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Home My Public Portal About5018-5026 ROSEMEAD BLVD_Plumbing__ 76A667 OBS 17 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER PERM T NU. FOR APPLICANT TO FILL IN DISTR ' GROUP I ZONE �� 0K 73 PLUMBER RECEI _BY READY FOR DATE ISSUED v FIR INSPECTION ADDRESS V " BUILDINGv CITY TEL. No. ADDRESS CO LOCALITY 0 NSE NO. EXPIRES NEAREST' PERMIT FEES CROSS ST.\k&-", NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL .L-fifl WATER CLOSET(TOILET) @ 0.50 $ ADDRESS- �V A1�1 BATH TUB @ 0.50 CITY L—;&&—TEL. SHOWER @ O.SO I 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 1 AM THE LEGAL OWNER OF THE RESIDENT( L PROPERTY DESCRIBED ABOVE, GAS SYSTEM OUTLETS @ 0.50 q�+ q SIGNATURE OF �� ! ✓ �� WATER HEATER @ 0.50 PERMITTEE_ tr T SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN 0 0.50 URINAL @ 0.50 Q HOUSE SEWER @ 0.50 _Z MISCELLANEOUS O Ir O A ^A APPROVALS r DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAB VENT CESSPOOL @ 1;00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ) PIT ) @ 1.00 SEWER _ PERMIT . I 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE $ / .FINAL 76A667' 089 17 11-SO APPLICATION FOR PERMIT ' DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING z WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT GROUP ZONEPERMIT 166,37 PLUMBER _ e,/ RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS BUILDING CITY $ •' TEL No. ��- ADDRESS COUNTY LI LICENSE NO. EXPIRES �+ LOCALITY -,141y zf,44e,4C:1- NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) @ 0.50 $ D ADDREBS BATH TUB @ 0.50 O CITY TEL No. SHOWER @ O.SO I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL 9j3UN-T-Y"'ORBINANCE9 KITCHEN SINK @ 0.50 - AND STATE LAWSrREG0L`P:TI' O PLUMBING. �p I CERTIFY THAT I POST3 HE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 jB ANGEL -OUNTY LICEN E AM THE LEGAL N OF THE'RESIDENTIAL P ERTY DF-HCRI13 AS _E. GAS SYSTEM_AZOUTLETB @ O.SO f �^ SIGNATURE OF WATER HEATER @ 0.50 FtERMITTE _ - SLOP SINK @ 0.50 '"' INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0W.50 IL _ Q , HOUSE SEWER @ 0.50 U_ MISCELLANEOUS J IL - o APPROVALS -DATE INSPEOTOR-9 NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL - @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK - DRAIN ( ) PIT ( ). @ 1.00 SEWER PERMIT ( 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE $ ,� FINAL W1711S 1-511 APPLICATION FOR PERMIT ENT OF BUILDING AND SAFETY OUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER DISTRICT O. 13 OUP I ZONE PERMI NO. FOR APPLICANT TO FILL IN / 66-37 PLUMBER - Of ®� RECEIVED BY READY FOR DATE ISSUED /L FIRST INSPECTION czs- // �-.<i. i ADORES ING �� CITYy TEL No. ADDRESSaA ,4® �{ LICUNTYENSE NO.oL �� EXPIRES �Q'�� LOCALITY p/ NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) @ 0.50 $ Y8 ADDRESS BATHTUB @ 0.513 �D CITY TEL. No. SHOWER @ D.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE_IS CORRECT _ �0 AND AGREE TO COMPLY WITH ALLsG6UNT -ORDtNANCEB A� KITCHEN SINK @ 0.50 S® AND STATE LIYB-RE'l3l' 1f JLATI PLUMBING. 1 CERVI THAT I PO_ E ABOVE VALI LOS LAUNDRY TUB OR TRAY @ 0.50 �� ANGELES COUNTY LICEN E CFFS� 1 AM THE LEGAL N OF THK RESIDENTIAL E %('Y 'GAS SYSTEM OUTLETS @ 0.50 P BIG N TORE OF /, WATER HEATER @ 0.50 ERMITTE SLOP SINK @ D.So INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ O:SD � ,M-V DRINKING FOUNTAIN @ 0.50 -4""`---�' URINAL @ 0.50 `V, r J / Q HOUSE SEWER @ 0.50 �C7G�dz - Z MISCELLANEOUS 19 O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT / CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . I 1.00 1 GAS TEST / UTILITY CO.NOTIFIED 9 TOTAL FEE $ FINAL 76AS67 DBS 17 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING . COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER OUP I ZONE PERMIT NEI. FOR APPLICANT T[] FILL IN ,,, 5 O.DISTRICT � PLUMBER �/� 1C, AA A-( p RECfIVED BY READY FOR DE ISSUED FIRST INSPECTION / � r ADDRESS -%1 ` BUILDING