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Home My Public Portal About9646 LONGDEN AVE_Plumbing__ is 76A667A(CE'B)7B),11/76 + r�APPLICATION iFOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINp Vim_ NUMBER FIXTURE OR ITEM ® FEE ADDRESS Lw--3k Ln •WATER CLOSET LOCALITY leg A NEAREST BATHTUB CROSS ST. SHOWER OWNER LAVATORY MAIL ADDRESS SINK CITY TEL.NO. � DISHWASHER. CONTRACTOR 1 CLOTHES WASHERloto - /J ADDRESS SWIMMING POOL RECEPTORLoo' CITY TEL.NO. LAWN SPRINKLER SYSTEM &-o . STATE 10_ LIC. WATERHEATER e--u •LICENSE•NO. CLASS GAS SYSTEM OUTLETS DISTRICT No. GROUP I^ gWD BY OUTLETS OVER 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD r LA Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE 3v Plan check applicant APPROVALS DATE. INSPECTORS SIGNATURE Name UNDER SLAB WORK Address L-0 ROUGH PLUMBING City ( Tel.No4. Rl;-oCf C74 GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I H E READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITI1 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 ABOVE DE RIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE ,r p n 7]/� OFFER EE FINAL /1-il 't !/l(1 tl PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VA IDATI CK. .O. CASH •1.5 4.cc--MAY 6 -51) 3 4-5 0 ,&M as WORKERS'COMPENSATION DECLARATION 'APPLICATION FOR PLUMBING PERMIT I.IRere6'4irm that I•have a certificate of consent to self 76A667A ^.Insure, of a certificate of Workers'Compensation Insurance,, CE 817(REV. 1.0/81) •* WHIPed copl tthleof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY a �� ``�� Company_4 1 r9C�vy+/�r+ fr d Certified copy is hereby,furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE.) BUILDING Certified copy is filed with the county building inspec- ADDRESS � L 8S7 tion department. + p NUMBER FIXTURE OR ITEM a FEE Date – A ll. ant G4,a I�QP T�i WATER CLOSET LOCALITY—T C_ PP 4 NEAREST e CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. G VA COMPENSATION INSURANCE SHOWER OWNER O COyb.SO'. C.o M,n IG (This section need not be completed if the work involved'by 440 the permit is for one hundred dollars($100)or less.) LAVATORYADDRESS Ll @75 15C0663Z 3 ve• ' I certify that in the performance of the work for which this permit is issued,I:shall not employ any person in any manner SINK ^ CITY C1 �^6 TEL. IVO..T��S_� so as to-.become subject to the.Workers'Compensation Laws. DISHWASHER CONTRACTOR CIO CO3 1 Q P1 Date Applicant CLOTHES WASHER 12, ADDRESS NOTICE TO APPLICANT:. If, after making this Certificate of _/� SWIMMING POOL RECEPTOR Exemption, you. should become subject to; the Workers' CITY TEL:NO. Compensation provisions of the Labor Code,-you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions+or this permit .shall be STATE ` LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION12— DISTRICT NO O ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of.Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full'force and effect. 5 PER SYSTEM FINALIL VALIDATI N O License NumberL['4_� Lic. Class G_316 ' DATE �� 6 Q FIN O Contractor Date '+ 3o- BY � ❑ I am exempt under Sec. B.&P..C, for this reason 7 , z Plan check fee_ffh ' te: PLUMBING:PERMIT ISSUING FEE$ U Signature -/ TOTAL FEE ;1 3 0 a l A SINGLE FAMILY Pian check applicant # 0 0 0 0 0 5 HOME.OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address "1 o 178,50 Law for the following.reason (Section 7031.5,. Business and Professions Code): Cit •;]$5 '_ ❑ Y Tel. No. o .o �0 v. I, as owner of the property, will.do the work and the I ..7��s 5 structure is not intended or offered for sale (Section a Q• 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 /n�/ & Lender's Address I certify thaY.l 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 representafives of this.County to enter upon the above- ent' ned p perty for inspection purposes. a SEE.REVERSE FOR EXPLANATORY LANGUAGE Signal. of Permittee Date WORKERS' I have a cerci DECLARt-ons ' APP'LICATI'ON FOR PLUMBING PERMIT I hereby affirm that I have a cert)fir8te'bf� onsent to self j�7A insure, br a certificate of Workers'Compensation Insurance., CE 817(REV. 1.0/81) or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS 9646 LOn Glen tion department. NUMBER FIXTURE OR ITEM @ FEE' LOCALITYTemple City Date A . li anT WATER.CLOSET PP c NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE I OWNER rs Development (Thislsection need not be completed if the work involved by SHOWER Owen MAIL ' the permit is for one hundred dollars($100)or less.) 4 LAVATORY ADDRESS 4275 Bi�ldwin Ave. I certify that In the performance of the work for which this permit is issued, I shall not employ any person.in any manner SINK CITY a Monter CA. TEL. No. 575-0503 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Gary r s Landscape. Service Date f Applicant " - CLOTHES WASHER NOTICE TO APPLICANT:. 'If, after ing this Certificate of i ADDRESS P. O, BOX 3358 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the.Labor Code, you must forth- LAWN SPRINKLER SYSTEM CIN San DilMS, CA. TEL'NO. 818-402-2)12 with comply with such-provisions or this permit shall beJQ_dSTATE, - LIC. deemed revoked. WATER HEATER LICENSE NO. 357261 CLASS C27 LICENSED CONTRACTORS DECLARATION DISTRICT NO, PROCESSED BY I'ereby affirm that:1 am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full.force and effect. 5 PER SYSTEM FINAL n VALIDAT 0 License Number 35726'1 �ic. Class C27 DATE .. fO r. I FINA O Contractor Cwary S TandsCctp�e 1:/13/86 BY V ❑ '1'am exempt under Sec. y,W B:&P.C. for this reason . . Plan check fee Date: �`'�Z 46 PLUMBING PERMIT ISSUING FEE$ Signature q ® P_39'1,5A TOTAL FEE # 0 0 0 0 05 Plan check applicant I o o 1650 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o o o 1 6509 1 hereby affirm that Lam exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and 0 1.24-86 Professions Code): City Tel. No. ❑ I, 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 i 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 ordinances and§49 laws regulating Plumbing, and hereby autthhor"e reP of this County to enter upon the,' �bov -menti vo action purpo s. p�y SEE REVERSE FOR'EXPLANATORY LANGUAGE 0 d . SI to Permittee D .e. ( 4'l