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Home My Public Portal About9454 OLEMA ST_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of Engineer DIVISION OF BUILDING & SAFETY WILLIAM J. FOX, County Engineer PLUMBING I D STRO. GROUP Z . FOR APPLICANT TO FILL IN re-J-1 001/ 6/15126 PLU BER RECE WED BY READY FOR DAT ED FIRST INSPECTION . ;D ADDRESS 04Y wv BUILDIWG CITY L>17TEL No. ADDREDRE SS `� T COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST • PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER WdA , WATER CLOSET(TOILET) 0 d 1.1513 B 440 ADDRESS 7 BATH TUB ® 11 13 DrrY EL No. SHOWER @ O 50 1 HEREBY CKNOWLEDGE HAT I HAVE READ THIS LAVATORY (WASH BASIN) SO APPLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK Q I 5D ® AND STATE LAWS REGULATING PLUMBING. 1+ 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 50 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER 1 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOV GAS SYSTEM OUTLETS Sb d' WATER HEATER 0 5p SIGNATURE:TEF �C GLOP SINK @ 6 5p INSPECTION RECO FLOOR SINK SO FLOOR DRAIN Is.91 y DISHWASHERO5 F•'s�'� ! DRINKING FOUNTAIN 6 OppO 54 7- Y,1 i //i, URINAL HOUSE SEWER 0.50 '� - S 3 C '11t � � �n(/�� ? MISCELLANEOUS , O QA LY ° I APPROVALS DATE /INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT / `�.� fir✓+ CESSPOOL 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) 0) 1.00 SEWER p�yy�� 1 PERMIT 1.D0 GAB TEST P 10 V -3 �,,/�(/ UTILITY CO.NOTIFIED --30 O L TOTAL FEE S ® FINAL1+.�� r�c�(' 7GA667 DBS#17 10/58 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A666 DPW 4/87 [� sure,or a certificate of Workers'Compensation Insurance,or a CE 81 7` ) luI P CE 817 REV.8/86 City of Temple City Policy ied copy thereof(Sec. mp lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. 201916 Company SCTF i 5031 F1 Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS 454 Olema St. department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY -,reMpl_a City (TOILET)Date *_l_gg APPIicaGpnPral =nG ,- ta� . WATER CLOSET(TcRossssT. a Cit Blvd. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 9454 Olema St I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY iffFT-2287-5026 as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTORreneral installation Co . Date Applicant CLOTHES WASHER ADDRESS 6558 West Blvd. NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- sation provisions of the Labor Code,you must forthwith comp- LAWN SP LER SYSTEM CITY Los An eleSEL' NO.753-2541 ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. 1 WATER HEAT M LICENSE NO. 151839 CLASS C3 6f LICENSED CONTRACTORS DECLARATION DIST NQQ-- P CESSED I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM AN- OUTLETS i/ 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER (� fe d Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL Q VA TION � DATE /5 v O License Number 151839 Lic. Class C36 V FINA Ic Contractor W- 0. PrOV in Date 4-55 BY O ❑ I am exempt under Sec. W IL B.BP.C. for this reason Plan check fee rA 02&.6A � g Date: PLUMBING PERMIT ISSUING FEE$ 10.50 o o ]j O 00h.0 h U Signature TOTAL FEE 16.50 0 0-0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 07.20-88 1 hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, Business and Professions Code). 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 reg Plumbing, and hereby authorize representat' of is C my to enter upon the above-m n' n d op y or 1 s ction pur oses. ! rIj&PEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date