CITY TEL No. ADDRE8B COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. k4J A-1.1 NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) @ 0.50 $ ADDRESS BATH TUB O.So CITY TEL. No. SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT 1 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 POSBEBB THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER OF THE REBIDENTI ROPERTY DESCRIBED ABOVE. ,-' GAS'SYBTEM OUTLETS @ 0.50 �Q SIGNATURE OF c j WATER HEATER @ 0.50 PERMITTEE 666!L_ SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0:50 S z� v DISHWASHER @ 0.50 DRINKING FOUNTAIN 0 0.50 URINAL @ 0.50 J Q HOUSE SEWER @ 0.50 U� ~ iAl Z MISCELLANEOUS O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING Jf GAS VENT / CESSPOOL @ 1:00 CESSPOOL ✓ G�!.t.�i%.� -S. /9` . ' r SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT , 1,00 GAS TEST J • UTILITY CO.NOTIFIED J TOTAL FEE 00 FINAL r 76A667 D2917 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY �' COUNTY OF LOS ANGELES WILLIAM J. FOX, cH1EF ENGINEER I TR . O. OUP O TM FOR APPLICANT TO FILL INj� / C/O KT �JJ _ PLUMBER I� i,^, L, r'f .y RE 1 BY READY FOR/ PATE 1 SUED FIRST NIPV1 N 12--1 �P/ ADDRESS ` BUILDINGo I ? CITY � TEL No. ADDRESS J G/,� !7�_-- COUNTY 41LOCALITY `v LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) @ 0.50 $ ADDRESS BATH TUB @ 0.50 CITY TEL. No. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POBSESB THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELESCOON LICENSE. OR I AM THE LEGAL OWNER OF THE RESIDE TI L PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ D.50 SIGNATURE OF 4 WATER HEATER @ 0.50 PERMITTE _ BLOP SINK @ 0.50 INSPECTION RECORD 0 FLOOR SINK @ 0.50 °7 FLOOR DRAIN @ 0.50 . DISHWASHER @ 0.50 - DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 J HOUSE SEWER @ 0.5c] (/ Z_ MISCELLANEOUS 6 Q' O APPROVALS DATE INBPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1:00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER v PERMIT . I 1.00 GAS TEST TOTAL FEE -q2- S- ®1 I UTILITY CO.NOTIFIED / FINAL I "Wool ly w-ag APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES PLUMBING 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN IN� t� INSTS NO. GR IUP ONE PERM IT RE R D T 1S4S_U BY READY EDPLUMBER FIRST INSPECTION ADDRESS � JN.-,. .�/ BUILDING CITY TEL. NO.; ADDRESS COUNTY N—LICENSE NO. EXPIRES LOCALITY - 1 NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER ♦ ,,, MAIL WATER CLOSET (TOILET) Q 0.50 I$ I_ 0 ADDRESS I '� BATH TUB @ 0.501 I CITY 40; TEL. NO. SHOWER Q 0.501 �� 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS ' I LAVATORY (WASH BASIN) Q O.SO 1 APPLICATION AND STATE THAT THE ABOVEIS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK Q 0.50STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q 0.50 I ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED AB E. I_GAS SYSTEM--/—OUTLETS Q 0.501 1 SIGNATURE OF WATER HEATER Q 0.50 PERMITTEE SLOP SINK @ 0.501 114SPECTION RECORD 1 FLOOR SINK Q 0.30 II FLOOR DRAIN Q 0.50 I ? DISHWASHER @ 0.30 DRINKING FOUNTAIN @ 0.501 URINAL Q 0.50 �y9 J 1 HOUSE SEWER @ 0.501 1 Q Z 1 MISCELLANEOUS I� 1� APPROVALS 1 DATE INSPECTOR'S NAME ROUGH PLUMBING -"' Y'b GAS PIPING I— GAS VENT CESSPOOL Q 1.00 CESSPOOL SEPTIC TANK: 1 SEPTIC TANKI DRAIN ( ) PIT ( ) @ 1.001 I SEWER PERMIT . I.00 GAS TEST I TOTAL FEE I $ y�.�() UTILITY CO. NOTIFIED Il—} — FINAL 76A667 DBB 17 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING 2 COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN I TR R l PLUMBER'-, ;.. q . ; '' f RECli1V READY FOR BY N9UED f�Jpr}� FIRST SF�E T{10N DATE 1�_ ADDRESS , CY I / a /3 BUILDING .� a CITY `•' -, ..�. ,TEL.No. ADDRESS C1 �.rL , yC., :^.-• n.. `}. „s "..rT_ o- P CU NTY LENSE NO. EXPIRES LOCALITY NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) 0.50 III ADDRESS BATH TUB @ 0.50 CITY TEL No. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O.SO ANGELES COUNT)a_LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDEOTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ 0.50 SIGNATURE Of WATER HEATER @ 0.50 PERMITTEE SLOP SINK @ O.SO INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 . DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 fW" HOUSE SEWER @ 0.50 `{} `,r U_ MISCELLANEOUS .J IL 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ) PIT ) @ 1.00 SEWER PERMIT I 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE I !p 2 j' FINAL 46 BUILDING AND SAFETY i APPLICATION FOR PERMIT COUNTY OF LOS ANGELES PLUMBINGFOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE �j PERMIT NO. ROUGH FIXTURES COMP41_TE �� / K /` J 43 HEATER CESSPOOL I-I SEPTIC TANK REEjE1VED READY FOR FIRST INSPECTION DATi ISSUED A8 -1-MISCELLANEOUS 7e .- APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY NAME JOB K ADDRESS W I ADDRESS �� LOCALITY nNEAREST J CITY TEL.NO. CROSS BT. COUNTY CERT.No. EXPIRES WC NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL NORTH O ADDRESS CITY TEL.No. . I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED pp ABOVE. 3 OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK77 BATH TUB FURNACE [7 SHOWER ` DISHWASHER !LLAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTALLAVATORY ROUGH PLUMBING Ic METERGAS RODA FOUNTAIN OUTL GAS PIPING I `Z_ 1/ I v 4�YS GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I I CESSPOOL X EPTIC TANK SEWER I I UTILITY CO.NOTIFIED TOTAL FEE FINAL 7e-Aee7 17 5-50 KD APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING ��' COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUPI ZONI,;,_ PERMIT NO. PLUMBER RECEIVED BY READY FOR DATE ISSUE FIRST INSPECTION ADDRESS ` BUILDING f CITY ..d - TEL. NO. ADDRESS COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) @ 0.50 I —ADDRESS y� BATH TUB @ 0.501 CITY.•' .r'�:!� rTEL. _. SHOWER @ 0.501 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. 1 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER OF THE RESIDENTI PR PERTY7DCRI EDABOVE. GAS SYSTEM--OUTLETS @ O.50 SIGNATURE OF �./5PERMITT $+ WATER HEATER @ 0. 0 I SLOP SINK @ 0.50 INSPECTION RECORD , I FLOOR SINK @ 0.50 J FLOOR DRAIN @ 0.50 DISHWASHER @ O.501 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50) J HOUSESEWER @ 0.501 1 Q Z MISCELLANEOUS (� I a I� o I APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK I DRAIN ( ) PIT ( ) @ 1.001 SEWER 1 PERMIT . . I 1.00 GAS TEST TOTAL FEE $ UTILITY CO. NOTIFIED -. FINALj �. WO RKERS'FOMPENSATIONDEC LARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I,have a certificate of consent to self 20-0026 DPW 6/87 insure, or a !ertificate of Workers' Compensation Insurance, 76A667A ,or akertified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company — ( J ��0_9 ❑ Certified copy isl hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Q Certified copy is filADDRESS ed with the county building inspec- C� tion department< NUMBER FIXTURE OR ITEM n FEE LOCALITY �� n - WATER CLOSET Date - Applicant NEAREST CERTIFICATE OF EXEMPTION F WORKERS' BATH TUB oV CROSS ST. COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if the work involved by MAIL q the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 1�� I a' C5IIa'r-a I certify that in the performance of the work for which this permit is issued, I shall not employ an person in an manner ++ SINK CITY TEL. NO. P P Y Y P Y l DO � �VYI.CZ S so as to become subject to the Workers'Compensation Laws. DISHWASHER r /`P CONTRACTOR (A h, CI t Date — ' A licant 11�J6"d't CLOTHES WASHER v NOTICE TO APPLICANT:Pf, after aking this Certificate of ADDRESS %� 1��s Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY GU 1 TEL. NO. ,s g 101 P P Y LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER &o LICENSE NO. l qCJ_ CLASS 0 LICENSED-CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS y� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER lJ and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL