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Home My Public Portal About5533 ROSEMEAD BLVD_Plumbing__ NASRTC ICE-mel -R/TB ,.APPLICATION FOR PLUMBING PERMIT {� BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TY PEI BUILDING 3 3 NUMBER FIXTURE OR ITEM FEE ADDRESS 3 WATER CLOSET �O Q OCALITY T BATH TUB NEAREST CROSS ST SHOWER OWNER ^J LAVATORY MAIL /CI OD OO ADDRESS SINK CITY TEL NO DISHWASHER CONTRACTOR m .y N" l- CLOTHES WASHER ADDRESS 'O W TM SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM CITY GF)RQ &) A TEL NO 3z3- 1j% STATE LIC WATER HEATER LICENSE NO 10119"1"144 CLASS DISTRICT NO P ZONE PRO SSED BY GP GAS SYSTEM OUTLETS O O' OUTLETS OVER 5 PER SYSTEM INDUgTflP11ALLOV AL W WASTE APflh INSPECTION RECORD = 1 + P Plan check tee PLUMBING PERMIT ISSUING FEE 5 11 TOTAL FEE Plan check applicant Name APPROVALS DATE iNRPECTGR B SIGNATURE UNDER SLAB WORK QA-1 Address ROUGH PLUMBING City Tel NO GAS PIPING HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT PND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REOUIRE D BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE OES CRIEED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL —�� PLAN CHECK VALIDATION cB M 0 3 FbG13fi� 267RIST JkALIDATION Z M1pP-.�c'�9j0 CASH 1 ONIPENSATION ofDECLARATION °P°arB9 APPLICATION FOR PLUMBING PERMIT I hereby aNum that I have a certificate of consent to sell Insure _ or yarificat0 of Worker a Compensation Insurance or a certified copy thereof(Sec 3800 Lab C) I I I Polley No company COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV ❑ Certified copy re hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Cendbd copy is filed wM the comfy building Inspection ADDRESS ✓ // department NUMBER FDITURE OR ITEM ® FEE LOCALITY Dela ApplrantWATER CLOSET NEAREST CERTIFICATE OF EXEMPTON FROM WORT(ERSaATH TUB CROSS COMPENSATION INSURANCEASSESSOR« (This section need not M complated If the work involved by iM SHOWER MAP BOOK PAD PARCEL permit Is for one hundred dollars($100)or Issue) OWNER 1 certify that In the performance of the wor or which t par LAVATORY u Issued I shall not employ any person as to SINK AWL become subject to the Workers Go Pon ADDRESS / DISWASHER CITY TEL NO Dale �ClZS aAppllcant CLOTHES WASHER CONTRACTOR r NOTICE TO APPLICANT If after making this Certificate al Exemption you should became subject to the Workers Compensation SWIMMING POOL RECEPTOR / provisions of the Labor Code, you must forthwith comply with such ADDRESS ZOy �� ^ 'l provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CTry /r/i.-.�h NO } I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER ` fTEL s5 R (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE E NO �g CLASS (%Z7 8 LEC Profession Code and my license la In full force and effect OUTLETS OVER DISTRICT NO PPOGESSED BY Q 5 PER SYSTEM p 0 License Numbs it, Q L. ClaseDATEn � w FINAL Contractor A4.0; L.- — 72.i� coo- ❑F1 I ern exempt under Sec B NAL 1 ITM z B 8P C for this reason TI it AL 72 _ 755 Date Plan check fee CHECK7::.7`r Signature q PLUMBING PERMIT ISSUING FEE$ Poo. HAffil ❑ TOTAL FEE O'. SINGLE LY Plan check applicant _ HOME OWNER UILDERIDDECLARATION Name OLID-DDIJ1 5I�51�4 I hereby affirm that I em exempt from the Contractors License Law 57« 1 AM11J:11 for the following reason (Section 7031 S Business and Professions Address Code) ❑ I as owner of theCity Tel No t property will do the work and the structure Is not intended or offered for Bele (Section 7014 Business and Professions Code) ' CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work to which this permit is issued(Sec 3097 Clv C) I.andera Name Lander a Address I certify that I have reed thea appllce the above Inlormetion is rtect 1 agree mply xnlh ell Court Inencas , and State cos regu1 9 Plumbin reby authorize represen Ives of th ounty to n the above mentioned props rKpn purposae SEE REVERSE FOR EXPLANATORY LANGUAGE 5 �Y ro rmittee DM TION WORKERS COMPENSATION De of consent �,�,4,90 APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self in- 7eA667A sure or a certrfimte of Workeri Compensation Insurance,ora SUI Policycertified copy thereof (Sec 3mpa Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS- Polity No Company Certified copy is hereby furnished FOR Certified copy is filed with the county building inspection APPLICANT TO FILL IN(PRINT OR TYPE) BUDDRESS I department NUMBER FIXTURE OR ITEM B Fff LOCALITY Date Applicant 3 WATER CLOSET(TOILET) 9. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BA44i1ila 5 afosssr COMPENSATION INSURANCE q / '/` O.VNER (This stolon need not be completed If the work Involved by 7 7 O MAIL the parnrH Is for one hundred dollars($100)or leu) LAVATORY y �� O Q ADDRESS certify that in the performance of the work for Vm per- SINK Cm TEL NO mit is issued, I shall net employ any person in ersoas to become subject to the Workers Compos OLSfro/SlIER N U J /VowCONTRA �� DotApplicanf CLOTHES WASHE 3D C) NOTICE TO APPLICANT If, after makrn rficate of Ex ADDRESS Ca emption you should become subIect t th orkers Compen SWIMMING POOL RECEPTOR cation provisions of the Labor Code, you must forthwith comp- CITY •✓ IZ7 -10-7 Iy with such provisions or this permit shall be deemed revok-comp- LAWN SPRINKLER SYSTEMS STA LIC ed WATER HEATER LICEN NO LICENSED CONTRACTORS DECLARATION DISTRICT NOBY I hereby offum that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS � � v.7i1.bi' 9(commencing with Section 7000)of Division 3 of the BusinessOUTLETS OVER 0 / and Professions Code, and my license is in full face and of- 5 PER SYSTEM lO FINAL fect 2 HOSE BIB Y Q Q DATE _ — V A &I--- 60� License Nor /� Lic Class.if Ylr�r%(J FINAL �i G,J 1.fLY.i Contra t BY {a (�[Q I am exempt under Sec - i9'S'! I � B 8P C for this reaW son Plan check fee 3 0pop. PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Q SIN LY Pion check applicant 9 ,`tIHHI�uI � YR;,1111 HOME OWNER 8 ER DECLARATION pP I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031 5 Business and Professions Code) Address [IIJ[I(J—�ID[Ii SJ 1J54 ❑ 1 as owner of the property will do the work and the Cary Tel No `-"124 1 M structure a not intended or offered for sale ti (Secon 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 op ication and state that the , above information is correct I ag a to comply with all County ordinances an Stat ws reg acing Plumbing, and hereby authorize re esen ti of s County to enter upon the ob e- a oned erty f inspection purposes _� SEE REVERSE FOR EXPLANATORY LANGUAGE net rminea Date