HomeMy Public PortalAbout9518 LA ROSA DR_Plumbing__ CE76667
817a56 APPLICATION. FOR PLUMBING PERMIT 1
BUILDING AND SAFETY DIVISION _
Department of,County Engineer
County of Los Angeles BUILDING 9 18 La Rosa
JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN,SUPT OF BUILDING Temple City
LOCALITY
FOR APPLICANT TO FILL IN I NEAREST
CROSS ST.
OWNER Alfred J• Saviano DISTRICT NO. GROUP ZONE READY FOWINSPECTION
MAIL 9615 E . "Garibladi �- .� I r�—/ I
ADDRESS
INDUSTRIAL
CITY Tem leClty TEL. NO. WASTEAPPROVAL f
PLUMBER Belvedere Plumbi g Co. , r INSPECTION RECORD
ADDRESS 11900 E. Garveytive. -
CITY E1 Monte TEL. NO.G1 89836
LICENSE NO. 5493
NUMBER TYPE OF'FIXTURE OR ITEM FEJE
2 WATER CLOSET (TOILET) @ $1.00 $
1 BATH TUB @ '$1.00
1 SHOWER @ $1.00
2 LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
Z WATER HEATER @ $1.00
1 GAS SYSTEM @ $1.00
1, dis e
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK t /���•pI
LREQUIRED
ERMIT S I 1 00 ROUGH PLUMBING .�/
12. 00 GAS PIPING
TOTAL FEE GAS VENT
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
L COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES l�1
G.
EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST �--- "Z
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFNIA OR THAT i AM THE LEGAL 0 NEROF HE ABOVE UTILITY CO.NOTIFIED
ED RESIDENTIA OPERTY.
URERMITTEE FINAL
ROBERT A.WOOD,'
JOHN A. LAMBIE, COUNTY ENGINEER ATION SUPERVISING WCHANICAL ENG'R
CH. M.O. CASH
,9"9t SR FEB 13 •3 A 1 2.0 0' M
,� A
WORKERS'COMPENSAfION DECLARATION20-0026 PW 4/87 APPLICATION FOR PLUMBING PERMIT
�I hereby; affirm that I have a certificate of consent-to self in- 76A667A n
sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified copy thereof (Sec. 3800, Lob. C. �� `11u11
Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Certi ' d copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE)
ertified copy is filed with the county building inspection ADDRESS �j 1
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
WATER CLOSET(TOILET) NEAREST
G' G•
CERTIFICATE OF EXEMPTION F M WORKERS' BATH TUB CROSS ST. c 4
COMPENSATION INSGRANCE SHOWER OWNER
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY, ADDRESS
I certify that in the performance of the work for which this per- SINK CITY TEL. N
mit is issued, I shall not employ any person in any manner so v
as to become subject,to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER O
ADDRES 5
NOTICE TO APPLICANT: If, after making this Certificate of Ex-
emption, you should become subject to the Workers'Compen-
sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER'SYSTEM CITY TEL. /E5
%
ly with such provisions or this permit shall be deemed revok- STATE c'� �, L1C.
ed. WATER HEATER O LICENSE NO. V rJ(J CLASS
LICENSED CONTRACTORS DECLARATIONDISTRICT NO. PROCESSED BY
I'hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS A
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �f
fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
DATE O
License Number Lic. Class V
/ BY
In
O
Contractors Date
I am exempt under Sec. LLI
IL
B.&P.C. for this reason Plan check fee �p ►
Date: — PLUMBING PERMIT ISSUING FEE$ Ov
Signature �{
TOTAL FEE J ��
SINGLE FA LY
HOME O NER-BUILDER DECLARATION Plan check applicant. s T
I hereby affirm that I am exempt from the Contractor's License Name -•r• s
Law for the following reason (Section 7031.5, Business and 1 �'
Professions Code): Addre
ElI, as owner of the property, will do,the work and the CityAl �G Tel. N . _3-
structure isnot intended or offered for sale(Section 7044, '""'i _
Business and Professions Code).
U AL 41,111, C110
CONSTRUCTION LENDING AGENCY
r.��i. .•.7 o`.I I
I hereby affirm that there is a construction lending agency for ,
the 'performance of the work for which this permit is issued ',e AlkIU"
(Sec. 3097, Civ. C.).
Lender's Name ".r4 - ' trr`� !"
–1 IPU
Lender's Address
,4`7 1
I certify that I have read this application and state that the ,
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing,'and hereby
authorize representatives of this County to enter upon the
above- e tioned property for ins ction purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
natr of P6rrr.1A46e Date