HomeMy Public PortalAbout10202 RANDWICK DR_Plumbing__ 76A667-CE#6175-61-
APPLICATION
75-61•APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINE M
UILD
Bim.EIR.IAMB ES.CoETWY ENNINe�N ADDDR S I®vto-_•
WILLIAM A. JENSEN, SUPIT OF BUILDING
LOCALITY s •
FOR APPLICANT TO FILL IN. CROSS ST: , y
NUMBER FIXTURE OR ITEM OWNER
WATER.CLOSET MAIL
SATS TUB ADDRESS
CITY TEL NO.
SHOWER
LAVATORY c0NTBACTOR Valley Plumbs
sum ADDRESS 442 W. Fleet o
DRiSWASHEH crrY Glendora TEL.NO. 1q-3 29a
LAUNDRY TUB 1 ISTER37ORN NCL60847 cOUNTY
® CLOS WASHER DISTRICT NO. I QROUP I ZONE I P SSED BY
WATER HEATER r L
a� GAS SYSTEM (� INDUSTRIAL V
WASTE APPROVAL
i INSPECTION RECORD
N
z
SQO
IT,
18T. S I �� �.S APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT ,
WITfi ALL BOUNTY ORDINANCES AND STATE LAWS-REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF f •w
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE GAS TEST
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE I J
OF PERMITTE r
FINAL WWI
VALIDATION ROBERT A.WOOD v
M.0. CASH SUPERVISING MECHANICAL ENG•R
LijCo 7 8 0 9- DEC 4 5 C 16.55- %,
- C2i���i r • .
ION
WORKER'S I have
a certificate
of consent to 719AWaDPIM1l9/89 APPLICATION FOR PLUMBING PERMIT
78Af367A
I hereby affirm that I have a certiflcate of consent to self insure,
or a certificate of Worker's Compensation Insurance, or a certified (17982)
copy thereof(Sec.3800 Lab.C.)
Policy her 6969®OOab.C.) ny I(' COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
❑ Temple Cit
Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 10202 E R
Certified copy is filed with the county ui Inspectionwick Dr.
department. ( NUMBER FIXTURE OR ITEM ® FEE LOCALITY
Date 4-1®91 Applicant WATER CLOSET CROs NEAREST
Ave ,
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION INSURANCE ASSESSOR
(This section need not be completed If the work Involved by the SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) LAVATORY OWNER g�W® Calvin
I certify that in the performance of the work for which this permit
Is issued, I shall not employ any person In any manner so as toSINK ADDRESS 10202 E. R$ndYJlliek ��.
AIL
become subject to the Workers'Compensation Laws.
DISWASHER CITY Temple City TEL.NC448-7230
Date Applicant CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT: If, after making this Certificate of General Installation
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code,you must forthwith comply with such ADDRESS6558 West Blvd.
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY L.A. TEL.N
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATERSTATE LIC. 0
°�53m2541
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS CENSE NO. 151839 CLASS C36
Professions Code,and my license is in full force and effect. 0
OUTLETS OVER DISTRICT NO. PROCESSED BY a:
C36 5 PER SYSTEM Q Q
License Number 151839 Lic.Class 1 D O
FINAL VALIDATION
General Install 4-91 DATE
LILI
Contractor cc
❑ I am exempt under Sec. BYrr
Z
BAP.C.for this reason
Date: Plan check fee
Signature
PLUMBING PERMIT ISSUING FEE$ 14;00 Poo.
❑ TOTAL FEE 22.15
Plan check applicant �
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Names
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions Address v3P7 22.15
Code): _
❑ City Tel.No. i 1 I��`•�
I,as owner of the property,will do the work and the structure
Is not intended or offered for sale(Section 7044, Business AL 22. 15
and Professions Code). , --•. r- ;Z
�.ftL�.it 4Lo L"
CONSTRUCTION LENDING AGENCY y •! t i= r;r
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 Nam 1 Ar, 9°u 4.-
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 above-mentioned
prZef 1ti p poses. SEE REVERSE FOR EXPLANATORY LANGUAGE
iD.� v_
2-28-91
Signature of Permittee Data