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Home My Public Portal About10656 KEY WEST ST_Plumbing__ COUNTY of LOS ANGELES APPLICATION FOR PERMIT Department OF of County Engineer DIVISION OF BUILDING &..;STA�FETY WILLIAM J. FOX, County Engln4yj DISTRICT NO. GROUPPERMIT- .FOR APPLICANT TO FILL IN 'r— �_ 14-4 2'rxs-1 PLUMBER VALLEY BOULEVARD PLUM RE EIVED BY READY FOR - DATE ISSUED FIRST INSPECTION ADDRESS 8300 EAST VALLEY BLVD. 1-- -7 n BUILDI�1�I1O r/ CITY ROSEtJIEAD TEL. No. AT. 2-27,19 ADDRE$8 COONTY E NO. """'� EXPIRES 6'3O- LOCALITY NEAREST PERMIT FEES CROSS ST. c NUMBER TYPE OF FIXTURE CR ITEM FEE OWNER T MAIL WATER CLOSET(TOILE') (aO.5 S _ V ADDRESS BATH TUB 0 0.So, CITY TEL. No. SHOWER (a 0.5.0 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) C� O. O -® APPLICATION AND STATE THAT THE ABOVE-IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 13.40 AND STATE LAWS REGULATING PLUMBING. �{ I CERTIFY THAT I ,POSSESS THE ABOVE VALID LOS O LAUNDRY TUB OR TRAY O. O ANGELES COUNTY LICENSE, OR I AM THE LEGAL GWNER GAS SYSTEM OUTLETS O. O -� OF THE REBIDENTIA PROPERTY DESCRIBED BOVE. �{ SIGNATURE OF L WATER HEATER D. O �/� PERMITTE r SLOP SINK G. D INSPECTION RECORD FLOOR SINK O. O FLOOR DRAIN 0.10 DISHWASHER O SO DRINKING FOUWrAIN 49 O SO URINAL 40 O 50 -J Q HOUSE SEWER a .SO Z MISCELLANEOUS 0 APPROVALS DATE INSPECTOR'S NAM ROUGH PLUMBING -GAS PIPING GAS VENTor CESSPOOL 1.013 CESSPOOL SEPTIC TANK: SEPTIC TANK rr +4 1 I 1) DRAIN ( ) PIT ( ) 0 1.00 SEWER PERMIT 1.00 GAS TEST A TOTAL FEE $ O UTILITY CO. NOTIFIED Ell /I �4_AV NXFINAL 1V 78A667 DBS##17 6-52 V WORKERS.COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereb a 20-0026 DPW 4/90 yt effi�in that I have a certificate of consent to self m- 76A667A sure,'or a•cerTificatea of Workers'Compensation Insurance,or a n certified copy thereof (Sec. 3800, Lab. C. _ U . COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �- Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Si E Date Applicant WATER CLOSET.(TOILET)-. NEAREST, CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. xLQjV�� Vim'• COMPENSATION INSURANCE SHOWER OWNER ) 15 1 C,4,ro& / (This section need not be completed if the work involved by MAIL / vv the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK CITYG�(j' TEL. NO.yy3—•7 7� as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR01��j�oJN4 9-10q[ Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY 0',d, N� TEL NO"—'7,f44W#1F sation provisions of the Labor Code, you must forthwith comp- ly with such provisions or this permit shall be deemed revok- STATELIC. ed. _ WATER HEATER LICENSE NO. 2—.6-" Z CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM' OUTLETS; !v p •9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 15 PER SYSTEM FINAL VALIDATION feet. HOSE BIB DATE. License Number ;2;9 O SIC Z Lic. Class C ?4 FINAL ACCT.s O Q CC / U Contractor��,e'.p6lN�� 'VDate �'l y�(v BY �..?0.� -' Cit 43 Q 4(8 ❑ I am exempt under Sec ITEMS U B BP.0 for this reason Plan check fee TOTAL43 , Date: PLUMBING PERMIT ISSUING FEE$ 7 CHECK 43e417— Signaturey r TOTAL FEE Z�q 'fO C;HAh(GE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name l -0000-0001 4/24/96 Law for the following reason (Section 7031.5, Business and Professions Code): Address 6045 1 PM 5a30 j, as owner of the property, will do the work and the City Tel. No. " structure is not intended or offered for sale(Section 7044, Business and Professions Code) , CONSTRUCTION LENDING AGENCY I 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 'r Lender's Address I certify that I have read this application and state that the ► a,r .,,, ,'•, above information is correct I agree to comply with all County ordinances and State jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- ntioned property for pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date