HomeMy Public PortalAbout9209 ROSEGLEN ST_Plumbing__ D".17,D.es APPLICATION FOR PLUMIBINC PERMIT 1
DIVISIbN OF BUILDING ,AND SAI=
D ft-wbm m# of C--t7 Enuin«r
X17 of Los Angels AUIL.DING
JOHN A. LJ#MBIE, COUNTY ENGINEER AID RKSD
CASSATT D.GRATIN,Durr or,BUILDING
LACALI'fY
MR APPLICANT TO FML IN N F-R
C 088 ST
O
WNER C DISTRICT' NQ. GROUP Z ■uoi ro[ I[[r[crloe
A I L
INDUSTRIAL
CITY T NO. WASTE APPROVAL
PLUMB" Valley Plumbing Co. INSPECTION 4ECOBD
AD � 442 W. Fleetwood Pl.
CITY Glendora T>� NO Ed 5-1293
Ll ME NO.
160847
mummut 7-fpK br FOCTURi OR ITd[ rTR
WATER CLOSET (TOILET) a 41.00
•
BATfi TUE s1.o0
SHOWER V.0.0
LAVATORY (WASH BASIN) $1.00
KIT HEN BINK ;1.00
DISHWABHNR 91.00
LAUNDRY TUE OR TRAY fl.w.
CLOTHED WAAHER V1.00
WA HIATIER t.db
GAB JSYBTEM V1.00
APPROVALS
DATE IIq$fECTO'Q`2'11 ATURE
UNDER K 1
PERl11T l 1 00 ROUGH PLUM81NO
GAS PIPIN
TOTAL FEE 4 SAI,V T
I HEREBY /1CKHOWLEDGE THAT I.HAVE REAb THIS APPLICAT{OR
AND STATE THAT THS. 4BOVE 15 CORRECT AND AGREE TO CORPLY HOT WATER EATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANIVOR GAS TEST
LICENBED AS REQUIRED BY LQS ANGELES COUNTT AND STATE OF
CALIFORNIA OR THAT 1 AN THE LE"L OWNER OF THE ABOVE UTILITY CO.NOTIFIED
DESCRIBED R99IDENTIAL P PER
SIGNATURE
OF PxRFtm FINAL
JOHN A. L.AMB1I;, COUIQTY ENGIN[TR VALIDATION ROBERT A.WOOD.CHISY PLBG. INGP[CTOR
az. ■.S. CASH
12189 FB13 3A 1000 91
1
+ 1 WORKERS'COMPENSATION DE{LARATION APPLICATION FOR PLUMBING PERMIT
ly 'y, affirm that Y have a certificate of consent to self In- �,'�
iu �certificate of Wo
Compensation Insurance,ora {L 817(REV, B/86)
cert�41ed copy thereof (Sec.
44 COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Pollcy�ylo„ .. 'Company .
Certified copy Is hereby furnished.
FOR APPLICANT TO Flu FN (PRINT OR TYPE) BUILDING �r�q
Certified copy I;filed with the cpunty building Inspection ADDRESS 2 v
department. NUMBER FIXTURE OR rTEM 8 FEE LOCALITY
r
Date Applltant WATER C)_OSET(TOILET) NEARESTCROSS ST
` w
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION INSURANCE
SHOWER
(This sect lon need not be Completed It twd he work Invofby MAIL
the pertntt Is for one hundred dollars ($10b)oe loss,) LAVATORY •SDR
ESS
I certify that In the performance of the work for which this per-
mit Is Issued, I shall not employ any person In any manner toSINK � +
as to b}ecorne subject to the
Work
Workynzat
DIS!-WAS-E2 COJTRACTOR
?dte� y�/:,qL/Appl
I CLOTHES WASMER ADDRESS
NOTICE TO APPLICANT! If, after maklpg this Certificate of Fac, 'SWIMMING POOL REC(PTOR
emption,you-should become sub act to the Worked Compen- CITY TEL NO
sotton proVisions of the Labor Code, you must forfhwlth comp- LAWN SPRINKLER SYSTEM
ty with such provisions or this permit shall-be deemed revok- STATE
ad. WATER HEATER UCENSE NO. CLASS
LICENSED.CONTRAdORS DEGLARATION•. DISTRICT NO,, BY
I}ereby afflrrrrthat Y am licensed undt p
erovlilonCof Chapter GASSYSTEM OUTLETS "T
9(commencingwith Section 700Q.)of Divlston 3 of the Business OUTLFFS I OVER
and Professions-Code, and my license is in full force and of- 5 PER SYSTEM FINAL, ,! VA D ION �44
fact. - DATE
Llcpnse Number Llc. Class
F I NAL
Cdntrdctor Date BY
I am exempt under Sec.
B.BP.C. for this reason_ Plan check fee ►
PLUMBING PERMIT ISSUING-FEF$
,SIgnatur
TOTAL FEE Ci . 3307 3.l3n-
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant f ITEM
I hefaby affirm that I am exempt from the Contractor's License Name
Low,for the following reason (Sxtlon 7031.5, Business and ToTx 28
Professions Code): Address
I, as owner of the property, will do the work and the C1 h' Tel. No. .I�
slructure•Js not intended or offered for sale'(Section70.",
Buslnals and Professions Code).
CONSTRUCTION LENDJNG AGENCY
� / f
I(hereby affirm that there Is a construction lending agency for
fhe pet-fo�monce o'f the.w(x* for wkIch this perrnit Is issued `tq 1 4�
(Sec. 3097, Cly. C.). !!
Lender's Name
Lender's Address
I certify that I have read this application and state that the
above Jnformatlon Is correct. I aflree to comply With all County
ordinances and$"a laws regulating Plumbing, and hereby
authorize representatives of this.County to enter upon the
abo ention Property Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of P&Mlttee Date