1r (1-,0) APPLICATION FOR PLUMBING PERMIT SUI
insure, oi4a certifirgte of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800.Lab. C.) COUNTY OF LOS ANGELES �� f BUILDING AND SAFETY
Policy No. y
Compan
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
ADDRESS O e-v
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM • FEE
department. LOCALITY
WATER CLOSET
Date Applicant NEAREST ��yt
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER N/ FtN 1006 �n—
(This section need not be completed if the work involved LAVATORY MAIL J'y� / Y
ADDRESS C
by the permit is for one hundred dollars ($100) or less.) O
SINK CITY . / Gli f' TEL. NO.
I certify that in the performance of the work for which this DISHWASHERI
permit is issued, I shall not empl any person in any manner CONTRACTOR v J f >?S O
so as to become subject to the or ars' Col nsa[ion Laws. CLOTHES WASHER / �
Date S' 2—Applicant ADDRESS )/ L` a
SWIMMING POOL RECEPTOR r^
NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO,2�O„J y N
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE Qq n !� LIC. Z
Compensation provisions of the Labor Code, you must forth- LICENSE NO. J / J ? / (� CLAS —1
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS D/IS -T�NO. BE V
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL 7
ness and Professions Cade, and my license is in full farce and DATE S_G q^a2 VALIDATION
effect. ��
License Number JC_.� Lie.Class FINAL !BY OJ
Contractor Date
ElI am exempt from the licensing requirements as I am a Plan Check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lie.or Reg. No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I 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):
1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project :9 4 O.b 8 A
(Section 7044, Business and Professions Code).
. # ° o o e e .5
CONSTRUCTION LENDING AGENCY
I herehv affirm that there is a construction lending agency 2 ° ° 1250
for the performance of the work for which this permit is
issued (Sec. 3097,Civ.C.). ° ° ° ) 2 Jr O,c=a
Lender's Name
0520-82
Lender's Address
1 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,ar.0 State laws regulating Plumbing, and hereby
authoriz rep esentatives of this County to enter upon the
above- entio ed pr arty for inspection purposes.
Signature o Permittee Date