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Home My Public Portal About10147 LYNROSE ST_Plumbing__ 78A687 +� n-Bo APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY 07 COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER I FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. 7;- I 9 — /3-- VALLEY BOULEVARD PLUMBING CO, RECEIVED BY READY FOR / DATE ISSUED PLUMBER FIRST INSPECTION ADDRESS 8300 EAST VALLEY BLVD. -0 -S/ ROSEMEAD AT. 2.2719 ADDRESS O/ 7 CITY TEL NO. COUNTY 93M - LOCALITY LICENSE NO EXPIRES NEAREST PERMIT FEES CROSS ST. _ NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAILWATER CLOSET (TOILET) Q O 50 $ Q ADDRESS 1 —BATHTUB Q O 5o CIT TEL. N.;IU LSHOWER Q O 50 1 ,HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS .y� APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND -I/ LAVATORY (WASH BASIN) @WASH BASIN) Q O 501 CJ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK Q O 50 STATE LAWS REGULATING PLUMBING. ANGELES TIFY COUNTYTHAT L PE SE, OR ITHE AM THE ABOVE LEGAL OWNER VALID LAUNDRY TUB OWNER 1 OR TRAY Q 0.50 OF THE RESIDENTIACf OPERTY DESCRIBED ABOVE. GAS SYSTEMOUTLETS Q O 50 SIGNATURE OF WATER HEAT R a O Sol PERMITTE -h SLOP SINK Q o so I 1 1 INSPECTION RECORD FLOOR SINK Q O 50 FLOOR DRAIN Q O Sol DISHWASHER Q O Sol DRINKING FOUNTAIN Q o 501 URINAL Q O SO 1 ..I HOUSESEWER Q o 501 Z MISCELLANEOUS I a II� � I� APPROVALS , DATE INSPECTOR'S NAME ROUGH PLUMBING /t! �I GAS PIPING I - G4S VENT CESSPOOL Q 1 00 I CESSPOOL SEPTIC TANK- I SEPTIC TANK /J DRAIN ( ) PIT ( ) (tQ 1 00 ISEWER / PERMIT . I 1 Oo GAS TEST // /�'• UTILITY CO NOTIFIE /" TOTAL FEE $,�jC/ FINAL WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 +•` L sure,or a certificate of Workers'Compensation Insurance,ora 76A667A - certified copy thereof (Sec 3800, Lab. C )_ • - _ Policy No Company Gft�Li � `1/Ii��ii��J COUNTY OF LOS ANGELES' . DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) - BUILDING - I�Ii Certified copy is filed with the county building inspection ADDRESS Z VA4J?eJ L� department NUMBER FIXTURE OR ITEM @ FEE /� _ LOCALITY Date /0~I _2,� Applicant )©t4.S E.1Lw�A, WATER CLOSET(TOILET) NEAREST aY BATH TUB CROSS ST ACERTIFICATE OF EXEMPTION FROM WORKERS' L 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 j TEL NO mit is issued, I shall not employ any person in any manner so CITY / U 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 Ex- SWIMMING POOL'RECEPTOR O emption,you should become subject to the Workers'Compen- CITY TEL NO f1*12 sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or This permit shall be deemed revok- STATE LIC ed WATER HEATER — LICENSE NO -6 7,fIfr CLASS C LICENSED CONTRACTORS DECLARATION. DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS n /j 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER [/J and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect- HOSE BIB �— } p � C— do,Number 1/17TAU Class o 'j DATE O P�t212 .h FINAL a Contractor I�L'1n_C M u Date �d `.31 —9r BY I am exempt undOer Sec � B&P C for this reason c V Plan check fee W ANT. (:T off N -. Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE ��a�l) SINGLE FAMILY f ITIrM.33 HOME OWNER-BUILDER DECLARATION Plan check applicant TIITr�L ,� � I hereby affirm that I am exempt from the Contractor's License Name Law_for the following reason (Section 7031 5, Business and (I••lECK 42.60 Professions Code) Address CHAfy} j, as owner of the property, will do the work and the City Tel No structure is not intended or offered for sale(Section 7044, _ Business and Professions Code) �i fa�0f101 A/20'Or CONSTRUCTION LENDING AGENCY Q I t ii E 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-ment ed p e 'for hon purposes -- SEE REVERSE FOR EXPLANATORY LANGUAGE Sign ture o Permittee Date