HomeMy Public PortalAbout10755 LYNROSE ST_Plumbing__ 7&MR-CES17-11-57
APPLICATION FOR PLUMBING PERMIT 1
COUNTY OF LOS ANGELES + L
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION BUILDIN
TOHN um
Tr A. Gamna°os p'e Ea eai� �D 107 L n r o s e
LOCALITY Temple Cit ,
FOR APPLICANT TO FILL IN NEAREST,
CROSS ST..
NUMBER FIXTURE-OR-ITEM
WATER CLOSET —OWNER L a r kw o o d C.ontruction
BATH RUB AADDDRESg 10229 Lower Azusa Rd.
SHOWER CITY E 1 M o n t e.. TEL.No.
LAVATORY CONTRACTOR R"i c h 8 r d Ca v a n.a u h F l b.
SINg ADDRESS 13354 S. Central
DISHWASHER CITY Chino TEL NO.
LAUNDRY TUB CONTRACTOR'S STATE ❑
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRICT NO. GROUP O I A INSPECTION
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
r A INSPECTION RECORD-----/ I
bdg AV
APPROVALS.
/ @ $1.00 PER ITEM I DATE' INSPECTOR'S SIGNATURE 6 O8 FDLTQAE $ Q 0 UNDER SLAB WORK / -r3e - -q d d-
PERMIT $ 00 ROUGH PLUMBING
TOTAL FEE j 0•0 GAS PIPING!
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT A AM PROPERLY REGISTERED AND/OR GAS TEST' () 'L► ' ✓--/
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY-CO.NOTIFIED N2—Yi-dj� Fes- ..��
DESCRIBED RESIDENTIA OPERTY.
SIGNATURE
OFPERMIYTE ' FINAL /D je •I..I, I
ROBERTA.WOOD.
®Fv VALIDATION SUPERVISING MECHANICAL.ENG-R,
cK. N.O. CASE
,► 5 0 & 5ull, ,SPR 4 5 A 1 2.0 0 M
WORKERS'COMPENSATION DECLARATION 76AG67A
I hereby affirm that I have if certificate of consent to self C8 er7(z-ael APPLICATION FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or
a`jcerT`iedc py aCoB thereof(Spec.3800,Lab.C.) 7, i
�Pbli�y . ), — ny� COUNTY OF LOS ANGELES BUILDING AND SAFETY
pa
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
!!! ADDRESS
Certified copy is filed.with th cou ljuilding i pectio NUMBER FIXTURE OR ITEM FEE LOCALITY i
DaterICATE
Applicant WATER CLOSET NEAREST
BATH TUB CROSS ST.
ERTIOFEXEMPTION FROM WORKERS' i
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved LAVATORY MAIL ADDRESS >.
.e a
by the permit is for one hundred dollars ($100) or less.) SINK
CITY T L.NO / V
I certify that in the performance of the work for which this j DISHWASHER —+ (Y
permit is issued, I shall not employ any person in any manner CONTRALTO 0
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER U
ADDRESS
Date Applicant SWIMMING POOL RECEPTOR
NOTICE.TO APPLICANT: If, after making this Certificate of CITY TEL.NO
Exemption, you should become subject -to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE NO.�16® CLASS tU
With comply with such provisions or this permit shall be
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PRO ESSED B
LICENSED CONTRACTORS DECLARATION OUTLETS OVER S�O
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL
DATE VALIDATION
ness and Professions Code, and my license is in full force and ` r
effect. r
AL
License Number Lic.Class BYAL
1 rt
Contractor Date -7
MI am exempt from the licensing requirements as I am a Plan,check fee d
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE.$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.N Date / Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
ness and Professions Code):
I, as owner of the property, am exclusively contracting Z 0 9&5 A
with licensed contractors to construct the project
(Section 7044,Business and Professions Code). # o o 0 0 0 5
CONSTRUCTION LENDING AGENCY 2 0 0 1 0.00
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is o 0 0 1 0.0 0 czi
issued(Sec.3097.,Civ.C.).
Lender's Name 0 8. 2 7 8
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
�bove-mentioned p operty for inspe tion purposes.
/
gnature of Perini tee Dple