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Home My Public Portal About6023 PRIMROSE AVE_Plumbing__ 76A567'(CE-817)-4/72 , APPLICATIO FO.R P MBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: ADDRESS Q o� AV/is HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) CNEARESTROSS ST ST. e NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 1.75MAIL BATH TUB 1.75 ADDRESS SHOWER. 1.75 CITY TEL.NO. LAVATORY 1.75 CONTRALTO rL0 � SINK 1.75 ADDRESS DISHWASHER 1.75 CLOTHES WASHER 1.75 fTATE LIC LICENSE NO./Q CLASS SWIMMING POOL RECEPTOR 1.75 1�11RICT0. GJ,1P NEJC P CESSEBY LAWN SPRINKLER SYSTEM 1.75Iyl WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL p GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM .30 p ti Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. NO. GAS VENT HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY . PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY C.O. NOTIFIEDLI CN ., COUNTY ANO.STATE OF CALIFORNIA OR THAT I AM THE LEGALBY LOSLES OWNER OF, AND INTEND TO' ShtO� PAP RESIDE IN THE ABOVE DESCRIBED RESIOENJ&A6 PROPERTY FINAL q SIGNATURE `� • D�7� /Jr � � OF PERMITTE PERMIT VALIDATION cK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 2 0. 80"ZMAY 29 5 D 4.7 5 ,&S'8 76A667—CE 817466 _ •a APPLICATION FOR PLUMB NG PERIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BU IN 6023 North Primrose Avenue JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple City, California NEARES FOR APPLICANT TO FILL IN(PR NT OR TYPE) SCROSS T. NUMBER FIXTURE OR ITEM EACH FEE OWNER Ray Rushton. WATER CLOSET 1.50 MAIL BATH TUB 1.50 ADDRESS SHOWER 1.50 CITY Stene TEL.NO.. LAVATORY 1:50 CONTRACTOR Pacific Instal lers Inc.. SINK Lso ADDRESS 10920 E. Grand Avenue DISHWASHER 1.50 CITY e171- .e City-., .No. CLOTHES WASHER 1.50 !�TATE LIC LICENSE N0.2�,�,s 8 CLASS C 2Q SWIMMING POOL RECEPTOR 1.56 DISTRIt GR ZONE P O S BY LAWN SPRINKLER SYSTEM 2.00 1 WATER HEATER 1.50 150 INDUSTRIAL STE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPE ION RECORD O OUTLETS OVER 30 1i l9 , ,7 �at4y 5 PER SYSTEM / / /1� ate. Vf z Plan check fee 25% of above. See reverse. i PLUMBING PERMIT ISSUING FEE S 2 00 TOTAL FEE 0 I APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City. Tel. No. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND 6REE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES jgrATE REGULATING GAS TEST PLUMBING. 1 HEpEBY CERTIFY THAT 1 AM RED AND/OR UTILITY CO.NOTIFIED LICENSED ASREQUIRED BY LOS AND STATE OF CALIFORNIA OR THAT 1 AM THE LED INTEND TO RESIDE IABOVE ED rv. FINAL 6 sIGNAT JACK R. ALLEN, SUPERVISD.K CHANICAL ENG'R. OF PERMI PERMIT VALIDATION M.0. CASH. PLAN CHECK VALIDATION CK. M.O. CASH WORKERS'COMPENSATION DECLARATICAN ' i APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have o certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800, Lab. C.) j COUNTY OF LOS ANGELES BUILDING AND SAFETY PolPolicy No. Company Certified copy is hereby furnished. , BUILDING �j pay F-1FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS `! �C Certified copy is filed with the county building inspec- tion department. , NUMBER FIXTURE OR ITEM @ FEE LOCALITY � Date Appligant WATER CLOSET @Q' NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER d OWNER `( (This section need not be completed If the work involved by the permit is for one hundred dollars($100)or less.) LAVATORY L� MAIL /� ADDRESS CJ I certify that'in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY - EL. NO.C9 7 so as to become subject to the Wor rs'Compensation Laws. 1�k: — -DISHWASHERA# �0� CONTRACTOR 9 6 Date Applicant CLOTHES WASHER ADDRESS it NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY If TEL. NO. « Compensation provisions of the Labor Code, you must.forth LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be 7 1 STATE t LIC. f IF deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT N PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER !v and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL , { �►f VALIDATION DATE License Number Lic. Class i L Ila FINAL cr 0 Contractor. Date BY I am exempt under Sec. � eN B.BP.C. for this reason � Plan check fee 100 Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant' SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 6, AMU, v I hereby affirm that I am exempt from the Contractor's License . Law for the following reason (Section 7031.5, Business and Address 2 Professions Code): City- em 10 I. No. & 7 L� I, as owner of the property, will do the work and the , ` C G S 5 A. structure is not intended or offered for sale (Section 7044, Business and Professions Code). 1 0 0 0 0 0 5 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 0 0 L'. 0 5 0 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). ' i1• % t. Lender's Name 7 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 regulating Plumbing, and hereby authorize representatives of this County to enter upon the &Gove-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 5A 7 Signature of Permittee Date