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Home My Public Portal About9464 LEMON AVE_Plumbing__ 76A667A ICE B1713)- 11;76 `APPLICATION FOR PLUMBING PERMIT d� BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS 9464 E. Lemc)n WATER CLOSET LOCALITY Temple NEA REST BATH TUB CROSS ST Trellawney SHOWER OWNER M a nd Mrs William Diinnan LAVATORY MAIL ADDRESS same as inh SINK CITY Temple City TEL NO 445-7107 DISHWASHER CONTRACTOR E. .L. PAYN E COMPANY CLOTHES WASHER ADDRESS 166 W_ Livp nak Ave SWIMMING POOL RECEPTOR CITY TEL NO _ LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LI ENSENO CLASS C-20 GAS SYSTEMOUTLETS DISTRICT NO GROUP �ZONE ROCE ED BY OUTLETS OVER � / `d � 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL 0 INSPECTION RECORD R O V1 z Plan check fee PLUMBING PERMIT ISSUING FEE$ 4 TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF AND INTEND TO RESIDE IN THE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE Q_2 FINAL NV1�, ci224- ICS®MPENISAToI®WSHa T I C14ERMIT VALIDAT�ON� CK M O CASH POLICY HOLDER: as ROR_ICY NUMBER: WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 16reby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) �oraopy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Company Certified copy is he by f rnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified c py is file it ty building mspec_ ADDRESS tion m 1 NUMBER FIXTURE OR ITEM Q FEE LOCALI Date Applicant WATER CLOSET NEAREST CERTIFICATE OF E MPTION RKERS' BATH TUB CROSS ST COMPENSA INS RA OWNER SHOWER (This section need not be complete if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS" k. I certify that in the performance of the work for which this , permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACT / Date Applicant CLOTHES WASHER ADDRESS /� NOTICE TO APPLICANT If, after making this Certificate of T, ` (• Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY /J/� TEL N7S�� with comply with such provisions or this permit shall be STATEy��v�f LIC deemed revoked WATER HEATER LICENSE NO J / CLASS LICENSED CONTRACTORS DECLARATION DISTRICT N / R CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /JX (commencing with Section 7000 of Division 3 of the Business ` ( 9 ) OUTLETS OVER and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALI TION DATE -� License Number Lic Class OC U �j FIN IM Contractor Date B 0. F-1V I am exempt under Sec � H B&P C for this reason , Plan check fee _ Date 3 1 4 2 a PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE # o o o o o 5 Plan check applicant SINGLE FAMILY 650 HOME OWNER-BUILDER DECLARATION Name Z-7- 402 A�j`,n I hereby affirm that I am exempt from the Contractor's License Addre (,�fZ.,/ 0 0 0 5 Q Law for the following reason (Section 7031 5, Business and Professions Code) City Tel No- 3 I❑ a 1 6-g 5 j, as owner of the property, will do the work and the . structure is not intended or offered for sale (Section , 7044, Business and Professions Code) 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 finances and State laws regulating Plumbing, and hereby hotepresives of this County to enter u on th onede tpr erty for inspection pur oses �• SEE REVERSE FOR EXPLANATORY LANGUAGE nat o i e D to ��ORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT It. hereby i-irm'that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A (f JI or a certified copy thereof (Sec 3800, Lab C )" COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS P (Z ollcy Na4 3 3 k Companyf'Ub r PAD ❑ Certified copy is hereby furnished FOR APPLICANT'TO FILL IN(PRINT OR TYPE) BUILDING •� �ertified copy is filed with the county building inspec- ADDRESS ✓�(04 ' ° tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY �w� �z�d� � WATERCLOSET Date Appli4anl O NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' a-' BATH TUB ` �O ' CROSS ST COMPENSATION INSURANCE SHOWER DOWNER VCS (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars ($100)or less.) 3 LAVATORY /Q ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any,person in any manner SINK 970 CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER- 70 CONTRACTOR Date -Applicant CLOTHES WASHER to ADDRESS NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code,•you must forth- CITY TEL _ 52 �.► LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER 0 LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 , GAS SYSTEM ,5 OUTLETS Q 0 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect 5 PER SYSTEM _ FINAL VALIDATION i License Number -1_,P155/icLic Class g- ` ga -S� Q�� p �D DATE ��(�(a? U' FINAL Contractor Date ��Z�"Q BY rJ Q' ❑ I am exempt under Sec B&P C for this reason A ` Plan check fee Z Date PLUMBING PERMIT ISSUING FEE$ Signa0 TOTAL FEE 4"71,1-7v Plan check applicant SINGLE FAMILY = HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and - - ��•; •�;t Professions Code) I.City Tel No _ ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale Section 7044, Business and Professions Code) 70 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 ) • r •s Lender's Name J. 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 authorize representatives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE-FOR EXPLANATORY LANGUAGE Signature of Permittee Date