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Home My Public Portal About10212 LA ROSA DR_Plumbing__ M A 667—CE 817 468 o ,. i APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS JOHN A. LAMBIE, COUNTY ENGINEER ICA COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1.50MAIL �) BATH TUB 1.50 ADDRESS !/ SHOWER 1.50 CITY L. NOLAVATORY 1.50 CONTRACTORSINK 1.50 / D ADDRES DISHWASHER 1.50 CITY ell TEL. NOCLOTHES WASHER 1.50 STATE LIC LICENSE NO. Z�� CLA SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP ZONE PRO BV LAWN SPRINKLER SYSTEM 2.00 7� ell CL O WATER HEATER 1.50 INDUSTRIAL V WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD O OUTLETS OVER 5 PER SYSTEM .30 r) w N Z Plan check fee 2554 of above. See reverse. PLUMBING PERMIT ISSUING FP]E $ 2 00 TOTAL. FEE 0 APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING - GAS VENT EH}. Lel. NO. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RE910E INTXE/J BOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL b G SI BRIM J _ � JACK R. ALLEN, suP RvI51NG CH ANICAL EN G'R. O PERMITTEE PERMIT VALIDATION cK. M.O. CASH, PLAN CHECK VALIDATION CK- M.0. CASH (yffl 3 5 3 9 ` M' 29 5 D 3.50 T4-68 a 1�7 f1 APPLICATION FOR PLUMBI G PER COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BVILDING BUILDING AND SAFETY DIVISION ADDRESS C JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS, SUPT. OF BUILDING LOCALITY I FOR APPLICANT TO FILL IN PR NT OR TYPE) NEAREST L. CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER / WATER CLOSET L50 l MAIL BATHTUB 1.50 ADDRESS SHOWER 1.50 CITY �. ,�� TEL. NO. 3 LAVATORY 1.50 CONTRACTOR �j O SINK 1.50 ADDRESS DISHWASHER 1.50 CITY TEL. NO. �L12, CLOTHE S WASHER 1.50 STATE LIC LICENSE NO. �� CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO GRO P ZO E P O BY LAWN SPRINKLER SYSTEM 2.00 O 1 O WATER HEATER 1.50 INDUSTRIAL V WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD 0 OUTLETS OVER / '� 0 _LPER SYSTEM .30 W d N Z ¢ qtc Plan check fee 25i� of shove. See reverse. 70 111- PLUMBING PERMIT ISSUING FEE S 2 00 ' 7 To TAL FEE. - APPROVALS' DATE I PECTOR S IGNAiu RE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES _ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST 1 PLUMBING. C' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR UTILITY CO. NOTIFIED .L LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANO STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF.AND INTEND TO RESIDE IN. THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL L� AN SIGNATURE CCC/Q JACK R. ALLEN, suPERVISING CH ANICAL ENG-R. OF PERMITTEE PERMIT VALIDATION CK. M.D. CASH. PLAN CHECK VALIDATION CK. M.D. CASH 3 5. 6 3F' FEB 2 5 0 3.5 0 Q 76A667-CE817-8-58 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTLDWISION EER BUILDING AND SAFETY JAC] DaDD7G L R St.CICHNBSA DD. GAIFFIERi, SPIy. 4 DBMS - 10212 E. a Rosa s cAL17Y Temple Gity FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE ORITEM OWNER Jack C. Hill - WATER CLOSET ADDRESS 10212 E. La Rosa St. , HATH TUB SHOWER ang Tom le City TEL. NO. LAVATORY CONTRACTOR.Anthony Bros. , Ihc. .. SwK ADDRESS 5871 Firestone Blvd .v DISHWASHER CITY South Gate TEL. No.SP-32210 CONTRACTOR'S 17O13 SO-)3 STATE LAUNDRY TUB REGISTRATION COUNTY EI CLOTHES WASHER DISTRICT GROUP Z(gINE OCESS BY WATER HEATER �T' GAS SYSTEM INDUSTRIAL _ WASTE APPROVAL INSPECTION RECORD Fresh water piping o swim pool APPROVALS @ $1.00 PER ITEM 1 DATE INSPECTOR'S SIGNATURE OR FDITURE If UNDER SLAB WORK PERMIT $ Z OO ROUGH PLUMBING TOTAL FEE 1-3100 GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT ' AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT 1 AM PROPER REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELE COUNTY ANO STATE OF CALIFORNIA OR THAT 1 M THE LEG OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDE j1T1A PROPERTY SIGNATURE / /� FINAL ' OF PERMITTEE„ ®P - VALIDATION ROSERTA.WOOD. SUPERVISING MECHANICAL ENG'R CK. Y.0. CASH LACO 6 2 6 6v; *y 13 5 A 3.0p�0 M WORKER'S haveacCOMPENSATION atiIfcDECLARATION tto 26°°66 DPW'fe9 APPLICATION FOR PLUMBING PERMIT I.h eby affirm that I have a cyrtif cele of consent to salt insure, or'a r,`lrtificate of Worker's Compensation Insurance, or a certified . copy thereof(Sec.3800 Lab. C.) - - - COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS , DEPT.,OF PUBLIC WORKS DIV. Policy No. Company - - - .. ❑ Certified copy is hereby furnished. T. ❑ - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ^ e Certified copy is filed with the county building inspection ADDRESS i- department. - 1. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date Applicant 2 WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM.WORKERS' CROSS ST. ...COMPENSATION INSURANCE 2 BATH TUB ASSESSOR : _ (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL r permit is far one hundred dollars($100)or less.) - OWNER `�. I certify that in the performance of the work for which this permit LAVATORY -- ,� 1CY .Y AtA is issued, I shall.not employ any person in any manner so as to SINKMAIL become subject to the Workers' Compensation Laws. - ADDRESS DISWASHER CITY Ale TEL OW , O.O Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of - CONTRACTOR ' 1 Exemption, you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS 1A� provisions of the Labor Code, you must forthwith comply with such U provisions or this permit shall be deemed revoked. 1 LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION - n CITU TEL.NO. •>_ IL I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER tJ (commencing with Section 7000) of Division 3 of the Business and STATE LIC. 0 Professions Code,and my license is in full force and effect. Z GAS SYSTEM OUTLETS LICENSE NO. CLASS V OUTLETS OVER DISTRICT NO, PROCESSED BY CC' 5 PER SYSTEM rad' YJt� �J Q License Number Liu Class LAG U DATE O FIN"L 1-a 7-0� ( VALIDATION Wa Contractor Date (n ❑ I am exempt under Sec. 00 BY AL�Q M��/y� ? B.&P.C.for this reason (� Date: Plan check fee - - � Signature PLUMBING PERMIT ISSUING FEE$ /3 ❑ TOTAL FEE SINGLE FAMILY Plan check applicant ' HOMEOWNER-BUILDER DECLARATION Name - A,._I .T 1 hereby affirm that I am exempt-from the Contractor's License Lew for the following reason (Section 7031.5, Business and Professions Address Cade): _ City Tel. No. - L iErtl - I, as owner cif the property,will do the woik and the structure q�4: is not intended or offered for sale (Section 7044, Business - _ TOTAL f O AL SE a 00 and Professions Code). - CHECK CONSTRUCTION LENDING AGENCY - CHANGE .UIJ 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.) p�IClir-pUit1 iDl?iVYa Lender's Name 6=1811 1 AN 11:40 Lender's Address , ,I certify that I have read this application and stale that the above - -• - - -- Pol.information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing,-and,he(eby_authorize �- representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE41FOR EXPLANATORY LANGUAGE