HomeMy Public PortalAbout10645 ROSEGLEN ST_Plumbing__ DOUMTY of Los ANGELES APPLICATION FOR PERMIT
�l DMSSDepartment ��SAFETY PLUMBING 1
WILLIAM J. FOX, CGoatY Eallmew
.FOR APPLICANT TO FILL IN � . -T— — 4L I— I
PLUM6ERVAI I EY B0111 EVARD PLUMBIMG, CQ R D[IV[ NY READY FOR DAT[ ISSUE
F1RST INSr[CTION r —
ADDR[!!S
.6UILDIND
CITY ROSEMEAD TtL.No. AT 9.9719
ADDRESS
COUNTY 93 LOCALITY
NEAREST
PERMIT FEES aR06Bl rT.
MUMaCR TYPE OF FIXTJRX OR ITCH FEE QWNER
• MAI L
WATER OLONET(TOILET) 0 0.60 ADDR�
RATH TUB 0.60 CITY TEL. Na.
■HOWER 0.60 1 HEREBY AOKNOWLEDO[ THAT I HAVE READ THIS
LAVATORY (WASH BASIN) a.5o AMLIDATION AND STATE THAT THE ABOVE IR CORRECT
AMD AORQ TD COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN ■IMK 0.60 AND STAT[ LAWS REOULATINO PLUM6INO.
I CERTIFY THAT 1 POSOMMS TH[ ASOV[ VALID LOS
LAUYDRY TUB OR TRAY C.6O ANO[LES COUNTY LIOENR[, OR I AM THE LEGAL OWNQi
OAS fYOT[ UTLETR 0 0.60
Of THE RESIDENTIAL ROPERTY D[SCRIMED L
—
Q10NATUR[ Df
WATER HEATER 0 0.60 PlOtmM[
•LOP RINK Q 0.60 INSPEC lq RECORD OF
FLOOR OINK 0 0.60
FLOOR DRAIN 0.60
DIBHWAEHER 0.60
DRINKING FOUKTAIN 0.60
URINAL Mau J
t
HOUSE 6EVYER 0 0.60 Z_
MIRCELLANEOLM
APPROVALS
DAT[ IHar[nT'EIR'■ N,u4E
ROUGH PLUM61NO
r
MAX PIPING
OA■ VENT
OKMPOOL Q 1.00 CLUMPOOL
SEPTIC TANKS SEPTIO TANK
DRAIN ) PIT ( ) 1.Oo SEWER
PERMIT 1.00 OAS TEST
TOTAL FEE M � �(y LMLrrY C0.NOTIFIED
TSAWT DBS#1T G W
7eAae7-C"a17 L/m
APPLICATION FOR PLUMBING PERMI
COUNTY OF IAS ANGELES
DEP OF CO GU= UMS1.
B I oG�FN01 NKI N
WILLIAM A.J EN1EN, kup T ov ■U I um M a
�r
FOR APPLICANT TO PILI. IN w k
NUMBER FIXTURE OR ITEM EACH FEE
'OW1ElE
WATER CLOSET 1135
KAIT
BATH Tull 135 DEW 0 S
SHOWER 133 MY mmVigo.
LAVATORY 1.25 GO7ITR11G!OII
SDIL 125 ADDHES6
DISHWASHER lsb C1TT TER.. xo.
LAIIlm1T TIIS 125 CONTRACTOR'S STATE B
[EGI ATIOIN NO. COUNTY
CLOTIEES MASS 125 D--5—"7f
3R N r ■Y
WATER HILK a 1.58
AAS,STSTDd Om1Sa ° uffyxLILL a
llf. AsrE� APPROVAL 0
OUTLETIS OVER i PER HTQTum m U
D[SPECTIOa< IECOlD
` nc
�--7-C 6, N.Ll1 I A 0
o.
Z
APPROVALS DATE INIT<CFOR'••IGNATUR!
PERMIT ; 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
I H13OT ACXNOWLJLDQE THAT I HAV[ RiAD THI■ APrLICATION GAS VENT
AND / T tC.
TAT[ THATHM ABOVE 1/ COIOT AHP AORIM TO COMPLY
WITH ALL COUNTY' ORDINAN[Z1 AND STATK LAWS RKGULA71Ma
PLuMUNa HOT WATER HEATER
I MUY ClMTIrY THAT 1 AM RMOPIRLY M01.1. AND/OR PLUMBING FIXTURES
LJCZNIm AA JRQU11® WY LOS ANi[Lim CbUNTY AND NTAT[ OF GAS TEST
OR THAT I AM Tit LKGAL OWNIR OF,AND INTKHD TO
RNSID[ IN,TH[APOVK ots rRrNKD RLSJDXNTAL PR PIMTY• UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTER
FINAL
IV VAIJDATIONY--N ROBERT A. WOOD
CPL. M.o. aAs4a// SUPERVIgING MgCHANICAI- F-NG'R
�o 0 9 0 9 AL 6 5 8 . 3-50-ddq
y WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby, affirm that I have a certificate of consent to self in- 76A66�A PW 4/87
sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified copy thereof (Sec. 3800, Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS E . S
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date Applicant WATER CLOSET(TOILET) NEAREST t E �
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER r� �F_iI" C=
(This section need not be completed if the work involved by MAIL n
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this per- SINK
mit is issued, I shall not employ any person in any manner so CITY7. TEL. 5r2��-
as to become subject to the Workers' Compensation Laws. DISHWASHER v
CONTRACTOR
Date 0/ —I Y—b-Applica CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this
rt"icate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the rkers'Compen- CITY TEL. NO.
sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS t h
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER L
fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL ��/�A� VALIDATION a
DATE l U Q
License Number Lic. Class V
FIN
Contractor Date BY 0
❑ I am exempt under Sec. W
a
B.BP.C. for this reason 101. Z
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$ 99876 A
Signature
TOTAL FEE '�
SINGLE FAMILY # • • • • • 5
HOME OWNER-BUILDER DECLARATION Plan check applicant
I • • 2250
1 hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and • * * 225050
Professions Code): Address
FV I, as owner of the property, will do the work and the City Tel. No.
p614-88
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 that the 00.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 prop ty for inspection purposes.
J (Y —11/_ yd SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Per? e Date