HomeMy Public PortalAbout5508 PARMERTON AVE_Plumbing__ 76AW 0A7 17 12/59 TEMPLE C'TY
,u APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUUJO,jDING� ES}FETY MSION aDDDmrG / OCOUNTY
JO N A I NGINEER ADDRVARWILLIAM A JENSEN SUP T oP BUILOIHOFOR APPLICANT TO FILL IN NEAREST'CROSS ST
NUMBER FIXTURE OR ITEMOWNERWATER CLOSET MAILADD BATH TDB TEL NOBRowEeCONTRACTOR
LAVATORYSm ADDRESSDISHWASHER CITY TEL NOCONTRACTORS STATE
LAUNDRY TUB REGISTRATION NOEj
CLOS WAS® DISTRICTNO GROUP ZONE I PRQCESSEDBY
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
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al
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Q El DOPER ITEM /� v
OR FnITURE E '/ APPROVALS D TE INSPE TOR S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK / 1A, e
TOTAL FEE ROUGH PLUMBING . J
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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 C IFY TH 1 PERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS EOUIRED B L GELES COUNTY AND STATE OF
CALIFORNIA 0 THAT 1 L GAL OWNER OF THE ABOVE
DESCRIBED RES IAL UTI LI7Y CO NOTIFIED
SIGNATURE L1 / B�
OF PER I FINAL U� Y
®. VALIDATION ROBERT.1
u ■ 0 uaN SUPERVISING MECHANICAL ENG R
LLfuG4626 � hulk330 5 D 600 °,
WORKERS CI have COMPENSATIONDECLARATION
of corse APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76q�7A ,
insure er a certificate of Workers Compensation Insurance CE 817(REV 10/81)
or a re'rhfied cothereof
Aetna Cathereof (Sec 38W Lob C )
CI 95858sualty ,& Surety
9CCOUNTY,OF LOS ANGELES / / BUILDING AND SAFETY
pl1�
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Company
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Certified copy s hereby furmshad
® FOR APPLICANT TO FILL IN(PRINT OR TYPE) , BUILDING
Certified copy ,s filed with the county building ,nspec- ADDRESS 5508 N. PARMERTON
tion department SERVAMATIC SOLAR NUMBER FIXTURE OR ITEM ® FEE LOCALITY
Date 9/9/83 Appl,tant SYSTEMS_ INC,- WATER CLOSET NEAREST TEMPI; CITY
CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST _
s COMPENSATION INSURANCE SHOWER OWNER ,NfCz`ERT`r LOUIS & MARY r
(This section need not be completed if the work Involved by
the permit is for one hundred dollars ($1170)or less ) LAVATORY MAIL
5508 N. PARMERTON
I certify that ,n the performance of the work for'which this
permit,s issued I shall not employ any person in any manner SINK CITY TEMPLE CITY TEL NG 448-3568
so as to become subject to the Workers Compensation Lows DISHWASHER + '
CONTRACTOR SERVAMATIC SOLAR SYSTEMS
Date Applicant CLOTHES WASHER ADDRESS 20290 E. CARREY ROAD
NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR
Exemption you should become subject to the Workers
Compensation provisions of the Labor Code you must forth CITY - WALNUT TEL NO 595-7433
with coin with such provisions or this,permit{sholl be LAWN SPRINKLER SYSTEM „
comply P p STATE LIC
deemed revoked I1 WATER HEATER s6lar 20 00 LICENSE No 390645 CUSS C36 SC44
LICENSED CONTRACTORS DECLARATION DISTRICT NO OCE55Eo Bdc
I hereby affirm that I am licensed under provisions of Chapter 9 ` GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER }
and Professions Code and my license,s,n full force and effect5 PER SYSTEM FINAL 7 9L�G 7 VALIDATION v
License Number 390645Lic doss C36 SC44 DATE
SERVAMATIC SOLAR SYSTEMS 9/9/83 FINAL p
Contractor Date BY U
❑ I am exempt under Sec
B &P C for this reason ;2 5 2 114 A Z
Plan check fee
Date s
#, 5
Signature 2 s 3 /t PLUMBING PERMIT ISSUING FEE$ 10 50 ile s a 5
, s 5 0 t
TOTAL FEE 30 50
Plan check applicant r•�' • vQ J Q2T5
SINGLE FAMILY O.9 1 1 4—83
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor s License Address
Law for the fallowing reason (Section 7031 5 Business and
Professions Code) City Tel No ' T
❑ I as owner of the property will do the work and the
structure ,s not intended or offered for sale (Section ► r ' '
7044 Business and Professions Code) _ ., • '
CONSTRUCTION LENDING AGENCY
I hereby affirm that there ,s a construction lending agencifor
the performance of the work for which this permit ,s issued
(Sec 3097 Civ C ) _
Lenders Name NONE '
Lenders Address
I certify that I have read this application and state that the ►
above information ,s correct j agree to complyiw,th all County - i
ordinances and State lows,reyulahng Plumbing, and hereby
authorize representatives of this County to enter upon the i
ve mentioned prop ty for pe<tion purposes '
' SEE REVERSE FOR EXPLANATORY LANGUAGE
9-8,�
ignoture of P r Wee Date _
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