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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAMT
10 31 E. Olive
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A.JENSEN, SUP'T OF BUILDING Temple Cj,(,
FOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM EACH • FEE
OWNER Badd
2 WATER CLOSET $1.25 2.150 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.251 25 CITY TEL. NO.
2 LAVATORY 1.25 2 CONTRACTOR Ovren Bros. Plumbing
1 SINK 1,25 1 �5 ADDRESS 4265 N. Baldwin. Ave.
DISHWASHER 1.25 CITY El Monte TEL' NO.
LAUNDRY TUB 1.25 REGIS�TRAATION NO. 197184 COUDP1�jr p
1 CLOTHES WASHER 1.25 1 2 DISTRICT NC. G OUP E P CESSED BY
WATER HEATER 1.50 ---f/ s�
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GAS SYSTEM OUTLETS 1.50 0 INDUSTRIAL n
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD V
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APPROVALS DATE INSPECTQ 'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 1 00 GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 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
PLUMBING. HOT WATER HEATER`
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES,
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE ESCRISED RESIDENTIAL PROPERTY. UTi LITY CO.NOTIFIED
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SIGNATURE Z-��.. '� Vl•
OF PERMITTEE
FINAL l
LIDATION ROBERT A.WOOD
CK.
M.0. CASH SUPERVISING MECHANICAL ENG'R
LAC0 3 3 9 5% SEP 1 5 D 15.00- 17
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
ereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87
sure, or a certificate of Workers'Compensation Insurance, 76A667A City of Temple City
a certified copy thereof(Sec. 3800, Lob. C.) I COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS
licy No. 6969-OQ94any M: C 114910
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec- ADDRESS 10531 Olive .Street
tion department. NUMBER FIXTURE OR ITEM � FEE LOCALITY
Tem le Cit
to 4/1/93Appti4.ntgeneral Install. WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. El Monte Ave.
COMPENSATION INSURANCE SHOWER OWNER Thomas e
his section need not be completed if the work Involved by MAIL
e permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS S e
ertify that in the performance of the work for which this
rmit is issued,I shall not employ any person in any manner SINK CITY W-448-0703
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOGeneral Installation Co.
to Applicant CLOTHES WASHER ADDRESS
TICE TO APPLICANT: If, after making this Certificate of 6558 West Blvd.
emption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
CITY Los Angeles TEL.No.753-
25
mpensation provisions of the Labor Code, you must forth- LAWN$PRINKLER SYSTEM
1h comply with such provisions or this permit shall be '9 STATE LIC.
emed revoked. 1 WATER HE '7 6 ® LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DkTRICT NO,./ PROCESKD BY
ereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
mmencing with Section 7000)of Division 3 of the Business OUTLETS OVER 41' U
d Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL Ail! ATIOHO
DATE
ense Number 151839 Lic. Class C36
4/91 BYALFIN
LI r
ntractor W.0_ Pr(yin Date O
I am exempt under Sec. LL
i..
B.BP.C. for this reason Plan check fee1100U
Date: G
PLUMBING PERMIT ISSUING FEE$ 10
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY E
HOME OWNER-BUILDER DECLARATION Name R%ti T°v
reby affirm that I am exempt from the Contractor's License Address
for the following reason (Section 7031.5, Business and nIZ7 [�.5)j
,`4
fessions Code): City Tel. No. i T TECl3
1, as owner of the property, will do the work and the _ _
structure is not intended or offered for sale (Section ® Trl7hL. 23 o 53
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCYL=4
ereby affirm that there is a construction lending agency for
performance of the work for which this permit is issued
c. 3097, Civ. C.).
der's Name 13401 1 Aft 1)3 u`6
der's Address
ertify that I have read this application and state that the
ove information is correct. I agree to comply with all County lop
finances and State laws regulating Plumbing, and hereby
thorize represent sof this County to enter upon the
ove-m q pr !y for inspection purposes.
�j r SEE REVERSE FOR EXPLANATORY LANGUAGE
4/19/90
nature of 14rmittee Date