HomeMy Public PortalAbout9856 LEMON AVE_Plumbing__ "7 Ar07`-CE817 10-60 �1
APPLICATION FOR PLUMBIN PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING
JOHN A. AA SAFETY COUNTY DIMENGINEER ADNG
DDRESS Lemon,
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
Temple Cit
FOR APPLICANT TO FML IN CROSSNEAREST
Baldwin
NUMBER FIXTURE OR ITEM OWNER S'. (x', Evans -
2 WAM-CiOSET �
1 BATH TUB ADDRESS
CITY TEL. NO.
1 SHOWER
2 LAVATORY
CONTRACTOR Allen•Bros. Plumbin
1 SIIx ADDRESS 2 N. Baldwin Ave.
DISHWASHER
CITY El Monte' Tom• NO Gi— 37644COxTw=O 's STATE
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LAUNDRY TUB -REGISTRATION NO. 197184 COUNTY ❑
1 CLOTHES WASHER DISTRICT O. GROUP ZONE PR CESSED BY
1 WATER HEATER -6- � (a /
1 GAS SYSTEM INDUSTRIAL
WASTE APPROVAL �.
INSPECTION RECORD
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10 OR FPEIXTUIT $ 10.00
O I DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00, UNDER SLAB WORK /J
TOTAL FEE 12 00
ROUGH PLUMBING �.
GAS PIPING ry '
I HEREBY ACKNOWLEDGE-THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWN REGULATING /'n
FLU MBING: HOT WATER HEATER A
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED A9 REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST r ��q��/yam
CALIFORNIA, OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ' bi Y 11/n.� 4/
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO NOTIF D ' �� , /�
SIGNATURE .,�� I OF PERM ITTEE FINAL
VALIDATION ROBERT A. OO61
M O. CASH SUPERVISING ECHANICAL ENG'R
i�i>0 2 4� 3 7 � SEP �i 5 Cf
ORKERS'COMPENSATION DECLARATION 78A867;
I herebyaffirm that I have a certificate of consent to self ce 817 z-eoI APPLICATION FOR PLUMBING PERMIT
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insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab C)
_ COUNTY OF LOS ANGELES / � � BUILDING AND SAFETY
Policy No Company Ct 1 �� ' W V� "
❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING r,
Certified copy is filed with t my building inspection NUMBER FIXTURE OR ITEM • FEE ADDRESS tp 1 Q/V1x6Y\
�
1
Datep men LOCALITY
Applicant WATER CLOSET NEAREST
BATH TUB CROSS ST
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
pjp
(This section need not be completed if the work involved LAVATORY MAILADDRESS
by the permit is for one hundred dollars ($100) or less.)
SINK CITY TEL NO .2 a0
I certify that in the performance of the work for which this DISHWASHER V
permit is issued, I shall not•emplo any person in any manner CONTRACTOR -
so as to eco a subject to the or rs' en tion Laws CLOTHES WASHER
J / ADDRESS !ZO �, ,p+ O
Date/ ` Applicant SWIMMING POOL RECEPTOR �( w - 0
NOTICE TO APPLICANT If, after mg this Certificate of CITY I TEL NO YZ�o7 OW.
Exemption,'you should become subject to the Workers' LAWN SPRINKLER SYSTEM
co
Compensation provisions of the Labor Code, you must forth-
STATE //�� G LIC /� Z
with comply with such provisions or this "permit shall be
WATER HEATER LICENSE NO '.L �O CLASS oCO� Z
deemed revoked. GAS SYSTEM OUTLETS DISTRICT ND BY
�O.. PR CESSE
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL 2J�� r VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect
FINAL
License Number Lie Class e36 BY
ContractorDate '/
I am exempt from the licensing requirements as I am a Plan check fee I / S/
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section-7051, Bus-
men's and Professions Code). TOTAL FEE S�
ns -
Lie 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 p 2 8 3
ness and Professions Code)-
I, as owner of'the property, am exclusively contracting JS i p, r,
with licensed contractors to construct the project
tY �.;.
(Section 7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY 0 0 0 1 2 5 0 6 ®0®i,
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is •0 Z 0 jr 8 2
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 representatives of this County to enter upon the
above- -ent Xrty for inspection purposes
_::
Signature Permittee Date