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Home My Public Portal About8802 HERMOSA DR_Plumbing__ O6A6APPLICATION FOR PLUMBING PERMIT 1 DBs,17(DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING gg02 E. Hermosa Dr. .JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN, SUP'T OF BUILDING LOCALITY Temple City 8802 APPLICANT TO FILL IN I RNEAREST ) , Rails CROSS ST. OWNER ails DISTRICT NO. GROUP ZONE READY EDR INSPECTTDN MAIL 1' ADDRESS V ,I ' INDUSTRIAL CITY TEL, NO. WASTE APPROVAL PLUMBER Belvedere Plumbing Co . INSPECTION RECORD ADDRESS 11900 E. Garvey Ave . y-/.S'7 WQA9Ae "X t A a,4 //u..0 -v .? CITY E1 Monte TEL. NO. GL 89836 /f L Jv G,s'r Apn ft!^ta /11 tP C LICENSE NO, 54932 II./ a>,o� ��Fn, �/ ''///�)�/ NUMBER TYPE OF FIXTURE OR ITEM FEE y--/?-j 7 y0 OAAI�/C //(///�Jf^ L.EFT�'.a A'/7/i 1 WATER CLOSET (TOILET) @ $I.00 $ 1 00 BATH TUB @ S1.00 1 00 SHOWER @ SI.00 1 LAVATORY (WASH BASIN) @ $1.00 1 00 KITCHEN SINK @ $1.00 DISHWASHER @ $1.00 LAUNDRY TUB OR TRAY @ $1.00 CLOTHES WASHER @ S1.00 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTORS SIGNATURE UNDER SLAB WORK PERMIT S 7 00 -�n ROUGH PLUMBING / s //,. 04 5,e.+->/ 7-= GAS PIPING OO TOTAL FEE 4 GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING FIXTURES PLUF PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OW"R OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTIA��IL PROPERTY. SIGNATURE OF TEE s. FINAL JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK, tl.1, CASN l( � 0 o E, F.:.AR13 3 4.0 0 ID WORKERS'COMPENSATION DECLARATION 7IA667A I hereby affirm that I have a certificate of consent to self CE 617 I=-aal APPLICATION FOR PLUMBING PERMIT insure;of a certificate of Workers'Compensation Insurance,or _ _ t . ' a certified copy thereof(Sec. 3800,Lab.C.) COUNTY OF LOS A £�ES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT T FILL IN (PRINT T PE) BUILDING ADDRESSS I y Certified Py is filed with the county building inspection NUMBER FIXTU E OR ITEM FEE department. A e 3 WATER CLOSET LOCALITY Dale Applicant t NEAREST BATH TUB CROSS ST. S C CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER . Z& r' MAIL LAVATORY (This section need not be completed if the work involved ADDRESS by the permit is for one hundred dollars ($100) or less.) - 1' SINK CITY ``�' ,+� TEL. NO 7_03 0 I certify that in the performance of the work for which this DISHWASHER //(tib 3 U permit is issued, I shall not employ any person in any manner CONTRACTOR G/ so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER2 ADDRESS O Date Applicant SWIMMING POOL RECEPTOR (~j NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO. W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. tad Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLA S Z with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS /��DISTRICT NO. P OCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that i am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL �-N c VALIDA ION ness and Professions Code, and my license is in full force and - DATE J�TI19 S effect. 1 '1\: FINALI ` '\\ License Number Lie.Class ' BY \�/�„\/ t Contractor Date _ - - I am exempt from the licensing requirements as i am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ 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): ❑ L as owner of the proper exclusively contracting with licensed �trat� to construct the project �A4(Section Business annd/Professions Code). 0 0 0 0 o j CONSTRUCTION LENDING AGENCY - I hereby affirm that there is a construction lending agency 2 0 0 3 0 0 for the performance of the work for which this permit is issued (See. 3097,Civ.C.). o e o 3 1. O C)tJ.. Lender's Name Lender's Address O a 2 5—8 0 I certify that i have read this application and state that the above information is correct. I agree to comply with all County SEF. REVERSE FOR EXPLANATORY LANGUAGE ordinances and-State laws regulating Plumbing, and hereby authorize representatives of lis Coun to enter upon the Abo - en ' ed opc ty fg(ns c poses. ]� Signature of Permittee Date