HomeMy Public PortalAbout6262 RENO AVE_Plumbing__ 76 A 6 f67-C E*S I Z_4-67
APPLICATION FOR _'PLUMBI G PER rITT 1
COUNTY OF LOS ANGELES
RUMIaEPARTMENT. OF COUNTY.ENGINEER svlLDnac
AND SAFETY DIVISION ADDRESS
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
OL WATER CLOSET *m O MAIL
BATH TUB -146 ' O ADDRESS
SHOWER ho I so
CITY D TEL.NO. /_'
3 LAVATORY Fe 50 CONTRACTOR.
SINK IA& ' S'D ADDRESS b,5- /
' DISHWASHER I'm CITY TEL.NO.. �,-p••p�.�
LAUNDRY TUB 1.25 STATELIC
LICENSE NO. �.,)I `J CLASS c- 3
1 CLOTHES WASHER h$S O DISTRICT NO. G NE P O S D BY .
WATER HEATER 1.50
GAS SYSTEMOUTLETS 150 / INDUSTRIAL
WASTE APPROVAL y}.
OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD D.
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APPROVALS DATE INSPE OR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
TOTAL FEE s
ROUGH PLUMBING / ,� 729 k�&'
GAS PIPING
I
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT I
ANO STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER-HEATER
I HEREBY CERTIFY THAT '1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED. BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST
RESIDE IN,THE AS DE IBED RESIDENTIAL PROPERTY.. UTILITY CO.NOTIFIED
SIGNATURE _
OF.PERMITTEE FINAL V
/—"LIDATION JACK R.ALLEN
CK.
M.0. CASH SUPERVISING MECHANICAL ENGIR.
u�2i52a DEC13 5 D 1 9.75' V
T
WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT
4here'by;'affirm that I have a certificate of consent to self in- 76A667A
sure,or a certificate of Workers'Compensation Insurance,or a
certified copy thereof(Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. 10209240(�bmpany Valley FOrge
Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) 6262 Reno
® Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY Temple Cit
Date 1-1-95 Applicant Owen Bros. Plmb. WATER CLOSET(TOILET) 5 NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER 5 OWNER L & W Home Center
(This section noed not be completed if the work involved by MAIL
the permit is for one hundred dollars($100)or loss.) LAVATORY ADDRESS 8812 E. Las Tunas Dr.
I certify that in the performance of the work for which this per- SINK CITYTEL. NO.
mit is issued, I shall not employ any person in any manner so San Gabriel 287-1131
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR Owen Bros. PLumbing, Inc.
Date- Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of Ex- 4265 N. Baldwin Ave.
em tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR
P Y I P CITY TEL. NO.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS E1 Monte 443-0078
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. 231-741 CLASS C36-20-16
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 7 (i ce,
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �7 d
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fect. HOSE BIB DATE >.
License Number 231-741 Lic. Class C36-20-16 a
FINAL � 0
ContractorQWen Rrna- Plmb Date 9-30-95 BY J `t U
tS
I
'C',
0
F1 I am exempt under Sec. '4 i °v LI
'°
B.BP.C. for this reason Plan check fee ® 3til�.. �° CL
Date: PLUMBING PERMIT ISSUING FEE$ 7275
Signature TOTAL FEE 1771,21751
�
^ '
=' `)� _ 5
72
SINGLE FAMILY +
HOME OWNER-BUILDER DECLARATION Plan check applicant `� ''°
I hereby affirm that I am exempt from the Contractor's License NameHt
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. cit."._'!-� ti 1 '� - jI
structure is not intended or offered for sale(Section 7044, t{jy` 4): ti
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 appJication 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
pe
mentioned property f insp cfion purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
re of Permittee Date