HomeMy Public PortalAbout10108 LYNROSE ST_Plumbing__ 76A667 oBs 17 1,-so APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY �'
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
ON G
FOR APPLII;ANT TO FILL IN DISTRICT BR13UP
s' - ZONE- !PERMIT N.-
77 p - 13
PLUMBER VALLEY BOULEVARD PLUNIMING CO. RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS 8300 EAST VALLEY BLVD.
LD'ROSEMCEAD ADDRESS Q Q
CITY TEL. No. AT. 2-2719
COUNTY
LICENSE No. 93M EXPIRES 6-30-,s' LOCALITY
NEAREBT
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) 0.50 0 O ADDRESS �_w/.���.1t —c ,tel'
BATH TUB @ O.SO CITY J:EL �f/ .J T.S
SHOWER @ 0.50I I HEREBY ACKAOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ D.506 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK 0.50 Q AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOB
LAUNDRY TUB qR TRAY O.SOLV`Q ANGELES COUNTY LICENSE. OR 1 AM THE -LEGAL OWNER
OF THE RESIDENTIAL R ERTY DESCRIBED ABOVE.
OAS SYSTEM OUTLETS 0.50
SIGNATURE OF
WATER HEA R @ 0.50 O PERMITTE
SLOP SINK @ O.SO INSPECTION RECORD
FLOOR SINK Q 0.50
FLOOR DRAIN @ 0.50
DISHWASHER Cta♦ 0.50
DRINKING FOUNTAIN 0.50
URINAL 0.50 J
Q
HOUBE SEWER a O.SD Z_
MISCELLANEOUS O
O
APPROVALS
nnDATE INSPECTOR'S NAME
ROUGH PLUMBING I �'
GAS PIPING I�/v �✓
GAB VENT
6'
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT . . . . . I 1.00 GAS TEST a/'—/J
UTILITY CO. NOTIFIED
TOTAL FEE $ Q v
FINAL
WORKERS'COMPENSATION DECLARATION APPUCATT QN FOR PLUMBING
pMBING PERMIT
f'hereby affirm that'I have a certificate of consent to self 76A667A -
insure, or a,'-rtificate of Workers' Compensation Insurance, CE 817(REV 10/81)
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 mspec_ ADDRESS 0(f'
tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date Appligant WATER CLOSET NEAREST `
CERTIFICATE OF EXEMPTION FROM WORKERS' r BATH TUB CROSS ST
COMPENSATION INSURANCE OWNER
(This section need not be completed if the work involved by SHOWER Lr
the permit is for one hundred dollars $100 or less. MAIL l' ►/
P ( ) ) r LAVATORY 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 CITY, `�'Cr TEL, NOt;.1 Mf�
so as to become subject to the Workers Com sate n L ws DISHWASHER c J ` l+V
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE APPLICANT If, after making this Certificatt of 1
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR 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 ab CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NQQ SSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS /1�
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER (j d
and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL
VALICATION O
�y
AT
License
` U
License Number L11-ic Class 09
ii FIN O
Contractor "Date r' a 6-6 B V
❑ tea
I am exempt u er Sec 3'8 9.6 A
B 8P C for this reason
Plan check fee $$ o 0 0 0 0 5
Date
PLUMBING PERMIT ISSUING FEE$ 7)
Signature n _ (, o,0 2 Qj p
TOTAL FEE
Plan check applicant " ° ° ° 2 a 5 0 F4
SINGLE FAMILY M
HOME OWNER-BUILDER DECLARATION Name L�� me-5 1.2 2 8 6
I hereby affirm that I am exempt from the Contractor's License p
Law for the following reason (Section 7031 5, Business and AddressA�1`
Professions Code) City Tel N
❑ 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 LENDINGAGENCY
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
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentione o Wert for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
� A E
Signature of Permittee Date