HomeMy Public PortalAbout5509 MCCULLOCH AVE_Plumbing__ 73A667
DBS17 12.34 APPLICATION FOR PLUMBING PERMIT
DIVISION OF BUILDING AND SAFETY 1
Deportment of County Engineer
County of Los Angeles BUILD 1 NG
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D.'GRIFF)N. SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
OWNER DISTRICT NO. I GROUP I ZONE/ I READY FOR INSPECTION
MAIL 1 To /J7J
ADDRESS o.
INDUSTRIAL
CI TEL. NO. WASTE APPROVAL
PLu R. INSPECTION RECORD
ADDRES
CITY �f TTE�E//L
LI NS N .3� J/ O /
NUMBER TYPE OF FIXTURE OR ITEM FEE ,
WATER CLOSET (TOILET)
BATH TUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO. ® 0.e0 APPROVALS
DATE INSPECTOR'S SIGNATURE
CAS SYSTEM OUTLETS @ 1.00
UNDER SLAB WORK
WATER HEATER @ 1.00.
ROUGH PLUMBING
PERMIT GAS
TOTAL FEE $ I ' �O GAS VENT
G
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY —
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED
CALIFORNIA OR THAT 1 M THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL R PERTY.
SIGNATURE
OF PERMITTEE FINAL
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION
00 9-b 7.*;.- FE828 3- 1 B*0
BY
YA-Ep
UTY!
t
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
76
I herebb y affirm that I have a certificate of consent to self in- 8666 DPW 4/87
7686678
sure,or a certificate of Workers'Compensation Insurance,or a CE,817(REV. 8/86) City of Temple City
certified copy thereof (Sec. 3800, Lab. C.) `flI
Policy No. 201 CJ1 6 Company $(+TF COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Certified copy is hereby furnished. 691
FOR APPLICANT TO FU.L IN(PRINT OR TYPE) BUILDING
® Certified copy is filed with the county building inspection ADDRESS 55509 McCullochA
department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Temple C
ity
Date 4/1/89 Applicant _ 1 WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB CROSS ST: Prepw St.
COMPENSATION INSURANCE OWNER
SHOWERHelen Scanlon
(This section need not be completed if the work involved by MAIL
the peimit is for one hundred dollars(5100)or less.) LAVATORY ADDRESS Same certify that in the performance of the work for which this per- .
mit is issued, I shall not employ any person in any manner so SINK CITY 8118"-°350-8060
as to become subject to the Workers'Compensation Laws.• DISHWASHER 1Z3 3
CONTRACTOR
Date Applicant CLOTHES WASHER General installation Co-
ADDRESS 6558 Weft Blvd.
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING . RECEPTOR
emption,you should become subject to the Workers'Compen- CITY TEL. NO.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKL TEM Los Angeles 753-254
ly with such provisions or'this permit shall be deemed revok- STATE LIC.
ed. 1 WATER HEATER 6 00 LICENSE NO. 1 CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT N¢ PRO SSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OAU v/)
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM e FINALVALI ION >_
fect.
License Number 151839 Lic. Class C36 ' ' DATE Z'ZZ— d
O
FINAL V
Contractor, W.G. PrCLV in Date 4434) BY O
F-
❑ I-am exempt under Sec. V
W
' a
B.&P.C. for this reason Plan check fee poolrn
Date: PLUMBING PERMIT ISSUING FEE$
Signature 10*50 2 0 2 4 5 A Z
TOTAL FEE 16150 SINGLE FAMILY Plan check applicant
# 0 0 0 0 0 5
HOME OWNER-BUILDER DECLARATION PP
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and :1--c 61 6 5 0
Professions Code): Address o 0 oil 6505
Fj I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered fori sale(Section 7044, o 7.2 0'` 8 8
Business and Professions Code). pool.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 ►
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorizerepres to e f this County to enter upon the
abov -m t+ d Eoperty or inspection pure
+ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perm)tT D ite