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Home My Public Portal About5917 MUSCATEL AVE_Plumbing__ 76AG67C (CE-81713) -9/79 y Y " - APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS Woff ATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST SHOWER 3 �—U OWNER LAVATORY MAIL ADDRESS c SINK C)TY ,. TEL.NO. DISHWASHER CONTRACT�'� h f CLOTHES WASHER f ADDRESS 3 0D SWIMMING POOL RECEPTOR r CITY Z_ TEL. N Q J LAWN SPRINKLER SYSTEMSTATE ��77 `G WATER HEATER LIC ENSE NO. `9!r `� CLASS 56Z6 e CD DISTRICT NO. I GROUP 111E I ROC ED BY v GAS SYSTEM OUTLETS Q OUTLETS OVER 5 PER SYSTEM INDUSTRIAL: L� W WASTE APPROVAL CIL INSPECTION RECORD Z Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE f Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. No. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 1 -HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES/ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST /5; ^•'+� 7f �� CALIFORNIA OR THAT. I AM THE LEGAL . OWNEj OF, AND INT ND TO RESIDE IN THE ABOVE DESCRI�ESIDENTIA PERTY.• UTILITY CO. NOTIFIED `S' J WV y SIGNATURE OF PERMITTEE. FINAL PLAN CHECK VALIDATION CK. M.O. CASH PER IT ALID ON CK. M.O. CASH 742ro-GEC 19.5U �: 01 7GA667 (C8-617.) - 1/75 �' - APPLICATION FPLUaNG PERMIT . COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER - BUILDING AND SAFETY DIVISION 7ADDRE AveKE CHECKS PAYABLE TO: 1 MI�SCatel /J'RST HARVEY T. BRANDT, COUNTY ENGINEER FOR'APPLICANT TO FILL IN (.P,RINT,OR TYPE) NEAREST . , CROSS ST. Garibaldi NUMBER FIXTURE OR ITEM @ FEE WATER.CLOSET 2.00" ' OWNER Umeda� Henry ' MAIL , BATH TUB 2.00 ADDRESS 5917ii. 'Muscatel SHOWER 2.00 CITY ,San Gabriel TEL. NO. 2 929 LAVATORY 2.00 CONTRACTOR We Di o Graham Plltlb SINK 2.00 ADDRESS 9127 Las Tunas Dr DISHWASHER 2.00 cITYTemple City TEL. No. 286-9293 C LOTHES.WASHER 2.00 STATE LIC. �` LICENSE_NO. -04'4b6 CLASS C-3Y SWIMMING POOL RECEPTOR 2;00 DISTRICT NO.GROUP ONE ESSED BY LAWN SPRINKLER.SYSTEM' 2,00 0 I WATER HEATER 2.00 OQ INDUSTRIAL WASTE APPROVAL GAS.SYSTEM OUTLETS 2.00 INSPECTION RECORD t, OUTLETS OVER 30 5 PER SYSTEM CC ' O h Z Plan Check fee See Reverse PLUMBING PERMIT ISSUING FEE $ o . TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan.check applicant. UNDER SLAB WORK Name .ROUGH PLUMBING Address GAS PIPING City TeJ. No.. GAS VENT HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND. STATE LAWS REGULATING, GAS TEST ` PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY 'REGISTERED AND/OR U.T1UTY!CO. NOTIFIED LICENSED AS REOy11RED BY LOS ANGELES COUNTY AND STATE OF - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AN5 •RD TO ' RESIDE IN THE ABOVE DESCRIBED RESIDENT A fIOPERT FINAL'. If-27-76 SI ONATU RE OF PERMI PERMIT VALIDATION K. .r M,o: CASH PLAN-CHECK VALIDATION, CK. M.O. CASH 5_0-4r" 22 W: 7.5 0.aye WOPdSERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby agirm that I have a certificate of consent to self 76A667A insure/or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) u it or0certiiied copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM (g FEE LOCALITY y� .� ' Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNERA14 (This section need not be completed If the work Involved by the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this F permit is issued, I shall not employ any person in any manner SINK CIT G9 TEL. N , '6,n, so as to become subject to the;Wor&keompensation Laws. DISHWASHERCONTRADate ' p !can9CLOTHES WASHER ADDRESS NOTICE AP LICANT: If, aftmaking this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. r deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRIP v. r PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS J` (! r (commencing with Section 7000)of Division 3 of The Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALV. IDATION n DATE C� - License Number Lic. Class F FINAL (, Contractor Date I am exempt under Sec. H BY ❑ B.BP.C. for this reason ® 4 Plan check fee e ate. PLUMBING PERMIT ISSUING FEE$ v Signature 61 2 4 A Plan check applicant TOTAL FEE # aoaaa5 SINGLE FAMILY o o 2 a 5 0 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address o o o 2 a 5�� Law for the following reason (Section 7031.5, Business and Profes 'ons Code): City Tel. No. 1 21 7 -86 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). 10. CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agoncy 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 tho above information is correct I agree to comply with all County 100 ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the above- entioned propert for inspection purposes nn SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permit Date