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Home My Public Portal About4973 LOMA AVE_Plumbing__ PLUMBING 1 DEPARTMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J. FOX, COUNTY ENGINEER ADDRESS *`' A' l LOCALITY I ( C- -FOR APPLICANJ TO FILL IN NEAREST BUILDING y CROSSST. ADDRESS ✓ ..• /�f //•� DISTR(CO. GROUP I ZONE PERMIT NO. LOCALITY &/C ` i NEAREST XROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL INDUSTRIAL ADDRESS WASTE APPROVAL CITY TEL.No. INSPECTION RECORD PLUMBER ALLEY BOULEVARD PLUMBING CM ADDRESS 8300 EAST VALLEY BLVD, ' rE� sc� ROSEMEAD '"" �'• m`' CITY TEL.N0. 0 STATE LICENSE N0. J PERMIT FEES NUMBER TYPE OF FIXTURE OR ITEM FEE E3 WATER CLOSET(TOILET) @ 0.80 3 Ei _ O BATH TUB @ 080 SHOWER @ 0.8011Csb- LAVATORY (WASH BASIN) @ 0 80 KITCHEN SINK @ 0 80 LAUNDRY TUB OR TRAY @ 0180'J k I ;J}. "'T SLOP SINK _ @___0 80 _ a FLOOR SINK @-0 80 FLOOR DRAIN @ 080 DISHWASHER @ 080 DRINKING FOUNTAIN @ 0.80 URINAL @ 080 GAS SYSTEM--------------OUTLETS @ 1.00 WATER HEATER @ 1 00 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK _ PERMIT $ 1 00 ROUGH PLUMBING y s TOTAL FEE O GAS PIPING IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS / REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFO NIA OR THAT,1 AM THE LEGAL OWN- ER OF THE ABOVE RIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OFPERMITTE --.._. �._.... .. INAL 76A667 DBS 17 1/53 �r DEPARTMENT OF COUNTY ENGINEER "PU M 6 9 N G DIVISION OF BUILDING AND SAFETY PERMIT APPLOCATION COUNTY OF LOS ANGELES BUILDING 1, WILLIAM J. FOX, COUNTY ENGINEER ADDRESS �/ M FOR APPLICAN JO FILL IN LOCALITY BUILDING CROSS STNEAREST ADDRESS �— i DISTRICT N0. GROUP �lZONE PE/R�MI(T�NO. LOCALITY '5 NEAREST CROSS ST. �JRECEI�VEjD BY Ready for Inspection DATE ISSUED OWNER MAIL INDUSTRIAL ADDRESS U WASTE APPROVAL CITY EL.No. (J INSPECTION RECORD PLUMBER ADDRESS CITY TEL.NO. []STATE LICENSE NO. [7 COUNTY PERMIT FEES J 4UM9ER TYPE OF FIXTURE OR ITEM FEE Its �DLl.0Q �Ro ` 9 m /,9CGap S U) r WATER CLOSET(TOILET) @ 0.80 $ BATH TUB @ 0.80 SHOWER @ 0.80 LAVATORY(WASH BASIN) @ 0 80 KITCHEN SINK @ 0.80 LAUNDRY TUB OR TRAY Q 0 80 SLOP SINK Q 0 80 114 FLOOR SINK @ 080 FLOOR DRAIN @ 0.80 r DISHWASHER @ 0 80 DRINKING FOUNTAIN Q 0.80 URINAL @ 080 GAS SYSTEM............OUTLETS @ 1.00 WATER HEATER @ 1.00 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUMBING TOTAL FEE df;, GAS PIPING 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- GASVENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY GROIN ANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR THAT I A THE LEGAL OWN- ER OF THE ABOvg DEScRIB /�jD RESIDEN PROPERTY. UTILITY CO.NOTIFIED SIGNATURE /�� I I A OF PERMITTEE-.._.. ((( ---...... _....-..�-......—.....—......—.... ' FINAL 76AG67 DBS 17 Ob 12-53 WORKERS'COMPENSATION DECLARATION AppUCQ7D®N FOR PdMMBNO PERMIT I$her*affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certjieci copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company ❑ Certified copy is hereby furnished C/ /� J y� FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS � / 7✓ . /v. Lo ol ve- ❑ Certified copy is filed with the county building inspec- tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY film PL& Ci/ /�7�^( WATER CLOSET Date Applicant O CROSS NEAREST t,��Oft-DWh -� r"COS�Y)1�r9-t7 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB Q COMPENSATION INSURANCE OWNER ALCI /�6NP (This section need not be completed if the work involved by SHOWER Q �I the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL N. 5 Ei-49 G/�. ADDRESS 603/ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK '0 ,0P 1 CIT C1el TEL NOC91� .�� 2.6 so as to become subject to the Workers Compensation Laws DISHWASHER n� ] CONTRACTOR Date wC'�•/05 Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS Exemption, you should become subject to the. Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL NO LAWN SPRINKLER SYSTEM with comply with such provisions or'this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 - GAS SYSTEM OUTLETS �`O (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my'license is in full force and effect 5 PER SYSTEM FINAL VALIDATION 0. DATE License Number Lic Class ` k) FINAL O Contractor Date BY U ❑ 0. I am exempt under Sec 0- N B&P C for this reason Z Plan check fee Signature Date PLUMBING PERMIT ISSUING FEE$ TOTAL FEE v Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and Professions Code) City Tel No ❑ j, as owner of the property, will do the work and the structureis not intended or offered for sale (Section a 7044, Business and Professions Code) $ 4 ale CONSTRUCTION LENDING AGENCY a a 4 0, 5 0 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 ) 1 227=85 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 ordinances and State laws regulating Plumbing, and hereby authorizer resentatives of t unty to enter upon the above- oned property f i on pur Ises SEE REVERSE FOR EXPLANATORY LANGUAGE SigIiature of Permittee Date