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Home My Public Portal About6263 PRIMROSE AVE_Plumbing__ se"ar W was 0 APPLEATSN FOR VIEDUr - DEPARTMENT bF soanM AND SAgsri PLUMBING - COUNTY OF LOS ANGffi.� ' WILLIAM J. FOX. CHIEF ENGINEER FOR APPIJCANT TO FILL IN DISTRI O. GROUP ZONE PERMITNO. B3 �-6 MIL PLUMBRR WINTERSOTTom �1 RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ' ADDRESS Kwuor :BUILDING CITY TML NO. ADDRESS V UNTY IR LOCALITY PEIMT F� 'c ff ARRsOW TEMPLE CITY IA.VO; ' NYMlER TM OF rlZMES O11 rMN FEE OWNER UEEKER LAND CO e � WATER CLAsir TOILET o.s0 JO ADDRESS .3?1$ E• L I n OAK Avo• MATH TUN 0 a.= 150 CITYARC •6A s CAL IF - No. 111HOWER 0 C.No 1 HEREBY ACKNOWLEDGE THAT 1 HAIR READ THIN LAVATORY WASH sl O.s0 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREN TO COMPLY WITH ALL COUNTY ORDINANCE AND KITCHEN sINK 0.1110 STATE LAWS REGULATING PLUMBING. 1 CERTIFY'THAT 1 PONBENN THE ABOVE VALID LAB LAUNDRY TUB OR TRAY O.s AANNGELES COU C I OR DI AN,w---RITHE LEGAL OWNS! am sYNrnL- oL Lsrs 0. NI WATER HEATER O.s0 PRRNITr SLOP MINK 0.50 FLOOR 91NK 0 ,0.00 FLOOR DRAIN a 0.80 018HWABHKR 0 0.80 f' DRINKING FOUNTAIN O.sO 7-76 I c+ ��f r-Uly" QI-:+r' L} Pri, URINAL 0 0.00 /, u Riee 16 W • ea rpeg „I HOUSEsRWER 0 0.80 M n 1 MISCELLANEOUS t9 d' Y O r ' APPRO V AM DATE IRSPiCro1 lw RAKE ROUGH PLUMBING ' am PIPING GAN VENT ' CESSPOOL 1.00 CESSPOOL SEPTIC TANKi sRPrIC TANK DRAIN ( ) PIT ( ) @ 1.00 amKR PERMIT . 1.00 GAs TEST . .s 5 0 UTILITY Co. oTIFIKD 2 ft” TOTAL FEE FINAL WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby,w ffirm that I have a certificate of consent to self in- 76A667A swe,'or a certificate of Workers'Compensat' once,or certifie qo �` e o_(Sec. 3800, Lab. C. 1 _ ��;Il , , COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 'fl Policy o. ompany F Certified copy is hereby furnished. 1 FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING nn ?:�, Certified copy is filed with the co nt� ilding inspection ADDRESSdeQ t. NUMBER FIXTURE OR ITEM @ FEE LOCALITY. Dote Applicant I / WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNS (This section need not be completed if the work involved by MAIL the permit is for one hundred doyars($100)or less.) LAVATORY ADDRESS ) I certify that in the performance of the work for which this per- SINK CITY mit is issued, I shall not employ any person in any manner so i as to become subject to the Workers'Compensation Laws.• DISHWASHER h CONT tftf Date. Applicant CLOTHES WASHER ADDRE 1 NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR Q i emption,you should become subject to the Workers'Compen- Cy TEL.40 sation provisions of the Labnr rode,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATELIC. ed. WATER HEATkR1 LICENSE NO. 03JZR -110 CLASS /.zU LICENSED CONTRACTORS DECLARATION GAS SYSTEM U DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter , e�d -,t��. 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code d y Allicese, is in II force and ef- 5 PER SYSTEM FINAL 7 VALIDATION fect. f,�yIM � HOSE BIB DATE !�e (License Number c. CIal a -3 J FINAL V Contractor �r_ Date "'°�' BY Ix ❑ O I am exempt under Sec. V B.BP.C. for this reason Plan check fee , N Date: PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE � f SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant . I hereby affirm that I am exempt from the Contractor's License Name A"C" 1 . Law for the following reason (Section 7031.5, Business and Professions Code): Address =,:1-'1 ❑ I, as owner of the property, will do the work and the City Tel. No. i ITC 'Z structure is not intended or offered for sale(Section 7044, Z•;; Business and Professions Code). ► iI}FAL. 42 . 60 ra:ik CONSTRUCTION LENDING AGENCY i- :a4e5%I 1 hereby affirm that there is a construction lending agency for CHAIN-GE .00 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 informatios orrect.I agree to comply with all County ordinances and tat laws regulating Plumbing, and hereby authorize r pr sent ves of this County to enter upon the above-men ed pf eP�f c ir�spe�tygn urpo e . .. k-37 u, �� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date ION WORKER'S I ' GOMPENSATate of consent to 7 A P�"91as APPLICATION FOR PLUMBING PERMIT Ll I hereby affirm that I have a certificate of consent to self insure,, , or A'certiffcatb of Worker's Compensation Insurance,or a certified copy thereof(Sec.3800 Lab.-C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. BUILADDDING FOR APPLICANT TO FILL IN(PRINT OR TYPE ❑ Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant J WATER CLOSET / C OSB ST. k , A111 �,Iv Lt'i CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR �t'► (This section need not be completed if the work Involved by the SHOWER MAP BOOK �� NAGE 4'6 0 PARCELD� permit.is for one hundred dollars($100)or less.) OWNER yL � G I certify that in the-performance of the Work for which this permit LAVATORY En is Issued, I shall not employ any person in any an r s a ti SINK ADDRESS 62 become subject to the Workers'Compens Ion J/7 • DISWASHER CITY !�.► TEL:NO. Date ` 9' Applicant J CLOTHES WASHER NOTICE YO A PLICANT: If, after maklnpfhis Certificate IS CONTRACTOR Exemption,you should become subject to theWorkers'.Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such proyisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. LIC. (�) Professions Cade,and my license is in full force and effect. OUTLETS OVER. DISTRICT NO. CES BY 0 5 PER SYSTEM O iQ 7 0 License Number Lic.Class FINALW DATE VtSL DATION a Contractor Date ( a sg f/3 El I am exempt under Sec. FINAL 3303 121 35_ a B.&P.C.for this reason 414n Plan check fee. , I E11- Date: �n' Signature PLUMBING PERMIT ISSUING FEE$ O' DOTAL- 121.35 ❑ - TOTAL FEE CHECK 121.35 SINGLE FAMILY Plan check applicant CHANGE .00 • - HOME OWNER-BUILDER DECLARATION Name I hereby affirm"that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address (il—[(0(1 j 9/95 Code)- - - City Tel.No. 9113 16 1 AM 9 n 06 ,as owner of the property,will do the work and the structure., Is not Intended or offered for sale(Section 7044, Business and Professions Code). , 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 thatthe above , Information Is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and .hereby authorize representatives of t Cou toe r n the ove-mentioned prop" for inspe pus. SEE REVERSE FOR EXPLANATORY LANGUAGE at...0...b