HomeMy Public PortalAbout10220 LA ROSA DR_Plumbing__ APPLICATION FOR .PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS /,0-2--2
_ JOHN A. LAMBIE. COUNTY ENGINEER ,oS
COLEMAN W. JENKINS. SUP T. OF BUILDING LOCALITY-
- FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET E1.25 MAIL .
BATH TUB 1.25 ADDRESS
- SHOWER 125 CITY TEL. NO.
LAVATORY 1.15
CONTRACTOR-
LAVATORY
SINK 1.25 ADDRES A
DISHWASHER 1.25 CITY Z
STATE LIC �o
LAUNDRY TUB 1.25 LICENSE N �&e CLAS9� 3`
CLOTHES WASHER 1.25 DISTRICT NO. GROUP e20NE OCESSjSE. BV
WATER 1.50 ,O r R>' _ -C!4
GAS SYSTE OUTLETS 1.50 INDUSTRIAL U-
WASTE APPROVAL -
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD C
O
U
W
a
h
Z
APPROVALS DATE INSPECTORS SIGNATURE
21T. 5, 5 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TFEEQGAS PIPING
IHEREBY.ACKNOWLEDGE THVE READ TH15 APPLICATION GAS VENT
AND STATE THAT THE ABOVE CT ANO AGREE TO COMPLYWITH ALL COUNTY ORDINANSTATE LAWS REGULATINGHOT WATER HEATER
PLUMSING. -1 HEREBY CERTIFY/THAT 1 PERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LES COUNTY AND'STATE OF GAS TEST
CALIFORNIA OR THAT I AM THOWNER OF.ANO INTEND TORE51DE IN. THE ABOVE DESCRIBENTIAL PROPERTY UTILITY CO. NOTIFIED
SIGNATURE
OF PERMIT
FINAL (p Q
ALIDATION JACK R. ALLEN
o. c>sN SUPERVISING MECHANICAL ENG-R.
I ALO 4 9 8 9 JUN 7 5 D 3.50—
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76A667-CE817 12/59 TEMPLE SORTV ,
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
` BUILDING AMBIESAFETY RIVISION AUILDING
DDRESS 10220 La Rosa Dr,
JOHN A. L MBI COUNTY NGINEER
WILLIAM A. JENSEN, SUP' OF BWLDING LOCALITY Temple City
F.FOR APPLICANT TO FILL IN - NEAREST
CROSS Arden Dr
NUMBER FIXTURE OR ITEM
OWNER La Corte
1 WATER CLOSET MAIL
RATE TOB ADDRESS 10220 La Rosa Dr.
SHOWER CITY Temple City TEL NO. *IN&fd
LAVATORY CONTRACTOR Tosepb Cadilli Plbg, Co,
SINE ADDRESS 7821 E. GarveyAve.
DISHWASHER CITY S. San Gabriel TEL, NO, AT-05349
CONTRACTOR'S 134935036 STATE LX
LAUNDRY TOB REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISC/NO I GROUP Z ty E pRpLSESSED BY
WATER HEATER CC` //j C�[Y}--/��,./,(-SLA i^
GAS SYSTEM extend). WASTEDUSALPL
WASTE APPROVAL
1 / INSPECTION/AECORD 1Yh
0I Zz 1' . o f2 :tom o
^ r U
4 X1 a
_ v
k,HEREBY
® OR FIR PER
" $ 4,00
APPROVALS pp DATE INSP
E
CTOR
'S
SIGNATURE
PERMIT $ 2 00 UNDER6 B•WORK 3/IJ 42. `sfJ�X/i—`�`✓.%
TOTAL FEE 6 00 ROUGH PLUMBING 1• n�t 2
GAS PIPING l rev
BY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
LL COUNTY ORDINANCES AND STATE LAWS REGULATINGHOT WATER HEATERG.EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURESD AS REQUIRED B LOSANGELES COUNTY ANDSTATE OFGAS TEST
NIA OR THAT 1 THE LEGAL OWNE TXE ABOV ED REST DENTIA P OPERTY. UTILITY CO. NOTIFIED ..URERMITTE FINAL I IMA-1
®� VALIDATION ROBERT A WOOD..
J�cc1J
m.0. CASH SUPERVISING MECHANICAL ENG'R
LA �96886 5 D 6.00 .
ION
WORKERShat I have
a cera DECLARATION CE
APPLICATION. FOR- PLUMBING
PERMIT
I hereby affirm that p"hjr)nave a' certificate of consent to self cr: en li-eol r M _ r f� r V 171 O 1 Y V PERMIT
f[ .
insure, or a certificate of Workers'Compen)a[ion
cer4ifie p [h re 3800 S 3800.LabC. ,
l t• I� COUNTY OF LOS ANGELES BUILDING AND SAFETY _
ompanY
: Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE)
ADID RESS aD -
Certified copy is filed wit he c u ty burtding inspection - NUMBER FIXTURE OR ITEM - FEE -
e a� entt .. WATER CLOSET LOCA L I TV�i�tlVx.
ate Applicant I - V _ NEAREST
BATH TUB° CROSS ST.
..
CERTIFICATE OF EXEMPTION FROM.WORKERS' -
OWNER
COMPENSATION INSURANCE SHOWER
LAVATORY .MAIL - -
(This section need not be completed if the work involved:. - ADOR ESS }
by the permit is for one hundred dollars ($100)'or less.) SINK -
CITY t� E n•
I certifv That in the performance,of the work for.which this DISHWASHER - U
permit is Issued, I shall not employ any person 'in any manner' CONTRACT R
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER cc
ADDRESS O
Date Applicant - 1
SWIMMING POOL RECEPTOR; ' ' I U
NOTICE TO APPLICANT:If, after.making this Certificate of. - CITY y TEL N Lll
SYSTEM
L
'
J'
Exemption, .you should becomesubject to the Workers. AWN SPRINKLER -
P STATE LIC. z
Compensation provisions ofi provLabor.Code, you mustforth- LICENSE.NO. CLASS ,. Z
n
�wh. comply' with such provsions or this permit shall 6e °, WATER HEATER
deemed revoked. �- GAS SYSTEM OUTLETS . DISTRICT NO. PRO ESSED BY
LICENSED CONTRACTORS DECLARATIONOUTLETS OVER.
S' a
I herebyaffirm that Iam licensed under.provisions of Chapter 5 PER SYSTEM - - -
,9 (commencing with Section 70 00) of Division 3 of the Busi- FINAL �( VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect. • '
FINAL �I
LicenseumberLic Class - BY
Con[rac or atelalicensed
am exempt from the licensing requirements as I ama Plan check fee'architect or a registered professional engineer PLUMBING-PERMIT ISSUING'FEE$cting in my professional capacity (Section 7051 Bus- J )
mess and.Pr f s'uts e TOTAL FEE J
Lic:or Reg.No. Date .lY. U Plan check aPPlmant r ..
,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. - 4$7. A
ness and Professions'Code): - - _ - -
O1, as owner of the property, am exclusively contracting ��': �y,o a ..5'
with licensed' contractors 'to- construct /the .project -
(Section 701.44,,Business-and Professions Code). - 2re•e -3.00
CONSTRUCTION LENDING AGENCY. - - - o a 01.3;O Q czi `
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is 0 4,21 _
issued'(Sec 3097_,Civ.C.). ° -
Lender's Name'
Lender's Address - - —
'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
uthorize-,representatives of this County to enter upon the
a ve-megtion operty for inspection,purposes: 'tom-•1f. "-'.��y//
I�
itore of Pe � tee Date -