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Home My Public Portal About9855 MILOANN ST_Plumbing__ 7SA887 (CB-817) - 1/75 ` JI APPLICATION FOR PLUMBING PERMIT ik, COUNTY OF LOS ANGELES DEPARTMOT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE .CHECKS PAYABLE TO: ADDRESS 98 uiiloann HARVEY T. BRANDT, COUNTY ENGINEER. LOCALITY. Temple City FOR APPLICANT TO FILL. IN (PRINT OR TYPEI CROSS STT. Agnes- St . NUMBER FIXTURE OR ITEM ® FEE OWNER W. V. Graham WATER CLOSET 2.00 MAILp Miloann BATH TUB 2.00 ADDRESS 7 �5 p SHOWER 2.60 CITvTemple City TEL. NO. 287 1280 LAVATORY 2.00 CONTRACTOR Valley -Heating Co . SINK 2.00 ADDRESS 305 E Valley Blvd. DISHWASHER - 2.00 CITY San Gabriel TEL. No.288 6812 CLOTHES WASHER 2.00 STATE (.,( LIC LICENSE NO.I / 7 7 CLASS ;?_10 SWIMMING POOL RECEPTOR 2.00 DISTRICT NO.GROUP ZONE CES ED LAWN SPRINKLER SYSTEM 2.00 `U + �7'LOti WATER HEATER 2.00 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 2.00 U INSPECTION RECORD V OUTLETS OVER 30 p 5 PER SYSTEM FF I C7 W CnO- Z Plan check fee )See Reverse PLUMBING PERMIT ISSUING FEE S TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. NO. GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THOT WATER HEATER HIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TD CoMPLY 'PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS ULA'TING - PLUMBING. GAS TEST Mud �P'y I HEREBY CERTIFY THAT I M PROPERLY GISTERED NO/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY ANGELES NTY AND S AT F _ CALIFORNIA OR THAT 1 A E LEGAL 0 ER OF, iCdSiR TO ,. RESIDE IN THE ABOVE IBED RESIDE IAL PROPERTY. - lD I NAL S I G NA.TU.R E'. OF PERMITTEE PERMIT VALIDATION K'. M.O: CASH PLAN CHECK .ALIDATION CK. M.D. CASH 6 8109DLC 9 5 a 7.5 0 ems WORKERS'COMPENSATION DECLARATION 76AG67A I hejeby aff'rm that I have a' certificate of consent to self CE 617 (2.66) APPLICATION FOR PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 0-1 -(EYA?LZ Ql Certifie opy is hereby fur FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING rlTlN'MBER FIXTURE OR ITEM FEE ADDRESS 1111 Cer ' ed co is filed ith the county buil ng inspectio LOCALITY p n ' WATER CLOSET Dat plican NEAREST BATH TUB CROSS ST. �"��+• CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER MAI L c� (This section need not be completed if the work involved LAVATORY ADDRESS ESS a� by the permit is for one hundred dollars ($100) or less.) SINK CITY—' TEL.NO. (� I certify that in the performance of the work for which this DISHWASHERIr permit is issued, I shall not employ any person in any manner CONTRACTOR - 0 so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS [O1 PC � Date Applicant SWIMMING POOL RECEPTOR LU NOTICE TO APPLICANT: If, after making this Certificate of CITY �' - TEL.NO. V2-?�70 N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE t t�q LIC. e Compensation provisions of the Labor Code, you must forth- WATER HEATER 3 co LICENSE NO. Q r IO / CLgSS 62 92 with comply with such provisions or this permit shall be deemed revoked. GAS SYSTEM OUTLETS DI1�NO. P C SSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER C�/Pi 0, �'Uf I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 t e Busi- FINAL IDATION ness and Pro ode, and my license is in 1 f rce and DATE effect. FINAL 'cans N e ' .Cl BY ElI am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ QO acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE p 00 Lic,or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name C I hereby affirm that I am exempt from the Contractor's Address #t a 0 0 0 0 5 License Law for the following reason (Section 7031.5, Busi- City Tel.No. 2 0 0 1 0.00 nese.and Professions Code): I, as owner of the property, am exclusively contracting / �� 0 0 0 1 with licensed contractors to construct the project o� (Section 7044,Business and Professions Code). 0 602-81 CONSTRUCTION LENDING AGENCY I 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.). � � �� FINAL Lender's Name INSA�CTI�N Lender's Address I certify that I have read this applicatio ate that the tSign!atu wittee I agrmDate all Count SEE REVERSE FOR EXPLANATORY LANGUAGE egulnd her his u e r ns WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT +, ' 76A666 DPW 4/87 I htTM-eb�s,'af€frm,that I have a certificate�of consent to self in- j6A667A • sure `-Wa cert.ificate of Workers'Compensation Insurance,bra CE 817(REV.8%86) certified cop�thereof.(Sec. 3800, Lab. C:) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ; Certified copy is hereby furnished. FOR APPLICANT TO FILL.IN(PRINT OR TYPE) BUILDING aa �• �/IL�J^ ! Certified copy is filed with the county building inspection ADDRESS 7 S.J /YI �NN department, NUMBER FIXTURE.OR ITEM @ FEELOCALITY A w Date Applicant `t!•+ /6 2V NEAREST 715FM L& c WATER CLOSET(TOILET CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB �t' / o CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by n JC�-1 G� M/� 6r the permit is for one hundred dollars($100)or less.) LAVATORY N� 3 P J ADDRESS J 85.5 /e■l��NN I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK CITYT�+ TEL. N2 ss�2 (30 as.to become subject to the Workers'Compensation Laws. DISHWASHER ' CONTRACTORS` Date Applicant CLOTHES WASHER ADDRESS �V S� /M/6.1L(c��/�lJ�/ NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Com pen- CITY TEL. NO. sation provisions of the Labor Code,you imust forthwith comp- LAWN SPRINKLER SYSTEM I.y with.such provisions or this permit shall Lie deemed revok- STATE LIC. ed. 'WATER HEATER /1 "LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION C/ DISTRICT NO. ROCES$ED BY I hereby affirm that I am licensed under.provisions of Chapter GAS SYSTEM OUTLETS , D 9(commencing with Section 7000)of Division 3.of.the Business OUTLETS.OVER fe a, Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION a DATE ( f O License Number Lic. Class C7 FINAL 1Z Contractor Date BY" _AA O I am exempt under Sec. W d B..&P,C. for this reason /J Q ► g Plan check fee Date:' PLUMBING PERMIT ISSUING FEE$ / .Signature TOTAL FEE f �Q SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and �, /'t y AN ri•lr t e R' Pr�fessione.): Address � i_, . 7 F1,�il.J Cit Tel. No. -x{'37 er of the property, will do the work and the Y gy. structure is not intended or offered for sale(Section 7044, T,0I p1.J Business and Professions Code). CONSTRUCTION LENDING AGENCY ® TOTAL 7_, -!TO I hereby affirm that there is a construction lending agency fori133 r€ �.5i1 r i��l•T� the performance of the work for Which this permit is issued ��•_,. �_;{ (Sec. 3097, Civ.: C.). i; (LIGE Lender's Name r' :•i Lender's Address I certify that I.have read this application..'and state that the + i'ii3t Arl 7-.57 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 propert for inspection purposes. • SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ;