HomeMy Public PortalAbout5549 NOEL DR_Plumbing__ 76A667 DER 17 11-50 APPLICATION FOR P,ERMT +
DEPARTMENT OFNG AND SAFETY PLUMBING
COIINTY OFF LOS LOS ANGELES
WILLIAM J. FOX. CHIEF ENGINEER
DISTRtUr. BROLIP I ZONL PLRMIT NO
.
FOR APPLICANT TO FILL IN �-1 I r 4
PLUMBER VALLEY BOULEVARD PLUMBING CO RECEIVED BY F,RREAINBPran EOTION DATE ISSUED
ADDRESS 8300 EAST VALLEY BLVD 2
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CITY ROSEMEAD TEL.No AT 2-2719 AODREm eSj- �L
L DEMBBY D 93M EXPIRES6-30- J oo LOCALITY
NEAREST
PERIM FEEs- . CROSS ST
NUMBER TYPE OF rIxTURE OR ITEM FEE OWNER
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MAIL
WATER CLOSET(TOILET) OBD III ADDRESS
BATH TUB ago CITY TEL No
BHOWER ago I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BABIN) ago APPLICATION AND STATE THAT THE ABOVE IN CORRECT
AMC AGREE TO COMPLY WITH ALL COUNTY ORDINANDEB
KITCHEN SINK ago AND STATE LAWS REGULATING PLUMBING
I CERTIFY THAT I POSSESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY 0513 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE r
GAB SYSTEM�OUTLETB O 50 •'
WATER HEATER 13513 SIGNATUREROF��� � w4
SLOP BINK O 50 ..����1����1����000000ION RECORD
FLOOR BINK 0513
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FLOOR DRAIN O 50
DISHWASHER ® ago * A/S TALC -7"l- me
DRINKING FOUNTAIN ® ago o
URINAL ago <
HOUSE BEWER ago Z
MISCELLANEOUS O
O
APPROVALS
DATE iN8PE0T0Rv6 NAME
ROUBH PLUMBING f✓`-'
GAB PIPING
GAB VENT
CESSPOOL 411 ADD CEBBPOOL
SEPTIC TANK BEPTIC TANK
DRAIN ( ) PIT ( ) 41 t Do NEWER
PERMIT IOD GAS TEST V
UTILITY CO NOTIFIED
TOTAL FEE
jSt
• FINAL
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WORKERS COMPENSATION DECLARATIp,N. APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A
insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81)
or a certified copy thereof(Sec 3800 C COUNTY OF LOS ANGELES BUILD"Ay SAFETY
Policy No Company
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING e
Certified copy is filed with the coun builds inspec- ADDRESS 7
tion deportmenjt NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date-III �-+ Appli4ant WATER CLOSET NEAREST ,
CERTIFICATE OF EXEMPTION OM WORKERS' BATH TUB CROSS ST
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work Involved by MAIL
the permit is for one hundred dollars($100)or less) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner SINK CITY TEL N
so as to become subject to the Workers Compensation Laws DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR
Exemption you should become subject to the Workers CITY TEL N0 77)iya'1d
Compensation provisions of the Labor Code, you must forth=
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO CLASS G
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I hereby affirm that I am Incensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER OL
and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION O
/ l DATE �"� '�� V
License Number Lic Class
FINAL O
Contracto Date BY V
❑ W
I am exem c d.
N
B&P C for this reason Plan check fee a
Date PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE
SINGLE FAMILY
Plan check applicant
- ,
HOME OWNER-BUILDER DECLARATION Name 9 4 3 8 A
I hereby affirm that 1 am exempt from the Contractor s License gddress
Law for the following reason (Section 7031 5 Business and # • •i• • • 5
Professions Code) City Tel No
❑ I as owner of the property will do the work and the 2 - . 1650
structure is not intended or offered for sale (Section
7044 Business and Professions Code) •�• • Jr c=i
CONSTRUCTION LENDING AGENCY 0128-83
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 )
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 jaws regulating Plumbing and hereby
authorize representati of this County to enter upon the
above me coned pro ert for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
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Sig V
re 6f Permittee Date