HomeMy Public PortalAbout9600 LOWER AZUSA RD_Plumbing__ 78A887 CE#817 2 82
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION Ann�Ns
JOHN A LAMBIE COUNTY ENGINEER
WILLIAM A JENSEN SUP T OF BUILDING LOCALITY Temple City, Calif•
FOR APPLICANT TO FILL IN Ross s Temple City Blvd.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER Carl & Joe Marchese
WATER CLOSET $125
MAIL
BATH TUB 125 ADDRESS 9600 Lower Azusa Road
SHOWER 125 CITY Temple City TEL No 443-8098
LAVATORY 1.25 CONTRACTOR Tubbs & Silver P l umb i n
SINK 125 ADDRESS 352 W. Foothill Blvd.
DISHWASHER 125 CITY Glendora Caltg.No Ed-5-122
LAUNDRY TUB 125 CONTRACTOR S STATE
REGISTRATION NO pAr, COUNTY ❑
CLOTHES WASHER 125 DISTRICT NO GROUP aZONEP EBBED BY
WATER HEATER 150 Q
GAS SYSTEM OUTLETS ISO �- 5 0 INDUSTRIAL
STESTRI ROYAL
OUTLETS OVER 5 PER SYSTEM 30 30 INSPECTION RECORD }
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APPROVALS DATE INSPECTOR 5 SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 3 80 GAS PIPING !0
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I A THE AL OWN R F AND INTEND TO n
RESIDE IN THE ABOVE IBE RE IDENTI OPERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMI E FINAL
VALIDATION ROBERT A WOOD
CK M O CASH SUPERVISING MECHANICAL ENG R
Co6 ka ae MT28 5 D 320- 4
WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A
insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) T
or a certified coy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy N — Company 6ZE edMpT�dS
❑ Certified copy is hereby furnished 7NEAR7ESTT_—,,
FOR APPLICANT TO FILL IN(PRINT OR TYPE) 061-A
�ertified copy is filed with the county building inspec NUMBER FIXTURE OR ITEM ® FEE
tion department C r
Date Appligont WATER CLOSET tt��CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUBtSi V J�
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved by MAIL
the permit Is for one hundred dollars($100)or less) LAVATORY ADDRESS
I certify that in the performance of the work for which this SINK CITY TEL NO
permit is issued 1 shall not employ any person in any manner
so as to become subject to the Workers Compensation Laws DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If after making this Certificate of u
Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR
provisions of the Labor Code you must forth LAWN SPRINKLER SYSTEM CITY L C TEL NO kV—
Compensation a
with comply with such provisions or this permit shall be STATE L /j / LIC
,
deemed revoked WATER HEATER LICENSE NO 44 T 41 `� CLASS
LICENSED CONTRACTORS DECLARATION , DISTRICT NO PRgICESSED BY
1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code and my license is in full force and
andel effect 5 PER SYSTEM FINAL VALIDATION d
License NumberAW60 OliLic Class ✓.SGSC2_ DATE .� o u
_ FINAL 00
Contractor= /V �/ Date BY V
❑ 1 am exempt under Secjt7/ W
VV d•
B&P C for this reason H
Plan check fee z
Date PLUMBING PERMIT ISSUING FEE$ 0 a
Signature
TOTAL FEE A-
Plan check applicant
SINGLE FAMILY 3 8'3,0 A
HOME OWNER BUILDER DECLARATION Name , e • s s 5
1 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 2 s - 1 6 50
❑ I as owner of the property will do the work and the o e 1 6506'
structure is not intended or offered for sale (Section "
7044 Business and Professions Code) Poo 07 20-83
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 Poo
information is correct I agree to comply with all County S
ordinances and State jaws regulating Plumbing and hereby
authorize representatives of this County to enter upon the
above mentioned property for inspection purposes
� SEE REVERSE FOR EXPLANATORY LANGUAGE
C� A 7-�o
Signature of Permittee Date