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Home My Public Portal About5607 ROSEMEAD BLVD_Plumbing__ /73 7�TA'(�CE-B,T jOW ABPPLICATION OR PLING PERMIT DEPARTMNTY ENNT OF LOS ENGINEER BUILDING AND SAFETY DIVISION BUILDING t�.n MAKE CHECKS PAYABLE TO ADDRESS 5w f No RA88m88CI BZ4fI• HARVEY T BRANDT, COUNTY ENGINEER LOCALITY Temple _ FOR APPLICANT TO FILL IN (PRINT OR TYPEI NEAREST CROSS ST NUMBER FIXTURE OR ITEM O FEE WATER CLOSET D 75 OWNERghbtqrt LAY BATH TUB 75 AAIL DDRESS P O Box 6 608 SHOWER 75 CITY Los Angeles TEL NO 6544,,822 LAVATORY 75 h CONTRACTOR Oren BTOBe Plumbing Inc. i SINK 75 ADDRESS DISHWASHER 75 CITY IU Monte TEL NO 443_M8 �— CLOTHES WASHER 75 STATE LIC FA E NO 2 CLASS C36-20 SWIMMING POOL RECEPTOR 75 LAWN SPRINKLER SYSTEM 75 T NO GR UP 20NE F CE55 B 08 '-z- C WATER HEATER 75 T RIAL WA APPROVAL GAS SYSTEM OUTLETS 75INSPECTION RECORD OUTLETS OVER 30 5PER SYSTEM 7G /)-/f QOWA� ,J0 � 4-+ct nL I\Plan check fee See Rere,te '/'PLUMBING PERMIT ISSUING FEE S TOTAL FEE PROVALS DATEPlan Check applicant I 50SLAB WORKName PLUMBINGAddress PINGCity Tel No NTTER HEATERIHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONAND BTATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLYNG FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUM BI NO GAS TEST I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRE0 BY LOB ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE O I RESIDENTIAL OPERTY FINAL SIGNATUREERMITTEE OF P PERMIT VALIDATION cK M G CASH PLAN CHECK VALIDATION CK u 0 CASH 1 9.5 0 131�ePP 5 5 U •its • WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT !7 I hereby affirm that 1,have a cMificate of consent to self 20-0020 DPW 0/87 G I insure or a certificate of Workers Compensation Insurance 76A007A lul or a certified copy thereof(Sec 38DOC,,JLob C )r COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Po No O W Campony ..Ti`• !-( a ElCertified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS / .. 7 Candied copy t filed with the county building Inapec- ADDRESS /OC! (tion deportment NUMBER FIXTURE OR ITEM ® FEE LOCALITY Dote •_1� —412-ApphSant� ` �� WATER CLOSET NEVffST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by the permit 1s for one hundred dollars ({100)or less ) ' LAVATORY ADDRESS I certify that in the performance of the work far which this permit is mod,1 shall not employ any person in any manner SINK CRY TEL NO so an to become subject to the Workers Compensation Laws DISHWASHER CONTRACTOR CL Dote A.ppbwnt CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of ADDRESS Exemption you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code you must forth Ory D C2 TEL N0243 7 a LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shell be LICENSE NO r079)bZ- t�SS 13 ��0 deemed revoked WATER HEATER LICENSED CONTRACTORS DECLARATION DISTRICT Np D BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS .CQ� (commencing with Section 7000)of Division 3 of the Busmen OUTLETS OVER ✓ and Professions Code and my license is in full force and effect 3 PER SYSTEM FINAL (/ VALIDATION License Number /7Z f0(3 Lit: Chair U/ 4 fU DATE NAL Contractor L)yUev651Atk Dote 7—17--22---22— B ❑ I am exempt under Sec 8 8P C for this reason d _ Plan check fee Dote PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE 3, Plan check applicant c SINGLE FAMILY HOME OWNFR-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Connocior's Ucense Law for the following reason (Section 7031 S Business aril Addren 3:117 JG.G.. Professions