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Home My Public Portal About9509 LA ROSA DR_Plumbing__ D.B.17 SM 5WrS 4-43 APPLICATION FOR PERMIT -DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING' WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NOto ROUGH FIXTURES COMPLETE � I .1 / ®� ! READY FOR RECEIVED By DATE ISSUED HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB� NAME ADDRESS mADDR SS LOCALITY J �J NEAREST a CITY l r TEL. NOQd G3 6 CROSS 8T. COUNTY _ CERT.No. EXPIRESJ- 3/ a! NAME W LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL A 3 Z . ADDRESS L/ ` - NORTH O CITYjg4 L(// TEL.No, y I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICA r. OF QUALIFICATION. PLUMBER I AM THE LEGAL OW ER OF THER�OPERTY DESCRI ED F ABOVE. m 3 i OWNER CORRECTIONS SOUTH z DESCRIPTION OF WORK � _z BATH TUB FURNACE SHOWER DISHWASHER 0 LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP LOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET -DRINKING FOUNTAIN " / DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT i I I ' y CESSPOOL TOTAL NUMBER OF FIXTURES Ifs SEPTIC TANK I{ 4 CESSPOOI SEPTIC TANK SEWER I I 8 UTILITY CO.NOTIFIED I TOTAL FEE f M� FINAL Z "" 02 D.B.S.-17 25M SETS,6-46 APPLICATION FOR PERMIT DEPARTCENT OF UNTY OF LOS BUILDING SAFETY NGELS PLUMBING Wm. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION PISTRICT NO. GR u o E PERMIT ROUGH FIXTURES _ II COMPLETE r/ I 1 HEATER CESSPOOL I I.SEPTIC TANK RECEIVED:BY READY FOR DATE ISSUED � . FIRST INSPECTION AS- MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY C NAME ADDRESS 2 ! 7- f v/719 �U"J /1 i, ADDR • C. -NOTTINGHAM CO. LOCALITY r%'fl-Y 2--p•r' 3 Cin, 123 No. 'Clovt&1jf,.Ave. Czo REST COUNTY CERT.NoTEWLE 1GA LIR - lz NAME- LOCATION OF SEPTIC TANK,-OR CESSPOOL Z MAIL 3 ADDRESS NORTH O CITY ' -�T s TEL.No. I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE.LEGAL OWNER OF.THE PROPERTY DESCRIBED ABOVE. . R U) OWNER - i CORRECTIONS SOUTH J DESCRIPTION OF WORK z BATH TUB FURNACE _SHOWER DISHWASHER O AVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE -INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER GAS -SODA FOUNTAIN OUTL GAS PIPING I 1 GAS VENT { 1 CESSPOOLxy TOTAL NUM R OF FIXTURES - SEPTIC TANK I- j CESSPOOLL. _S\r� SEPTICTANK SEWER I I UTILITY CO.NOTIFIED TOTAL FEE Z& . 1 FINAL WORKERS'COMPENSATION DECLARATION a CE 81 w APPLICATION FOR P L U M.B I N G PERMIT I hereby- affirm that I have certificate of consent to self ce s�� I2-eo) insure, or a certificate of Wdrkers'Compensation Insurance,or a certified cdpy thereof(Sec. 3800,Lab.C.) COUNTY OF LOS ANGELES / ' BUILDING AND SAFETY Policy 1141�Company Aetna InsuranrP 3 Certified copy is hereby.furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS 9509 La -Rosa Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE department. WATER CLLOCALITY WATER-CLOSET • Date Q/14/81 Applicant Owen BroS_Plbg_ NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPE NSATION INSURANCE SHOWER OWNER MurrayLan . & D.ev. LAVATORY MAIL >_(This section need' not be completed if the work involved ADDRESS 3606 N.R i O Hondo Ave . 0- by the permit is for one hundred dollars ($100) or less.) SINK O CITY Rosemead TEL' ND' 443-15 SP I certify that in the performance of the'work for which this DISHWASHER cc permit'is issued, I shall not employ any person in any manner CONTRACTOR Owen Bros ."Plumbing O so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER F-- ADDRESS 4265 N N . Bald-win Ave . 0 Date Applicant SWIMMING POOL RECEPTOR LU NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. N _00 78 V' Exemption, Vou should become subject to the Workers' LAWN SPRINKLER SYSTEM to STATE LIC. - Z Compensation provisions of the Labor Code, you must forth- LICENSE NO. 231 741, CLASS C 3 6—20 -with comly with such provisions or this permit shall be WATER HEATER Q - deemed revoked. DISTRICT NO. PRO ESSEP BY GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION OUTLETS OVER Y-;13 , Ihereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL ,�� VALIDATION ness and Professions Code, and my license is in full force and DATE effect. License Number 23.]—,741-- 36— 0 BY AL l-- Lic.Class lflf Y Conttact&Ua Bros. ,6Dafe 9/14/R fes' ElI am exempt from the licensing requirements as I am a Plan check fee O �/ licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Buson - iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Addressr License Law for the following reason (Section 7031.5, Busi- City Tel.No. ness and Professions Code): ;9 1 2 Q 8 A I, as owner of the property, am exclusively contracting y " with licensed contractors to construct the project # o o 0 0 0 5 (Section 7044, Business and Professions Code). .2 34,00 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency "0.0,0 for the performance of the work for which this permit is issued(Sec. 3097,Civ.C.). () 9, 7-81 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 authorize representatives of this County to enter upon the bv e ned property for inspection purposes. V= 9/14/81 ignt re of Permittee Date