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HomeMy Public PortalAbout9609-9611 LONGDEN AVE_Plumbing__ 76A667/V(.CE 61719.-4/77 APPLICATION FOR PLUMBING PERMIT yl'Jt1 Lot-#1.6 B DING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT.OR TYPE) BUILDING NUMBER FIXTURE OR ITEM PEE ADDRESS 9609 Lo n Ave. // WATER CLOSET LOCALITY TEaple a -ty I BATH TUB Q NEAREST CROSS S . SHOWER OWNER F haven Development A0LAVATORY00MAIL I W1 ADDRESS 865.6 E. Bunt on Drive SINK' CITY San Gabriel TEL.NO. '287-9527 DISHWASHER CONTRACTOR 0*yea BRoB.. Plumbing Inc. CLOTHES WASHER ADDRESS . 4265 N. Baldwin Ave. SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM CITY XL Monte TEL.NO. —0 $ STATE LIC. WATER HEATER LICENSE NO: 231 7 CLASS 036-20 GAS SYSTEM OUTLETS DISTRICT NO. d UP j7AE RO SSED OUTLETS OVER 5 PER SYSTEM INDUSTRIAL C2 WASTE APPROVAL CG INSPECTION RECORD y _ z Plan check fee PLUMBING PERMIT ISSUING FEE$ 000 TOTALFEE Plan check applicant Name APPROVALS DTE ASPECTOR11 SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel:No. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THATTHE 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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST xa LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL1.0 PLANN'CHEC?,'VXLTQNQT Q C:0M P9.NSi T!gl"' PERMIT VALIDATION CK. M.O. CASH POLICY HOLDER:L.�� 'rte �.v+� (�(.rQ• U 22 5 D 7 5 . O POLICY DUMBER: 2f l6-- 33-SLS WORKERS'COMPENSATION DECLARATION DPW APPLICATION -FOR PLUMBING PERMIT I hereby, affirm that ljaave�o�c6rtificate of consent to self in- i 76A667A 4/90sure,or a certificate of Wotkldfs'Compensation'Insurance,or a certified copy thereof(Sec. 3800, Lob. C.) _ Company C'N b f _I n 1,01'rn n.i iy COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Certified copy is hereby furnished.' - BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) /_ /� ©/Certified copy is filed with the county building inspection ADDRESS CC/ ZI L department. NUMBER FIXTURE OR ITEM @ FEE LIOCALITY ! WATER CLOSET(TOILET) o e Date (�T 9F"S Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' v BATH TUB CROSS ST. C . COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY �' TEL.NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. . DISHWASHER C,ONTRACTOR p/�n 1 e Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS 1 1,ri emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR sation provisions of the Labor Code,you must forthwith comp- CITY TEL.NO. L(y, O P Y P LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. �1 ed. WATER HEATER B LICENSE NO. CLASS du C- 6 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS —lot (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. / �j _ HOSE BIB DATE J,—b� } License Number /n 7.11166 r Lie. Class y a FINAL i V Contractor Date Z0 -31 ,92 BY a ❑ I am exempt under Sec. U O ACCT. B.&P.C. for this reason W I Plan check fee Poo. 3303 �� Date: PLUMBING PERMIT ISSUING FEE$ :0 1 ITEMS Signature .401 TOTAL FEE '40 SINGLE FAMILY an check applicant I Plan i TOTAL 4 ,� HOME OWNER-BUILDER DECLARATION PP i CHECK 43.40 1 hereby affirm that I am exempt from the Contractor's License Name CHANGE n Law for the following reason (Section 7031.5, Business and e�V Professions Code): Address 1, as owner of the property, will do the work and the City Tel. No. �Q��— �1 12/26/95structure is not intended or offered for sale(Section 7044, Business and Professions Code). , 39?2 1 Pn12:10 CONSTRUCTION LENDING AGENCY + I hereby affirm that there is a construction lending agency for I ' the performance of the work for which this permit is issued (Sec:3097, Civ. C.). r 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 ' authorize representatives of this County to enter upon the i above- ti ed pro or inspection purposes. or SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of R ittee Date