Cade) City Tel No 1 ITEMS ❑ 1, as owner of the property will do the work and the structure is not intended or offered for sole (Section TATAL 53 - 85 7044, Business and Professions Code) polo CONSTRUCTION LENDING AGENCY CHECK 5-1.v5 1 hereby affirm that there is a construction lending agency for C H14haE .Lill the performance of the work for which this permit is issued (Sec 3097 Civ C ) Lender's Name 4CIQL1—�091 4J 17/9 ' Lender's Address 9911 1 AM10a42 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 jaws regulating Plumbing and hereby authorize reprelentatives of this County to enter upon the above mentioned property for inspection purposes Z / 7_� SEE REVERSE FOR EXPLANATORY LANGUAGE ure of Permittee !Date r RICER S COMPENSATION OC-CLARATgN 1h002B DPW a/ae t �1 I/len het i`heve • certdmale o1 consent to self msa,b 77A APPLICATION FOR ,PLUIiABI�Ifi' PI=, Y� & .1 c, 1 Worker a Compensation Insurance or a certified Y * r copy t 3800 Lab C) r r• I % ,1 + 0. Company OF LOS ANGELES DEPT OF PUPLIC W0 ,�u�r f-OF P IC WORKS DIV Certified copy Is hereby furnished ❑ I ' � Certified copy s hied with dna county buAdep FOR APPLICANT TO FILL IN(PRINT OR TYPE)Inepectlon d m NUMBER FIXTURE OR RFM ® FEE Y LOCALE Dere ti Applicant WATER CLOSET C r CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB , L..AS •• �I�'Ka S +�' COMPENSATION INSURANCE E' ASSESSOR SSE MAPSO 1 FADE AR�Et,I (This section need not be completed It the work Involved by the ER r / permit In for ons,hundred dollars IIor Nu) LAVATORY OWNER t '` r I certify that in the performance of the work for which this permit MAIL X7"9/ is issued I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Lewy DISWASHER CT' 1 C - ' C.T .'�r� Tf Date b L Appkcenl �. .. `^'�""•\ CLOTHES WASHER CIXRRACTOR A••'1` Ts �rlJ �' 1 NOTICE TO APPLICANT If after making this Certificate of Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR `�� provisions of the Labor Code you must forthwith comply with such ACCRESSf ,g` ,r E—L 4' Qa1Ttt.f , provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY �, y r p A 1 hereby affirm that I am licensed under provisions of Chapter B WATER HEATER (commencing with Section 7000) of Division 3 o1 the Business and STATE OAT SYSTEM Professions Code and my license is In full farce and effect 1 CUTLETS LICENSE NO OUTLETS OVER dT No. 2 ��•• S PFA SYSTEM 0 License Number � Lt. Cf.-C,--ra�� FiNAL' - �/�� DATE Convector • ' ^KCete 7" i HAL " Z Eler I sm exempt undSec fBY I BaPC for this mason t, Date Plan check fee _ SignaturePLUMBING PERMIT ISSUING FEE$ r f • to ,` - ❑ TOTAL FEE 3 �, BINDLE FAMILY Plan check applicant C I?-- +f' - HOME OWNER BUILDER DECLARATION Name eC " I hereby affirm that I am exempt from the Contractor a License Lew R for the following reason (Section 7031 5 Business and Professions Address ^ Code) City 5 E] I as owner of the property will do the work and the structure Tel No _ ACCT.* A Is not Intended or offered for sale (Section 7044 Business . •- 3.7v7-fr� -49.30end Professions Code) r �.i, ,� , '30 CONSTRUCTION LENDING AGENCY • S:A•,�-ULT�. ITEI R39 3?3 I hereby affirm that there is a construction lending agency for the „•,wL ' performsnca of the work for which this permit is issued(Seo 3087 Civ C) Lender Name VVUV-��1 12/ 3/r' Lender a Address !�S•1/ 1 fiI11U 41 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 re resentetives of this County to enter pon the above m nI rise prop for i p -ISEE REVERSE FON EXPLANATORY LANGUAGE Z SIgnt4ure of Permittee Date