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HomeMy Public PortalAbout10566 OLIVE ST_Plumbing__ 7GA667-CERS17 2-66 B16136 CITY OF TEMPLE CITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 10566 Olive COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Tem le Cit FOR APPLICANT TO FILL IN NEAREST O 1 ive NUMBER FIXTURE OR ITEM EACH FEE OWNER Thomas Brummitt WATER CLOSET ;1.25 MAIL RATH TUR 1.25 ADDRESS Same SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR General Installation Co. SINK 1.25 ADDRESS 6558 West Blvd. DISHWASHER 1.25 CITY Los Angeles TEL. NO. PL 3-2541 STATE LAUNDRY TUB 1.25 LICENSE NO. 0-36 151839_ CLASS CLOTHES WASHER 1.25 DISTRICT NO GRO Z P E D BY WATER HEATER 1.50 V e C' i GAS SYSTEM OUTLETS 1.50 WDUSTRIASTE P1PROVAL a OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V CD WATERSOPTRNBR 1 50 ' Ready for Inspection Now o rJ W N C) Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT 50 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER L UMBING.HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFGAS TEST LIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TOIDE IN,THE ABOVE DESCRIBED RESTIPROP Y. UTILITY CO.NOTIFIED NATUREF PERMITTEE FINAL :t / VNALIDATION JACK R. ALLEN cK. M.0. CASH SUPERVISING MECHANICAL ENG'R. LkW 1 6 1 7:0- Nov 8 5 0 3.50- 17 pf, ERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I here thiaf-1.have a certificate of consent to self 76A667A i'insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certifiEd copy thereof(Sec. 38000, ab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY P❑olicy �Company J J Certified copy is hereby furnished. ` ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING C Pte' o `,n Certified copy is filed with the county building inspec- ADDRESS G VCi tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY to 10D Date Appl)4ant WATER CLOSET NEAREST , CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. I COMPENSATION INSURANCE SHOWER OWNER •e:% (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this i permit is issued,I shall not employ any person in any manner SINK CITY TEL..NO !I Ifso as to become subjeVtoa Workers' m nsation Laws. DISHWASHER CONTRt—q-01? Shp OA Cjory+ Dat ' CLOTHES WASHER A Q/� �Q ti NOTICE TO APPLICANT: I , f er making this Certificate of SWIMMING POOL RECEPTOR r \�L � Exemption, you should become subject to the Workers' 891 Compensation provisions of the Labor Code, you must forth- CITY cAa TEL. Nr LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE !�s��6 LIC. n deemed revoked. WATER HEATER LICENSE Na ill= CLA Vr LICENSED CONTRACTORS DECLARATION DISTRICT NO. P E ED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL l/J VAL ATION } License Number— 105 2 Lic. Clas G? & DATE lj I a ContracTt�2 �/�& Date `'So 87 FIN U� ❑ ;l I am exempt under Sec. a�U B.B.P.C. for this reason W Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ "D z Signature TOTAL FEE 3 .150 Plan check applicant SINGLE.FAMILY 1 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address i Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the ;9469.28 structure is not intended or offered for sale (Section ` f i # 0 0 0 0 0 Co 7044, Business and Professions Code). ` CONSTRUCTION LENDING AGENCY � n .1 0 0 3 4.5 the performance of the work for which this permit is issued o 0 0V (Sec. 3097, Civ. C.). © 1 522-86 4. I Lender's Name i . I 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 ordi nces and State laws regulating Plumbing, and hereby out o ize representative f this County to enter upon the ab - enti ned prop ty r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE lo&vv ofur of Perm'. ee Date