The URL can be used to link to this page

Home My Public Portal About4930 ROSEMEAD BLVD_Plumbing__ 7GA667 DBS 17 7-51 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER D1 R G O . pF❑R APPLICANT TO FILL lql PLUMBER�/'� �/ —� �e � � i i E(VED BY READY FOR DATE ISSUED FIRBT INSPECTION FF ADDRESS cl� BUILD N' r0�l?dP ADDRESS CITY TEL No. COUNTY LOCALITY LIPENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. `/� NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER / ��,� 4� J/ MAIL . v v WATER CLOSET(TOILET) 0.50 $ ADDRESS BATH TUS @ 0.50 CITY TEL. No. SHOWER 0 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PR E TY" ESCRIBED OVE. GAS SYSTEM OUTLETS 0.50 ///JJJ tTURE OF � ��/_ i" . WATER HEATER 0.50 ERMITTEE T a SLOP BINK 0.50 INSPECTION RECORD FLOOR SINK 0.50 FLOOR DRAIN 0.50 DISHWASHER 0.50 DRINKING FOUWrAIN @ 0.50 URINAL ® 0.50 J HOUSE SEWER D.SO Z MIBCELLANEOUB I7 Ix O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAB VENT I i CESSPOOL @ 7.00 ®® CESSPOOL L+,LL-st2c.� J/Z'Al. SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER � � .469.��/ /'•°� P• PERMIT 1.00 GAB TEST P TOTAL FEE UTILITY CO.NOTIFIED $ rey p/ t0 ® FINAL 1 7dX667 17 s-so APPLICATION FOR PERMIT • DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING 1 ~ WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. (J(� �J `V/( ,pig PLUMBEI50 r ✓ (OR 1 �►U At(-si N `'"�1�VI`'�� RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS CITY �/�, l OV�; TEL. NO.FCS' ADD EISS 19 3 v7 -y� v o� A ✓ COUNTY rl O LOCALITY /; A/' LICENSE NO. J �•j' 1" EXPIRES • NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) @ O.50 $ I_0 ADDRESS V BATH TUB @ 0.501 j-0 CITY TEL. NO. SHOWER @ 0.501 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS / 1 LAVATORY (WASH BASIN) @ 0.50 1 N . 'APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND 1 KITCHEN SINK @ 0.501 STATE LAWS REGULATING ING. 1 CERTIFY THAT ESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.501 d ANGELES COUNTY SE 1 AM THE LEGAL OWNER OF THE RESIDE R DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ 0.50 I I SIGNATURE O 1 WATER HEATER @ 0.5.0 I �-d PERMITT SLOP SINK @ 0.50 I INSPECTION RECORD FLOOR SINK @ 0.501 FLOOR DRAIN @ 0.50 J DISHWASHER @ 0.50I DRINKING FOUNTAIN -W0.50 I URINAL @ 0.501 I ..I HOUSESEWER @ 0.50 I Z 1 MISCELLANEOUS a I � o �1 'APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING I� GAS PIPING GAS VENT l CESSPOOL @ 1.001 CESSPOOL SEPTIC TANK: I SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.001 SEWER PERMIT , I 1,00 GAS TEST UTILITY CO. NOTIFIED TOTAL FEE $ � FINAL �ALWORKE JDMPENSATION DECLARATION �pp`��q�ap� FOR PLUMBING PERMIT,.�rl here Jy, Jhfirm ! have a certificate of consent to self 78A667A insure, or a ce"riNicate of Workers' Compensation Insurance, CE 817(REV.8/86) or a certified copy thereof (Sec. 3800, Lab. C.) T 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 Certified copy is filed,with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE 7 11 LOCALITY � Dote Appli4anl WATER CLOSET (/ v NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB tlO CROSS ST. COMPENSATION INSURANCE OWNER ?r (This section need not be completed if the work involved by SHOWER �{() the permit is for one hundred dollars($100)or less.) LAVATORY —07) MAIL ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITYi TEL. NO. �� so as to become subject to the Workers C pensation aws. DISHWASHER r CONTRACTOR Date �pplica CLOTHES WASHER ADDRESS NOTICE Td APPL CANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit sholl'be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DIST, y¢ P CESS BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS C/��,v(/// (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM DATE VA DATION U License Number Lic. Class % IX FI O Contractor Date B 4t 41-A t3 ❑ 1 am exempt under Sec. LU B.&P.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant 0 7 8 5,4 A SINGLE FAMILY 0 0 0 HOME OWNER-BUILDER DECLARATION Name #. 0 0 5 I hereby affirm that I am exempt from the Contractor's License Address ( -.- 5250 Law for.the following reason (Section 7031.5, Business and ® Professions Code): 'o 0 0 City Tel. No. 5 2 5 0 5 I, as owner of the property,.will do the work and the 9,o8-87 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 thot 1 have read this application and state that the above information is correct. I agree to comply with all County pool ordinances and State.lows regulating Plumbing, and hereby authorize representatives of this County to enter.upon the above-mentionl d property lot inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee l5ate /I WORKER'S COMPENSATION DECLARATION 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT ' 76A667A �"9 r /'"� I hereby affirm that I have a certificate of consent to self insure, , or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab. C.) � Zw (C� COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy/ \No. Company � Certified copy is hereby furnished. BUILDING a ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspection department) NUMBER FIXTURE OR ITEM Q FEE LOCALITY T Date - - v plicant WATER CLOSET NEAREST CROSS ST. CERTIFICATE OF EXEMPTI N FROM WORKERS' BATH TUB ASSESSOR COMPENSATION INSURANCE MAP BOOK PAGE, a PARCIQD (This section need not be completed if the work involved by the SHOWER permit is for one hundred dollars($100)or less.) OWNER LAVATORY I certify that in the performance of the work for which this permit MAIL ,p is issued, I shall not employ any person in any manner so as to SINK ADDRES become subject to the Workers' Compensation Laws. v ( Ali L' OS�- DISWASHER CITY TEL.NO. 10 1 117 Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of L Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS e �� U provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY I _` TEL.NO. 2 3-1 " a I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER u� J (commencing with Section 7000 of Division 3 of the Business and STATE LIC. O ( 9 ) LICENSE NO. ,[/ '2 CLASS /a��S Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS l� V Z�> ,!J V OUTLETS OVER DISTRICT NO.1 PROCESSED BY Q[ 5 PER SYSTEM Y Q 6 / 0 0 License Number Z Lic.Class Q FINAL LU U DATE _ L, VALIDATION Contractorw~(� Date El FINAL Z I am exe`mpt�under Sec. BY B.&P.C.for this reason Date: Plan check fee ® � ' Signature PLUMBING PERMIT ISSUING FEE$ f_,f_. e ElTOTAL FEE a 3 .jw 57.3-D Plan check applicant SINGLE FAMILY 'U HOME OWNER-BUILDER DECLARATION Name T•j_4!PAL !�� I hereby affirm that I am exempt from the Contractor's License Law 7 - 30 for the following reason (Section 7031.5, Business and Professions Address =^? ;), Code): Piet_tt J f e_._ ❑ City Tel. No. LFA'= i o tl-j I, as owner of the property,will do the work and the structure s It-'T.M is not intended or offered for sale (Section 7044, Business and Professions Code). , ,� CONSTRUCTION LENDING AGENCY l�)'fl ('—i1 `"`�` I hereby affirm that there is a construction lending agency for the v i1 AM Q:10 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 Poo.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 property for inspect n pur oses. SEE REVERSE FOR EXPLANATORY LANGUAGE Ignature of Permittee Date