I VALIDATION License Number k) 9g� Lic. Class �-,��` Cq DATE _0 Im Q. 1`1 V Cpf II1 "I '�O �!r I FINAL 0 Contractor t �'�� BY / ❑ 1 am exempt under Sec. V W B.BP.C. for this reason Plan check fee CO� � Date: Z PLUMBING PERMIT ISSUING FEE$ i Signature TOTAL FEE SINGLE FAMILY Plan check applicant � HOME OWNER-BUILDER DECLARATION Name "t I hereby affirm that I am exempt from the Contractor's License A�.t:T e Law for the following reason (Section 7031.5, Business and Address °8 50 Professions Code): _ City Tel. No. 3307 �� " ❑ I, as owner of the property, will do the work and the 1 ITEMS structure is not intended or offered for sale (Section 7044, Business and Professions Code). — TOTAL 802. 50 CONSTRUCTION LENDING AGENCY CK 802e11 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANGE ,00 (Sec. 3097, Civ. C.). Lender's Name—L 0000-0001 7/31!89 Lender's Address 47cg 1 AM y.td� 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Q )JA ffla_z� -�-7 - 9 Si ature of Permi tee Date 74 ;' • , ' WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 1 I hereby offkrm that (,hove a certificate of consent to self 20-0026 DPW 6/87 1 insure, cr a?erti icate of Workers'Compensation Insurance, 76A667A _- _ _. _ ora ert fled copthereof'(Sec. 3800, Lab. C.) (� Q COUNTY OF LOS ANGELES•. DEPT.OF PUBLIC WORKS - Policy No. rompany ^( •,-'•. ; -. aCertified copy is ereby Turn' t R ! FOR APPLICANT TO.FIL IN(PRINT OR TYPE) BUILDING• _ Y Certified copy is f� with the county building inspec- ADDRESS �O� tion deparimQn NUMBER' FIXTURE OR ITEM:a ®° FEE y LOCALITY Date = Appli4ant WATER CLOSET. _ NEAREST f'r r �• BATH TUB.. CROSS ST. CERTIFICATE OF EXEMPTI�FWORKERS` QCT COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed If the work Involved byMAIL the permit Is for one hundred dollars($100)or less.) l LAVATORY ADDRESS - aft w 1 certify that in the performance of the work for which this rmif is issued,I shall not employ an person in an manner SINK' CITY' TEL. NO. = soas to become subject to the Worke s'Compensation Laws. ` ; w �,1/ DISHWASHER.,__. CONTRACTOR r -r D Date /� (/ owf_Applicont L a CLOTHES WASHER �lrlfr� NOTICE TO APPLICANT: If, after eking°this Certificate of ADDRESS Exemption, you should' become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY COCl 11 TEL. NO, with comply with such provisions or this permit shall be ) LAWN SPRINKLER SYSTEM STATE � LIC. deemed revoked. �''� WATER HEATER LICENSE NO: CLASS LICENSED CONTRACTORS DECLARATION DISTRiCi NO kROCESUD By (hereby affirm-thot 1 am licensed under provisions of Chapter 9 1� GAS SYSTEM - OUTLETS i O 1 � (commencing with Section 7000)of Division 3 of the Business x OUTLETS OVER ' �•.• and Professions Code,and my license is in full force and effect. d 5 PER SYSTEM d ' r } na DATE ,UVALIDATION FINAL �•_` ; License Number C)q2) Lic. Class Q. 1[�f�LD�[P I'C� trYt�dte 't� 1 FINAL Contractor l C) 9 f ? t d Q s r . ElI am exempt under Sec E' V 7 t Lt! r B.BP.C. for this reason Plan check fee _ ► a ' U)Date: Z PLUMBING PERMIT ISSUING FEE$ Signature 7J TOTAL FEE Plan'check applicant s :, SINGLE FAMILY x • 5 HOME OWNER-BUILDER DECLARATION Name w~' - 1 hereby affirm that 1 am exempt from the Contractor's License Addre1ss • ,..._ Hb4 ■T- "r Law for the following reason(Section 7031.5, Business and - 8�T�y Professions Code): City.•i Tel. No. 3M7 - 802.50 t 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section. 1 ITEI9S- " 6- 7044, Business and Professions Code). - $ TOT( $� 50 . . 4 CONSTRUCTION LENDING AGENCYCWCK W2.50 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.). i -_ ___.� ._ .•.__,.__G "_. _. goo Lender's Name 7/31/311 3 r Lender's Address ;�y� r� , (;certify that I have read this application and state that the a- ► 4759 1 AM 9:50 ; above information is correct- 1 agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the r. above-mentioned property for inspection purposes. 9 SEE REVERSE FOR EXPLANATORY LANGUAGE 14 t .1.21PLL