HomeMy Public PortalAbout9143 LA ROSA DR_Plumbing__ 76A667-CE-817 6-65 '
CITY OF TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
JOHN A. LAMBIE, COUNTY ENGINEER 9143 La Rosa Dr.
COLEMAN W. JENKINS. SUPT OF BUILDING Temple City
FOR APPLICANT TO FILL IN Encinita
NUMBER FIXTURE OR ITEM EACH FEE OWNER E.0T.Rockenbach & Son/Gnl-Cont
WATER CLOSET fUtUre $1.25 6j.25 MAIL
BATH TUB 1.25 ADDRESS 10128E R '
CITY So.ElMonte TEL. NO. GI 455
SHOWER 1'u CONTRACTORAero Flumbing Co.
LAVATORY _ 1.95 6
-25
1 SINK 1.25 1.05 ADDRESS 2 IIT Durfee
DISHWASHER 1.25 CITY El Monte- TEL. NO. GI 2.600
LAUNDRY TUB 1.25 STATE LIC
LICENSE NO 2384.85 CLASS C 36
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY
1 WATER HEATER 1.50 of r
AL
GAS SYSTEM 5 OUTLETS 0
1.50 WASTE APPROVAL �
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
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W
D.
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APPROVALS DATE INSPECTORjS SIGNATURE
UNDER SLAB WORK w � ��_.si°'f/RISS-N. -_
PERMIT $ 2 00
ROUGH PLUMBING
TOTAL FEE Xd25 GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY i
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES / A 0
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST //J
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO / �� //?�,
RESIDE IN,THE ABOVE DEC RIBED RESIDE T'r P PE RT�Y. UTILITY CO. NOTIFIED 71 /y
SIGNATURE
OF PERMITTEE FINAL
LIDATION
CK M O CASH
LAUo 8 1 3 8:a APR 2.0 5 D 2 025—
a
WORKERS'COMPENSATION DECLARATION } 7 8f7 f ) APPLICATION FOR -PLUMBING PERMIT .
h�rea cE'by affirm that I have certificate of consent to self ev z-eo
insure, or a certificate of Workers'Compensation Insurance,or ;
27YN�
d copy thereo Sec. 3800, -��.
� � •. , COUNTY OF ANGELES BUILDING AND SAFETY,
PCompany J
Certified copy is hereby furnished. / / OR APPLICANT TO FILL IN (PRINT TYPE) B IN
KESS
Certified copy is filed with the county building inspection
NUMBER FIXTURE OR ITEM •. FEE
department., LOCALIT
de
p . WATER CLOSET
Date Applicant NEAREST
BATH TUB. CROSS ST. CR-
CERTIFICATE•OF EXEMPTION-FROM WORKERS'-
COMPENSATION INSURANCE SHOWER OWNER Nt
LAVATORY MAIL
(This section need not be completed if the work-,involved ' 4oDREss g
by the permit is for one hundred dollars ($100)'or less.)' SINK CITEL. NOI
Y /Vj T .
I certify that in-the performance of the work for which this DISHWASHER, CONTRALTO
�c� �/'O O
permit•is issued, I shall not employ any person in any manner !(J C.
'so as to become subject to the Workers' Compensation Laws, CLOTHES WASHER
ADDRESS �U�J IU
Date Applicant SWIMMING POOL RECEPTOR
NOTICE TO APPLICANT'•If, after making this Certificate of CITY �Gy l� TEL. NOto
Exemption,., you should become. subject to 'the Workers' LAWN SPRINKLERSYSTEM Z
P J STATE LIC... �f /�2
-Compensation provisions of the Labor Code, you must forth- LICENSE NO CLAS (� "425
with comply with such provisions or this permit shall be WATER HEATER
deemed'revoked. GAS SYSTEM OUTLETS D/IfST�RICT NO. R ESSED BY
LICENSED CONTRACTORS'DECLARATION OUTLETS OVER t�tO� mac/
I herebyaffirm that I am:* licensed under provisions of Chapter 5 PER•SYSTEM
'9 •(commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license,is in full force•and DATE ���•✓ �
effect. FINAL y�
zLicense Numb Lie.ClaassssC% v BY �1
Contractor Dateell
I,am exempt,from the licensing requirements,as I am a Plan'check fee
licensed architect or a registered professional•engineerl`
acting'in my professional capacity (Section 7051, Bus- PLUMBING PERMIT ISSUING FEE$
iness and Professions Code). TOTAL FEE ,-
Lie.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name' InAon � _f_qAGy' C
I hereby affirm that,I am exempt from the Contractor's Addres
License Law for the following reason (Section 7031.5, Busi-. City Tel.No.
ness and Professions Code):
I, as owner of the property, am exclusively contracting
with licensed contractors 'to construct the project
(Section 7044, Business and Professions Code). 1804A:
' . ' � - •• •• '
CONSTRUCTION LENDING AGENCY # o,o o`o o rj =
1 hereby affirm that there is a construction..lending agency 1 O 0 O
for the performance of the work for which this permit is
issued Sec. 3097,-Civ.C. x
Lender's Name ).
0 0 0 1.0.Q b,
Lender's Address a 1 .
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
r e representatives' of this County to enter upon the
,
,ab ve-te- entioned-p o for inspection pur oses.
Si nature of Permittee Date