HomeMy Public PortalAbout10109 LANDSEER ST_Plumbing__ 76A667 (1E-817)-8-71• `
«- APPLICATION FOR PLUMBINGPERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION' BUILDING
ADDRESS /
LOCALITY
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
�
NUMBER FIXTURE OR ITEM @ FEE CROSS ST.
OWNER my
WATER CLOSET 1.75MAIL '
BATH TUB 1'75 ADDRESS 1,ell r ;
SHOWER 1 75 CITY TEL.
LAVATORY 1 75 CONTRACTOR
SINK 1 75 ADDRESS 0 6 J
DISHWASHER 1 75 ZT
CITY �7r�� TEL NO. y Q
CLOTHES WASHER 1 75 STATE LIC
SWIMMING POOL RECEPTOR 1 75 LICENSE NO. �/ CLASS
DISC/VB d CT fy�! G$6t7P PVr FL
LAWN SPRINKLER SYSTEM 1,75 WATER HEATER 1 75 INDUSTRIAL
WASTE APPROVAL G
GAS SYSTEM OUTLETS 1 75 INSPECTION RECORD tD
OUTLETS OVER 30 Z
5 PER SYSTEM
W
0.
V1
z
Plan check fee See reverse.
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE 7
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO. GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING, GAS TEST ' A XV
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DES CRIB RES]; L PR PE TY. FINAL
SIGNATURE E •
OF PERMITTEE - _
PERMIT VALIDATION CK. M.O CASH
PLAN CHECK VALIDATION CK., M.O. CASH
C
76A607-CE817 10-60
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 1010 3 Iandseer
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY Temple City
FOR APPLICANT TO FILL IN CROSS ST .
NUMBER FIXTURE OR ITEM OWNER
J B vdeber Construction Co
WATER CLOSET MAIL
ADDRESS
BATH TUB
CITY TEL. NO.
SHOWER CONTRACTOR Valley rlubing Co.
LAVATORY ADDRESS 442 W. Fleetwood P1 .
SINE
DISHWASHER CITY Glendora TEL. No. Ed 5-12CONTRACTORS STATE ❑
LAUNDRY TUB REGISTRATION NO.160847 COUNTY ❑
1. CLOTHES WASHER DIISS''TPICT O. I GROUP- ZONE PR/9/; EESD BY
1 WATER HEATER /
1 GAS SYSTEM INDUSTRIAL
WASTE APPROVAL �.
INSPECION RECORD D'
- O
u
x
O
a
Z
ra $1.00 PER ITEM
10 OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER WORK
TOTAL FEE 12 00 ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST _
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PRO RTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITT FINAL
RLMATION ROBERT A. WOOD
CK.. M.0. CASH SUPERVISING MECHANICAL ENG'R
l
WORKERS'COMPENSATION DECLARATION 76A667A
I hereby affirm that I have a certificate of conset(t to self Ce i17 (2-60)' APPLICATION FOR P L U:M B I N G:. PERMIT {�
insure, or a certificate of Workers'Compensation Insurance,or J
a certified copy thereof(Sec. 3800,Lab. C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
lADDRESSD/o
Certified copy is filedwith t co t ding inspection NUMBER FIXTURE OR ITEM • FEE
fle a me
LOCALITY
WATER CLOSET
Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE
O WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
MAIL }
(This section need not be completed -if the work involved I LAVATORY` ADDRESS
by the permit is for one hundred'dollazs ($100) or less.) SINK CITY EL. NO. � 7 U
T
I certify that in the performance of the work for which this DISHWASHER
-permit is issued, I shall not employ any person in any manner CONTRACTOR O
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER,
ADDRESS U
Date Applicant SWIMMING POOL RECEPTOR d
NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL. NO. U)
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. z
Compensation provisions of the Labor Code, you must forth-. LICENSE NO. CLASS'
with comply with. such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER Q
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- Q� /' FINAL
ness and Professions Code, and my license is in full force and �4 „ ' `�� �GKT DATE �-/ �Z VALIDATION
effect.
FINAL
License Number Lia Class BY a
Contractor Date
.I am exempt from the licensing requirements as I am a Plan check fee '
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.No. Date Plan check applicant
Name 4 9 Q,a;R
HOME OWNER-BUILDER DECLARATION �G �i9y � � V
I hereby affirm that 1,am exempt from the Contractor's Address �O/p ,Lj�,clJ> � �T. - 4 •
'# o o;o'o 0,5
License Law for the following reascn (Section 7031.5, Busi- City �L� / T.I. No. ���5 `
ness and Professions Code): 2-'- c' l 25.0
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project' o C 0.1 2.5 0 t5.�
(Section 7044, Business and Professions Code).
01. 1 2' 8 2
CONSTRUCTION LENDING AGENCY -
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is
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
authorize re entatives of this County to enter upon the
above- t�pert o i pection purposes. '
ature of Perinittee ate