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HomeMy Public PortalAbout10536 LIVE OAK AVE_Plumbing__ 7 DBS-17' APPLICATION FOR ,PLUMBING PERMIT B6- DIVISION OF BUILDING AND SAFETY .� Deportment ofCounty Engineer County of Los Angeles ABUILDING DDRESS /® Live Oak JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D.GRIFFIN,SUP'T OF BUILDING LOCALITY Temple City FOR APPLICANT TO FILL IN NEAREST AddyCROSS ST El Mont e OWNER iv d - DISTR�r GRO P ZONE READY FOR INSPECTION MAIL I ADDRESS Live Oak ��11 CITY T©mole CitY TEL. NO HI 71079 INDUSTRIAL A TE APPROVAL PLUMBER C e S. Crain INSPECTI N RECORD—, ADDRESS 11123 Wildflower H� CITY TMMPJA r-ity TEL. NdGI 87758 LICENSE NO. 100591 d NUMBER TYPE OF FIXTURE OR ITEM FEE 1 WATER CLOSET (TOILET) @ $1.00 $ 4 /'�, ,Q /J� 1 BATH TUB @ $1.00 arm SHOWER @ $1.00 � s LAVATORY (WASH BASIN) @ $1 00 e 0 KITCHEN SINK @ $1 00 0 '7 / DISHWASHER @ $1 00 �Ll.C�e��/ L-1-2 S- LAUNDRY TUB OR TRAY @ $1 00 CLOTHES WASHER @ $1 00 11.00 i WATER HEATER @ $1 00 GAS SYSTEM @ $1 00 1 APPRdVAL•S DATE INSPECTORS/SIGNATURE UNDER SLAB WORK PERMIT $ 1 OO ROUGH PLUMBING ' S 00 GAS PIPING o TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY "'�"✓J /' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST D�3� LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF y CALIFORNIA OR THAT I AM _THE LEG L' OWNER F THE ABOVE UTILITY CO NOTIFIED A DESCRIBED RESIDENTIAL P ERTY SIGNATURE OF PERMITTEE e FINAL Tel JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG INSPECTOR CK. M.0. CASH 3287OR ,AJC. 2 g 5 A 8.0 0 C7 WORKERS' COMPENSATION DECLARATION ��®A �,� /A��®[�fl 2®Irk PLUMBING 9p II I11�G1[��Qe� fL�F2�f�{�Bg 20-0026 DPW 4/87 ll"L� Gil N FOR PLSVdf(l BI tlF1 11–L� U�11 Il I hereby, affirm that I'have'a certificate of consent to self in- 76A667A - - 1 , • sure,or a certificate of Workers'Compensation Insurance,or a 'CE 817(REV 8/86). City-"Of Temple City,- certified"copy thereof (Sec 3800, Lab C') ,_ , COUNTY OF LOS ANGELES -DEPT:-.OF PUBLIC WORKS p , Policy -No' �Company $( TF _ - . 701017194r Certifiedicopy is hereby furnished - , FOR APPLICANT TO FILL-IN(PRINT OR-TYPE) BUILDING; Ceitified'copy is filet!with'the'cour't building inspection ADDRESS ] 36 ,LiV 'A department' y,'a',' NUMBER FIXTURE OR,ITEM' Lal` ° FEE s LocaurY. Arcadia .., Date �l' A' A licant L� FI1 'ra'� InSt� WATER CLOSET(TOILET), _ �J ,/8 PP 1 NEAREST' ! BATH TUB CROSS,ST E tE A 'CERTIFICATE OF EXEMPTION'FROM WORKERS r _ COMPENSATION INSURANCE , OWNER R P ]ce A SHOWER` ' - v (This section need not be completed if the work involved by MAIL -the permit is for one•hundred dollars-($100)or,less.)+ LAVATORY, ADDRESS Same ceoifythat,iri theperformance of the work for which this per- - t mitis issued,'I shall not employ any person in dny manner so. SINK'- CITY ° g1iS47�107G3 as to become•subject to the Workers',Compensation Laws DISHWASHER „" CONTRACTOR Date - —' Applicant. CLOTHES WASHER NOTICE TO APPLICANT If, after makmg'this Certificate of Ex, ADDRESS- 65558 West Blvd. t- emphon, you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR- ' - , k sation,provisions of the Labor Code;ybu'must forthwith`comp- LAWN SPRI YSTEM ;CITY Los Angeles TEL NOS 3�� ��' ly with-such provisions or this permit shall,be deemed•revok- = STATE- LIC / ed .� ". r WATER HEATER LICENSE NO CLASS' LICENSED CONTRACTORS,DECLARATION "` DISTRICT NO PROCESSED BY I hereb'y,affirm that I amd licensed under,provisions of Chapter GAS SYSTEM ETS 9(commencing'with,Section 7000)of Division 3 of the Business OUTLETS OVER and Professions,Code,-and my license is in full force and ef- 5 PER SYSTEM 'P/ FINAL ��� feet - VALIDATION a % r DATE ,�� O License Number 151839' Lic Class C36 (� FINALS Q Contractor W^'n 'Prr►v 4_n-Date ' ° �1 la9 BY 11 O n, ,I amae,empt under-Sec 7 ` e W IL P' B &P C for this redson� t Plan che&'fee r Date ~PLUMBING PERMIT ISSUING,FEE $ 1 4 50 Signature _ TOTAL FEE Fv SINGLE FAMILY - n''. HOME OWNER-BUILDER DECLARATION Plan check applicant - I herebyaffirm.that I,am exempt from the Contractor's License Name - 0'4 4, 6A Law for the following reason (Section 7031 5, Business and Professions Code) Address `• { # o o '0 0 0 5 rI as owner of the'property, will do the work and the City Tel Noy structure isnot mtended,or offered for sale(Section 7044, V " Business'ond Professions Code) CONSTRUCTION LENDING-AGENCY r Y I hereby affirm that,there is a construction lending agency for o 's the performance of the work for which this permit is,issued Q 6 H $O , (Sec 3097, Civ•C ) Lender's Name �• Lender's Address " `I certify'that I have read this applica ion and state that the c,, above informahon is correct I agree,to comply with all County ; ordinances and State'la uI tIng '"Plumbing, and hereby - authorize r pr n es of his County to enter upon the r abo - `1 a ape or Inspection purposes SEE REVERSE FOR,EXPLANATORY LANGUAGE Signature of Permittee ;Date