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Home My Public Portal About10733 LYNROSE ST_Plumbing__ 76A887.CE#817 4-64 4-'-r7�PLUMBING PER a. APPLICATION FOR L COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS WILLIAM A.JENSEN,SUP'T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST ` CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER I WATER CLOSET 51.25 MAIL !d BATH TUB 1.25 CI17L. NO.. SHOWER 1.25 LAVATORY 1,2,5 CONTRACTOR az4j& SINK 1.25 ADDRESS Q r DISHWASHER 1.25 CI L.NO. LAUNDRY TUB 1,25 CONTRACTOR' STATE REGISTRATION NO. COUNTY [ICLOTHES WASHER 1.25 DIST ICT NO. OR O E� BY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50INDUSTRIAL 0 WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD IJ 0 U W D. Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 '00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORNECTAND AGREE TO 'COMPLY' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING:FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY 'AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE I FINAL ,v ATION ROBERT A.WOVD CK. M.0. CASH SUPERVISING MECHANICAL ENG'R r ( .8 4 9 1Qo- MAY-11 5' D- ' '. 3.50N b 76A657-CE817-11-57 APPLICATION .FOR PLUMBII`IG PERMIT 1 COUNTY OF LOS ANGELES Job 1-504 _ DEPARTS= OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN D. s a t Emm�� ADDREIT 1 0 n r o s e CASSA of R LO�� T.e m 1 e C ' t _ FOR APPLICANT TO FILL IN NEAREST NUMBER FIXTURE OR ITEM CROSS ST. WATER CLOSET OWNER L a r kw o o d Co n s t r u c t i o n MAM J BATHTUB ADDRESS 10229 . Lower Azusa Rd. SHOWER crrY El Monte TEL.iva. ;L LAVATORY coNTRACToR R i cha r d Cavanaugh P l b. am ADDRESS 13354 S- Central DISHWASHER crrr Chino TEL.NO. TDB CONTRACTOR'S STATE El LAUNDRY REGISTRATION NO. COUNTY ❑ J CLOTHES WASHER D1SiRIC NO. GROUP Z IVE oRIHSP6cTION WATER.HEATER GAS SYSTEM :: INDUSTRIAL WASTE APPROVAL s°I G INSPECTION RECORD APPROVALS e $1.00 PER ITEM 0O DATE 1NS ECTOR'SSIGNATI RE OR F18T088 $ I /0 UNDER SLAB WORK `_30,�q PERMIT $. 00 ROUGH PLUMBING TOTAL FEE GAS PIPING Y! 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY { HOT WATER HEATER r �� LCALIFORNIA COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES• CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST S REQUIRED BY LOS ANGELES COUNTY AND STATE OF 'QR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.•NOTIFIEDRESIDENTIAL OP.ERTY. ITTE IGNATUR FINAL - ROBERTA.WOOD. eF VALIDATION SUPERVISING MECHANICAL ENG'R CK. M.c. cases ' LAIC05071- AR14 5 A 12.00 � - WORKERS'COMPENSATION DECLARATION 7GA667A I hereby affirm that I have or certificate of consent to self CE 6,7(z-6e) APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) '-- C � e}`3 �N COUNTY OF LOS ANGELES BUI LDfNG AND SAFETY Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING lD / �/ZbSC . �ertified copy is filed with th county.building inspection NUMBER FIXTUFIE OR ITEM • FEE ADDRESS L d artme LOCALITY Date t Applicant WATER CLOSET NEAREST ; BATH TUB CROSS ST. CERTIFICATE'OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER. LAVATORY MAIL (This section need not be completed if the work involved, ADDRESS (0' 73 (� 8 } by the permit is for one hundred dollars ($100) or less.) SINK CIT L� TEL N O I certify that in the performance of the work for which this DISHWASHERV permit is issued, i.shall not,employ any person in any manner CONTRACTOR /A 012)6,44• so as to become subject to the Workers'Compensation Laws.: CLOTHES WASHER ADDRESS4. 7-- �-5 07-79 0 Date Applicant SWIMMING POOL RECEPTOR a� NOTICE TO APPLICANT:•If,after making this Certificate of CITY�A„o G �� TEL.NO.' -LU Exemption, you should become subject to the Workers.' LAWN SPRINKLER SYSTEM STATE LIC. CL Compensation provisions of the,Labor Code,you must forth- LICENSE NO. I . 