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HomeMy Public PortalAbout9903 NADINE ST_Plumbing__ 79A667 TY 5-49® APPLICATION FOR PERNIIT ' DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER PLUMBING 1 FOR APPLICANT TO FILL IN DISTRICT GROUP ZONE PERMIT NO. FADD ER VA LEY QOUCEVARD PLU-MOING -ry RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION 't SS -966 EAST VALLEY BLVD. CITY ROSEMEAD BUILDINGasp� TEL. NO. ADDRESS COUNTY 9n �A (CENSE NO. 73M EXP( ES �/ LOCALITY NEAREST Pte. FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL / WATER CLOSET TOILET 0.501,5--0 ADDRESS V .y- ` BATH TUB O.50 -� CITY TEL. NO J SHOWER O.SO I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY WASH BASIN) 0.50 SO APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK (� 0.50 v STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS I LAUNDRY TUB OR TRAY O.SO Q ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER _ OF THE RESIDENTIA P PERTY DESCRIBED ABOVE, r GAS SYSTEM OUTLETS @ 0.50 SIGNATURE OF WATER HEATER ® 0.50 PERMITT SLOP SINK o.sO INSPECTION RECORD FLOOR SINK 0.50 FLOOR DRAIN (g7 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN 0.50 URINAL C4? 0.50 HOUSE SEWER 0.50 a _Z MISCELLANEOUS G_ O APPROVALS DATE 1 PECTOR'S NAME .ROUGH PLUMBING / S GAS PIPING /� 2 GAS VENT r/ CESSPOOL 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT 1.00 SEWER PERMIT . 1.00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE FINAL yt"W R'SCbMPENSATIONDECLARATION 200028 DPW 9/89 �ppLICi4T^�DN FOR PLUMBING PERMIT Ll 76AS67A 'I.he�by�-af�4rm t I have a certHtcate of consent to self Insure, -or a cedtificate of Workers-Compensation Insurance, or a certified I copy thereof(Sec.3800 Lab.C.) ❑ Policy No:10-0489604.�mp�y CNK.Ins.. Co. COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.~- ..-----w- . 99.m3 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING , Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY _ :Temple City Date 2-20-92 'ApplicanQwen Bros. Plumbing WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCEMAP BOOK PAGE PARCEL ASSSOR (This section need not be completed If the work Involved.by:tne 1 'SHOWER 14' 55 permit Is for one hundred dollars($100)or less.) 3 LAVATORY 43 65 OWNER Lar Dunn I certify that in the performance of the work for which this permit MAIL Is issued, I shall not employ any person In any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITY Monrovia TEL.NO.•359-1714 Date Applicant 1 CLOTHES WASHER •14 55 NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Owen .Bros-. 'Plumbing, InC'. Exemption,you should become subject to the Workers'Compensation -. SWIMMING POOL RECEPTOR ADDRESS 4265 N.: .Baldwin Avenue provisions of the Labor Code, you must forthwith comply with.such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM 443-0078 LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 1 WATER HEATER 14 155 a (commencing with Section 7000) of Division 3 of the Business and STATE GAS SYSTEM OUTLETS LICENSE NO: 231'. '741 LIC. C36-20-16 U Professions Code,and my license Is In full force and effect. 1 3 14 55 OUTLETS OVER DISTRICT NO. PR Y Q 5 PER SYSTEM Q 231 741 G36-20-16 - �,©8 License Number Lic.Class 4 V Owen .Bros. Plmb. ' oa VALIDATION AL a Contractor Date 2-20-92 �l`� CD "1 ? ❑ I am exempt under Sec. FINAL BY B.BP.C.for this reason Date: Plan check fee , Signature,,. PLUMBING PERMIT ISSUING FEE$ 24 74 ❑ TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am.'exempt from the Contractor's License Law for the following reasori-(Section 7031.5, Business and Professions Address Code): "Al I _70 a I,as owner of the property,will do the work and the structure City Tel.No. Is rMigUnded or offered for sale (Section 7044, Business t_i�L?,� 1.7:€n�4 and Professions Code). J r , CONSTRUCTION LENDING AGENCYrt�;1r 1 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.) --rf t_€t E �i,L-r.. 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 n S ate laws regulating Plumbing, and hereby authorize e nta Ives Ahis County nter upon the above-mentioned rt f i oar p os SEE REVERSE FOR EXPLANATORY LANGUAGE 2-20-92 nature of Permi a Date