HomeMy Public PortalAbout9712-9714 LONGDEN AVE_Plumbing__ 76J►667A (%
CE 617(REV.6/76).
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APPLICATION F R PLU ING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
.FOR APPLICANT TO FILL IN(PRINT OR TYPE! BUILDING
ADDRESS 9712 LO den Avenue
NUMBER FIXTURE OR ITEM ® FEE
LOCALITY T�gle City.
WATER.CLOSET 3.O A--Gm
NEAREST
4.-Z BATH TUB CROSS ST. _
SHOWER 0 OWNER J. B. Weber Develo nt
MAIL
LAVATORY ( ADDRESS 26 T le Ci Blvd.
�-Z
SINK :CITY Temple City TEL.NO- 444-0971..
4-2, DISHWASHER CONTRACTOR
Valle Plumbing
CLOTHES WASHER ADDRESS
�•�F2 W Flee od Pl
SWIMMING POOL RECEPTOR
CITY Glendora TEL.NO. 33
2
LAWN SPRINKLER SYSTEM
STATE LIC..
WATER HEATER LICENSE NO. 2o9431.
1} .1. CLASS✓` .•SC42 20
'.y GAS'SYSTEM OUTLETS APPROVALS DATE INS 'S SIGNATURE
OUTLETS OVER UNDER SLAB.WORK ] �.
5 PER-SYSTEM ROUGH PLUMBING
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES 42
GAS TEST 7 S
Plan check fel UTILITY CO.NOTIFIED
PLUMBING PERMIT ISSUING FEE'$ 00
TOTAL FEE FINAL
Plan check.apglicdrit PLAN CHECK VALIDATION
Name �� l.e l 4.� -C C t�F
Address GL d d
City Tel.No.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE
THAT THE ABOVE IS CORRECTAND AGREE TO COMPLY WITH'ALL COUNTY ORDINANCES q n
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION d i.5 f1
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE #,O .0'0 O O-5
LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL O - 7300
SIGNATURE O D o `]3 O 0 U
OF PERMITTE
DISTRICT NO. OCESSED BY 0426-79
INDUSTRIAL i
WASTE APPROVAL +
• r
t ,
WORKERS'COMPENSATION DECLARATION ', APPLICATION FOR 'PLUMBING PERMIT
thereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87
ms4e;ior a certificate of Workers'Compensation Insurance; 76A667A
or a ,ertified copy thereof(Sec. 3800, Lab. C..) ', COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS- '
PolityNo. � Company
❑ Certified copy is hereby furnished: I ,�
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDIN y�
Certified copy is filed-with the county building inspec- ADDRESS (J
tion.d9partment. NUMBER FIXTURE dR ITEM @ FEE
LOCALITY
Date Appligant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTI.Q FROM WO KERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE ' OWNER
(This,section need not be completed if the work involved by' SHOWER
WMAIL
the permit is for one hundred dollars($100)or less.)- LAVATORY CL In ADDRESS A
I certify that in the performance of the work for which this
permit is issued,I shall not employ any person in any manner SINK CITYTEL. NO.
so as to become subject to the Workers'Compensation Laws: DISHWASHER'
CONTRACTOR IF
Date Applicant CLOTHES WASHER ADDRESS '/J�( ,
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
P Y- I ' CITY TEL. NO.
Compensation provisions of the Labor Code, you must forth,- LAWN SPRINKLER SYSTEM
with comply with such provisions or this. permit 'shall be STA �^ LIC.
deemed revoked. WATER HEATER LICENSE NO. �gj 3 . CLASS�
LICENSED CONTRACTORS DECLARATION DISTRICT _ PR ES5E BY
I hereby affirm-that I am licensed under provisions of chapter 9 GAS SYST W OUTLETS.
(commencing with Section 7000)of Division 3 of the Business 6UTLETS OVER
and.Professions Code,and my license is in full force and effect 5'PER SYSTEM FINAL C
O / VALIDATION G:
f Q" -' / CIO �+ Zn—C% DATE Q
License Nu r Lic
. /_v . s�•� C�
FINAL p
Contracto AM te V Q BY L �`
❑. I am exempt UP&Sec.
B.BP.C. for this reason Plan.check fee
Date. .. PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE J�
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 �ry
'Professions Code.): City TedL
T6.1. No. """ "" °"'_""_ e501
❑ I, as owne1 of the property, will do the work and the 1 17M
strudture is not intended or offered for sale (Section
7044, Business and Professions Code).
22.50
e. CONSTRUCTION LENDING AGENCY 22.50
1,hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued o
(Sec. 3097,Civ. C.).
Lender's Name ' M01 7/71/89
Lender's.Address j `rtxuF 1 ARCO-=
I certify that I. have read this application and state that the "
above information is corrForf
I agree to comply with all County
ordinances and State toegulating.Plumbing; and hereby
out. raze represent v this County to enter upon then
a ve-mentioned' r r for insaction purpo s. ?
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of 00filtree DcOb