40.Z CLASS z with comply with such provisions or,this permit shall beWATER HEATERdeemed revoked. DISTRICT NO. PR .CESSE GAS SYSTEM OUTLETS ,� � LICENSED CONTRACTORS DECLARATION OUTLETS OVER v� I hereby affirm that I am licensed under provisions of Chapter 5.PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi FINAL VALIDATION ness and Professions Code.;and my license is.in full force and I luso De� 3 DATE /0 ��j' �� effect. FINAL .License Number�S I'D Z Lic.Class G�s 3 - BY C6�� Ar�c. `FpILN� ntracor B-T El I am ex t from the licensing requirements as I am a Plan check fee / licensed rchitect or a• registered. profesiional engineer PLUMBING PERMIT ISSUING FEE$ 7 acting in my professional capacity (Section 7051, Bus- , iness and Professions Code). TOTAL FEE 14- 1 Lic.or Reg.No. Date Plan check applicant ROME OWNER-BUILDER DECLARATION Name Q (91+9daz I hereby affirm that I am exempt from the Contractor's Address B S A License Law for the following reason (Section,.7031.$, Busi- City -514A/ eJ_ Tel..No. ness and Professions Code): I, as owner of the property, am exclusively contracting Ab 6 8.5 A with licensed contractors to construct the project (Section 7.044,Business and Professions Code). i# o'0 0 0 0 5 CONSTRUCTION LENDING,AGENCY I 2'p '0 1 .600 ' I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is o 0 0 issued(Sec.3097,Civ.C.). Lender's Name p 8,O T—8 1 I Lender's Address �• ; I certify that I have read this:application d.state that the above information is correct.I a ee to co y with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinance' and State Is re sting P bing, and hereby authoriz epresentati t • Cou to enter upon the above-m tioned pro ty f r i esti purposes. of Per ee Da e r p�p s� WORKERS'COMPENSATION DECLARATION APPLICATION. FOR PLUMBING PERMIT - I he�eb ffirm that I .have a certificate of consent to self 76A667A insure} a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) ►: o#,a ce•ified copy thereof(Sec.3800,.Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pdf y No. Companysi�ii. R 's'o Certified.copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is,filed with the county building inspec- ADDRESS %� / 1� r e J T. tion department. NUMBER FIXTURE OR ITEM FEE ^ ; �/� fZes,, LOCALITY Date2 Zl'11 � Appligant 7-.ZA WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST:. COMPENSATION INSURANCE SHOWER OWNER es a e-(-S4c e (This section need not be completed if the work involved by the ermit is for one:hundred dollars $100 or less. MAIL P ( ) ) LAVATORY ADDRESS S*A-L _ I certify that in the.performance of the workfor which this permit is issued, I shall not employ any person in any manner SINK CITY TEL,NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER �+� CONTRACTOR I, . (q�JS• Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after .making this Certificate of 117'bye{ fL5F1 4OV,•- SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL.N . �` Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with. such provisions or this permit shall be STATE ! L LIC. deemed revoked. WATER HEATER r LICENSE NO. !s61V CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS •� J �� (commencing with.'Section 7000)of Division 3 of the Business OUTLETS OVER J 9 and Professions-Code,and my license is in full force and effect., 5 PER SYSTEM FINAL !— VALIDATION IL DATE `, ,S V License Number-Z` S' Lic. Class `' / FINAL Contractor�/�� S•i � Date 2`Zf 4P BY 0 I am exempt under Sec.. ;21568A IL -B;&P.C. for this reason h Date: Plan check fee ► #. 0 0 0 0,0 5 PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE $ '(. o o 2 a 5 O ' Plan check applicant o o o 2$5 Q.xic SINGLE FAMILY' HOME OWNER-BUILDER DECLARATION Name 2 2 -8 5 I hereby affirm that I am exempt from the Contractor'sti.cense Address Law for the following reason (Section 7031.5, Business and 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 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address Icertify 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-mentioned property for inspection purposes. �y,/ SEE.REVERSE FOR EXPLANATORY LANGUAGE . nature of Permittee Date