HomeMy Public PortalAbout9156 LA ROSA DR_Plumbing__ 78AC67.CE0817 4-64 CITY OF EILPLE CITY
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER B
UILDING
BUILDING AND SAFETY DIVISION ADDRESS 9156 La Rosa Dr
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING CALITY Temple City
FOR APPLICANT TO FILL IN -I,- init8
NUMBER FIXTURE OR ITEM EACH FEE OWNER Comunity Disposal
WATER CLOSET $1.25 -MAIL
BATH TUB 1.25 ADDRESS 9167 La Rosa Dr.
SHOWER ' 1.25 CITY Temple City. TEL. NO. in AT 63342
5 ILAVATORY 1.45 6.25 'CONTRACTOR Aero Plumbing Co.
1 SINS 1,25 1 125 ADDRESS f N Durf,Lee
onto
DISHWASHER 1.25 CITY El Montep TEL. NO. GI 2L�6OO
STATE
LAUNDRY TUB 1.25 REGIIS RAT ON NO. 238485 C-36 COUNTY
CLOTHES WASHER 1.25 DISTRICT NO, GROU ZONE PR ESSED Y
1 WATER HEATER 1.50 1 S I C
INDUSTRIAL }
2 GAS SYSTEM OUTLETS 1.50 WASTE APPROVAL a
OUTLETS OVER 5 PER SYSTEM .$0 INSPECTION RECORD 0
G
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 20425 GAS PIPING
IH
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER '� v
PLUMBING.
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTU ES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OW R OF,AND INTEND TO GAS TEST
RESIDE IN,THE ABOVE DESC IBED RE IDE PROPERTY. UTILITY CO. NOTIFIED v
SIGNATURE ./
OF PERMITTEE
FINAL
VALIDATION ROBERT A. WOOD
cK
WO CASH SUPERVISING MECHANICAL ENG'R
LAO,l6451 APR 29 5 D 2 02 5
WORKERS'COMPENSATION DECLARATION a e Csnee7; . APPLICATION FOR PLUMBING PERMIT
I hereby affirm that 1 have certificate of consent to self ceir z-so)
insure, or a certificate of Workers'Compensation Ins6rance,or
a certified copy thereof(Sec. 38 0,Lab.C.)
W C• p�1�/ �y �!P COUNTY OF LOS ANGELES / �� BUILDING AND SAFETY
Policy No.-'/�°—Company G
❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING �s
ADDRESS /.� "
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE
de a tme t. LOCALITY
Date Applicant WATER CLOSET NEAREST
BATH TUB CROSS ST.
CERT F_ICATE OE EXEMPTION FROM WORKERS
COMPENSATION INSURANCE SHOWER OWNER
LAVATORY MAIL 67
(This section need not be completed if the work involved ADDRESS }
by the permit is for one hundred dollars ($100) or less.) v
3 ' SINK f/ 1-2 CITY TEL. NO. 0
I certify that in the performance of the work for which this DISHWASHER V
permit is issued, I shall not employ any person in any manner CONTRAOTO
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER 1 41
ADDRESS /rar
Date Applicant
SWIMMING,POOL RECEPTOR h __I
NOTICE TO APPLICANT:•If, after making this Certificate of CITY t-!� 'TEL. NO fi� �� UJ
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM Z I(
Compensation provisions of'the Labor Code, you must forth- STA E LIC. 1'
LICENSE NO.2 CLASS L' 2,01J(„ Z
WATER HEATER
with comply with such provisions or this permit shall be DISTRICT NO. PROCESSED BY
deemed revoked. GAS SYSTEM OUTLETS
LICENSED CONTRACTORS DECLARATION OUTLETS OVER V
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- � FINAL
DATE ( ry VALIDATION
ness and Professions Code, and my license is in full force and /
effect. 7>
2-tf3 ZL sC,QQ_LJto' R FINAL
License Number Lic.Clas (� G BY
Contractor Date
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer So
acting in my professional capacity (Section 7051, Bus- PLUMBING PERMIT ISSUING FEE$
inees and Professions Code). TOTAL FEE
Lic.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. 5-4 a A
ness and Professions Code):
I, as owner of the property, am exclusively contracting _ 0 0 o 5
with licensed contractors to construct the, project 2'-'°'2 4 5 0
(Section 7044, Business and•Professions Code).
CONSTRUCTION LENDING AGENCY .' -, 02.i505 -
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is 8'0.61'-8 2
issued(Sec:3097,Civ.C.).
Lender's Name
Lender's Address
I cerArt
haead this application and state that the
abovrrect.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinlaws regulating Plumbing, and hereby
authov ty to enter upon the
abov
rope
for inspection pur oses.
SA nature of Permittee ate