HomeMy Public PortalAbout6232 PRIMROSE AVE_Plumbing__ sBABae• n s�o APPLrATION FOR P>BBUT
D>�ASTJl�iT OF SOlJmG AND SAFETY
COUNTY OF LOS ANGEM PLUMBING 1
WILLIAM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRI?O. . GROUP I ZONE PERMIT NO.
ININTERBOTTOM BROS., `3
PLUM■ER RECEIVED BY READY FOR DATE NISUED
WESTMINSTER AVE. PIRST INSPECTION
ADDRESS 1112
BUILDING
CITY ■■aa TR NO ADDRESS
Aviv-
COUs 0 d 19 IDIP1R (Phnom LOCALITY
P»T Fm c�ei• TawL.0 G OTY lBLVIi o
OWNER Mama Land p'
NYMSSI! 'rYfN OF rI7I'Rlpt OR NUN FEE CO•
WATER CLOSET TOILET O.P& MAIL MAIL
3612 E o LOVE OAd AUL'ta
MATH TUB 0.50 CITY A 940OAn COL I r. TEL.No.
SHOWKR_ O.BO I HERESY ACKNOWLEDGE THAT 1 HAVE READ THIS
(WASH BASIN O.BO p
APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
LAVATORY
AGREMTO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN BINK 0.00 STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POESESB THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY O.■ OF,r LES COU LICENSE. OR t MRISTW LEGA` OWNER
pax ism
GAB SYBTEuOUTLETS 0.00 BI
WATER HEATER O.BO P MITTAg 1w.
SLOP BINK a.00 mmmcmcm BBC
FLOOR SINK O.BO
FLOOR DRAIN 0.1110
DISHWASHER 0.110
• DRINKING FOUNTAIN 0.50
URINAL 0.00 ,J
�. HOu■i SEwiR
0.90 Z
MISCELLANEOUS m
S
O
APPSOVAN
DATE IN •� NAME
Y
ROUGH PLUMBING I ,
'yam GAS PIPING
GAS VENT ,
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
+ DRAIN I ) PIT I ) B I.00 emm
PERMIT . 1.00 GAS TEST FRAL 1-k-y.3
UTILITY Co. NOTIFIED �11 A#6
TOTAL FEE s .
FINAL
W6RKERS'COMPENSATION DECLARATION /A j�j�p 0CATI N FOR
PLUMBING
UMBI G PER IT
ItSereby,affirm that I have a certificate of consent to self in- 76A66jq PW 490 6=c4u u I5 LS !v® tl! ■ SY!
sure,or a certificate of Workers'Compensation Insurance,or a
certified copy Onbt(Sec. 3800, Lab. C.)
Policy No. 3511)555 Company narnror Tn RF_T,4TY COUNTY ®F LOS ANGELES DEPT. OF PUBLIC WORKS
❑ ertified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 6232 PRIMROSE
Certified copy is filed with the ounty building inspection
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY TEMPLE CITY, CA
Dtlte 06/24/96 Applicant WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER ROBIN
BRANNUM
(This section need not be complotod If the work Involved by MAIL 6232 PRIP9ZOSE
the permit is for one hundred dollars($100)or loss.) LAVATORY ADDRESS
I certify that in the performance of the work for which this per- SINK CITY TEL.
mit is issued, I shall not employ any person in any manner so TEMPLE CITY, CA 91780 X8/285-7393
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR FRANK MARRONE & SONS, INC.
Date Applicant CLOTHES WASHER
ADDRESS 9860 LOWER AZUSA ROAD
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY EL NDNTE, CA 91731 TEL819/444-2548
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. 397884 CLASSC/36 C/16
LICENSED CONTRACTORS DECLARATION v DISTRICT NO. PROCESSEb BY
I herebyaffirm that I am licensed under provisions of Chapter Ap
GAS SYSTEM OUTLETS
9(comencing with Section 7000)of Diviion 3 of the Business OUTLETS OVER
5 PER SYSTEM A pA��
and Professions Code, and my license is in full force and ef- FINAL 75.LO
fect. HOSE BIB DATE �— s
License Number 397884 Lic. Class 0/36 C,/16
FINAL ����r �� �i
ContractoF. MARRONE & SONS, TNBate12/31/9h BY "----'-�+� -� g
I am exempt under Sec. C
® 7161 1 Rt111:40 0
B.BP.C. for this reason Plan check fee
u
Date: PLUMBING PERMIT ISSUING FEE$ j; a
Signature TOTAL FEE
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and
Professions Code): Address
I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044,
Business and Professions Code).
or
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
Lender's Name
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 rep sentatives of this County to enter upon the
o e-menti property for in ection pur;as.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig azure of Permittee Date