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Home My Public Portal About9555 PENTLAND ST_Plumbing__ 76,A 667 --CE 817 7-69 CITY (Fr TEMPLE Ci17 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES -DEPARTMENT OF COUNTY ENGINEER N svic LDl BUILDING AND SAFETY DIVISION BUILDI C JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple City— "FOR.APPLICANT TO FILL IN PR NT OR TYPE NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEET OWNER WATER CLOSET 1.50 GAIL BATH TUB 1.50 ADDRESS 0535 Pentland SHOWER 1.50 C1 ty TEL. N LAVATORY 1.50 CIONTRACTOR TALLERS INC o- r SINK 1.5.0 ADDRESS I 99n E. Grand Avg DISHWASHER 1.50 CITY r1i'1 p p TEL.NO. P-707 CLOTHES WASHER 1.50 TATELic LICENSE NO. 213 898 CLASSC=20 SWIMMING POOL RECEPTOR 1.50 No DISTR C NOS GROU Z E P CE BY LAWN SPRINKLER SYSTEM 2.00 C/Ji WATER HEATER 1.50 1.50 INDUSTRIAL rPTE APPROVAL GAS SYSTEM OUTLETS 1.50 i INSPECTION RECORD u OUTLETSOVER / 5 PER SYSTEM .30 ;�—�1��'T/' i'f0 Cl � '1 ra Ile— O I � Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE S 2 '00 TOTAL.FEE 3.50APPROVALS DATE INSPECTOR'S SIGNATURE Plan check appllCant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING 6AS VENT City, Tel. NO. HOT WATER HEATER i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSEW AS REQUIRED BY LOS ANGELES COUNTY AND STATE OP CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND T RESIDE IN,THE ABOVE DESC D IDENTIAL PROPERTY. .FINAL .0 C, SIGNATURE JACK R. ALLEN, SUPERVISING MECHANICAL EN'G'R. OF PERMITTEE PERMIT VALIDATION M.O. CASH PLAN.CHECK VALIDATION CK. M.O.- CASH I 04 ION WORKER'S I have a certificate of consent to 76A666DPW9/89 AIBP CATT OIIYI FOR If'll�C�9�yIJBPNC% PERMIT 76A667A l t "I� I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) r City o� Temple City 6969-OOQ( ,pang NMT(' COUNTY CF LOS AI WE@f emPlkl�bg PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. ❑ Certified copy is hereby furnished. 6 FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 9555 13 Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM ® FEE Date 4/1/91 A licant (man LOCALITY PP ex'e�l �;}$.��x, WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. COMPENSATION INSURANCE BATH TUB ncinl a ASSESSOR (This section need not be completed If the work Involved by the SHOWER MAP BOOK PAGE PARCEL permit Is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORYErmiest Smith MA Is issued, I shall not employ any person in any manner so as to SINK ADDRESS 955 Pentland become subject to the Workers'Compensation Laws. DISWASHER CITY TEL.NO. Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of General Installation CO. Exemption,you should becomesubject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code,you must forthwith comply with such ADDRESS 6558 West Blvd. provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 1 WATER HEATER — d (commencing with Section 7000)of Division 3 of the Business and STATE LIC. Q GAS SYSTEM OUTLETS LICENSE NO. CLASS (� Professions Code,and my license is in full force and effect. 36 OUTLETS OVER DISTRICT NO. PROCESSED BY Q 5 PER SYSTEM rJ Q License Number 151839 Lic.Clas J. a V VIM FINAL p DATE .Z,., / d VALIDATION W Contractor ,(1 pSoTi�% Date 4�i (n ❑ I am exempt under Sec. FINAL Z B.&P.C.for this reason Date: Plan check fee PLUMBING PERMIT ISSUING FEE$ Signature ❑ TOTAL FEE Plan check applicant SINGLE FAMILY c HOME OWNER-BUILDER DECLARATION IvZrAe I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address "'' .7 Code): F1 1, Tel.No. I,as owner of thero ert ,will do the work and the structure f P P Y is not intended or offered for sale(Section 7044, Business _ and Professions Code). > 20 =ff CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the .3W Civ.performance of the work for which this permit is issued(Sec.3097, t' ' SE Civ.C.) Lender's Name r '10"• 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 re sting Plumbing, and hereby authorize representati his ounty to enter upon the above-mentioned propert ins ect' purposes //�//r > SEE REVERSE FOR EXPLANATORY LANGUAGE