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Home My Public Portal About5610-5618 1/2 ROSEMEAD BLVD_Plumbing__ 7"4 t4 r A(CB P76t 11/76 II 111LLL APPLICATION FOR PLU BING PERMIT 1 BUILD AND SAFETY DTVI , FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 16'(1/0y'OSE/1/F/� Y1 NUMBER FIXTURE OR ITEM O FEE WATER CLOSET LOCALITY 7�Jy pLE c-/7y BATH TUB NEAREST CROSS SHOWER OWNER 'I/Q Al. ,LQ-e _ LAVATORY ADDRESS P101 Box SINK OTY rflO _/ le TEL NO 3.85'33/ DISHWASHER CONTRACTOR Mi IT (;IQA a COn CLOTHES WASHER ADDRESS r Q r7 d. 097 ? SWIMMING POOL RECEPTOR OTY ma LE./00� TEL No 1/7 0 /1lO3 LAWN SPRINKLER SYSTEM STATE �p }] WATER HEATER LICENSE NO / .�V D CLASS g— / GAUSTLSEYFSTEEyM OUTLETS DISTRICT NO GROUP nZONE D B 55 PER SYSTEM INDUSTRIAL ASTE APPROVAL y `'7 G INSPECTION RECORD V Plan check fee PLUMBING PERMIT ISSUING FEE$ 3'(7 TOTAL FEE FD Plan check applicantq;k G/ 8 Coos , Cp Name /' �' '17(F C� APPROVALS GATE INSPECTORSSIOMAIURE 10 UNDER SLAB WORK Address f C /g FG ROUGH PLUMBING Gty of c✓Ob Tel No � O GAS PIPING HERE ACRXOWLEDGE THAT HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE 6 CORRECT ARD AGREE TO COMPLY WITH ALL C W NTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR LICENSED AS PLUMBING FIXTURES REWIRED BY LOS ARGELES COUNTY AND STATE OF CAUFORNM OR THAT I AM THE GAS TEST LEDAL OWNER OF AND INTEND TO A E IN THE ABOVE DESCRIBED RESIDENTML PROPERTY UTILITYCO NOTIFIED SIGNATURE oP PERM TTi FINAL 10 1 PLAN CHECK VALIDATION CE Mo CASH PERMIT VALIDATION CK. MO CASH 9 3 1i-Nov 2 5 D 1 0.5 0 A=a �L DQ IT IGH etre Ia APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES �L�� ' VUM J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION Him ROUGH FIXTURwg XEATER CEQSPOOI. BtPTIC TAMK RECEIV®BY FI R 1 �6TION DATE IBSYED o -�p- APPIICA14T FILL IN HEAVII,Y OUTLINED PORTION ONLY JOB 6, NAME ADDRESS -7J4 A tl D ADDRESS LOCALIT 7 j • NRRIII G C Td NO. CROSSR COUNTY CER No E PIREQ NAME LOCATION OF SEPTIC TANK, OR CESSPOOL MAIL MAIL NORTH CITY TEL NO I AN THE LEGAL POSSESSOR OFTXE ABOV LOQ ANGELES COUNTY CKRTI►ICA OF QUALIF/ICATIO PwtlCER I AM THE LEGAL OWNER OF THU PROPERTY DEQCRIBKD ABOVE. owNm CORRECTIONS SOUTH J DESCRIlvnON OF WORK I ATM TUB FURNACE O R "NOWKR ^IQHWAQHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER R SINK GANDTRAP IN SINK ^^R DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INtFDCtOR•NA" WATER HEATER DENTAL LAVATORY ROUGH PLUMBING ETER._____OAS SODA FOUNTAIN GAS PIPING OUTL GAQ VENT CESQFOOL TOTAL NUMBER OF FIXTURED SEPTIC TANK lSSPOOI ��*IC TANK w� SEWER TOTAL FEE UTILITY Co NOTIFIED WORKERS'COMPENSATION DECLARATION APPLICATION PP ICA TION FOR PLUMBING L MBIN PERMIT hereby affirm that I have r certificate of consent to self 76A467A M L \rM 1 �\ f R f V V GR insure, or a certificate of Workers'Compensation Insurance, CE Bl](REV. 10/81) or�,y cceerr/.f drecoop'y7the !g Secs 3800, Lab. C ) �/. - COUNTY OF LOS ANGELES BUILDING AND SAFETY PPooyit cy No. J ! ",Sj"CSo r: _.tib" L'r."'. Z.!`^!'►F 4'�'+'`/ T.�^�L Certified copy is hereby furnished. ./�"--" FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / -) ❑ Certified copy Is filed with the county building Lie inspec- ADDRES (^>• Imen�.s NUMBER FIXTURE OR ITEM ® FEE LOCALITY D Appli —`' WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKER n BATH TUB CROSS ST. ,.p/ F% tet✓ COMPENSATION INSURANCE OWNER i (This section need not be completed if the work involved by SHOWER ^!" the permit is for one hundred dollars ($100) or less.) LAVATORY MAIL ADDRESS / ,( .-�f' • I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY t .% 'iEKNO5,L T7 so as to become subject to the Workers'Compensation Laws. DISHWASHER \ - CONTRACTOR Date Applicant CLOTHES WASHER F - NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS? !"- Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR ' P P LAWN SPRINKLER SYSTEM CITY ^^" TEL. N(S"'- Compensation provisions of the Labor Code, you must forth- v .L = with comply with such provisions or this permit shall be STATE -^ ``-r _ •- LIC. deemed revoked. WATER HEATER LICENSE NO. f- l'" -'?`^ CLASS LICENSED CONTRACTORS DECLARATION �-FISTRJCT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM InTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER } R an rofeesions Code and�y license is in full force and effect. 5 PER SYSTEM �_. ^] �J/�'' _T�/ FINAL VALIDATION O 4icause Numbed Lic. Clas --3 '1-^" �2 DATE W F 41 �✓ ,... ! Y ...�. ._ v FINAL BY Dote �. ❑ am exempt undyer Sec 0c B.BP.C. for this reason Plan check fee - O a_ Date. PLUMBING PERMIT ISSUING FEE$ w Signaturet" TOTAL FEE Plan check applicant SINGLE FAMILY f HOME OWNER-BUILDER DECLARATION Name .t I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ 1, as owner of the property, will do the work and the .. ' structure is not intended or offered for sale (Section pool7044, 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 application and state that the 1100above information is correct. I agree to comply with all Count' ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes _.--y-+ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS COMPENSATION DECLARATION _ APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 200028 DPW 8/87 Insure, or o certificate of Workers Compensation Insurance 76A807A or a certified copy thereof (Sec 3800, Lob ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No Company Certified copy s ereby furnished ' ❑ FOR APPLICANT TO FILL IN(PRIM OR TYPE) BUILDING ,y') Certified copy s filed with the county sliding inspec- AODRE55 hd 7! on department NUMBER FIXTURE OR ITEM ® FEE LOCALITY �� Date /d /c/,ppbgant WATER CLOSETNEAREST - 'n CERTIFICATE Oj E%EMPTION FROM WO ERS BATH TUB �ST Q COMP NSATION INSURANCE OWNER (This section need not be completed R the work Imrohred by SHOWER !� to the permit Is for one hundred dollen($I00)or less ) MAILLAVATORv AGGRESS Lfd I certify that to the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITYre e NO so as to become subject to the Workers Compensation Laws DISHWASHER _ CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of AWRE55 Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth LAWN SPRINKLER SYSTEM CITYTFL NO with comply with such provisions or this permit shall be STA ( —LICC deemed revoked WATER HEATER I NO 2fCLASS LICENSED CONTRACTORS DECLARATION VU DISTRICj,Nq, PRo� BY I hereby affirm that I am licensed under provisions of Chapter 9 OAS SYSTEM OUTLETS OF o Y (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 FINAL q AUDATION p; License Number Lic Class DATE t li 2 l O FIN 4 � U Contractor Date ❑ I am exempt under Sec B 8P C for this reason Plan check fee 0111. rn Dote PLUMBING PERMIT ISSUING FEE S Z Signature TOTAL FEE SINGLE FAMILY Plan check applicant 5 HOME OWNER-BUILDER DECLARATION Name ACCT.: I hereby affirm that 1 am exempt from the Contractor s License Address ? 52.50 Low for the fallowing reason (Section 7031 5 Business and Professions Code) City Tel No 1 ITM ❑ I on, owner of the property will do the work and the ' TOTAL 52structure is not intended or offered for sale (Section 41 ► , �� 70 , Business and Professions Code) CECK 52.50 CONSTRUCTION LENDING AGENCY - C .00I 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 ) 684 Lende 'Nome 0�0-0001 11/ i s 6589 1 AI110:59 Lender s Address I certify that I have read this application and state that the Poor above infomahan is correct I agree to comply with all County ordinances and State laws regulating Plumbing and hereby authorize relxelentatnves of this County to enter upon the abov mentioned props for inspection purposes Date SEE REVERSE FOR EXPLANATORY LANGUAGE Slgrgture of er nee affirm that CI have DECLARATION APPLICATION FOR PLUMBING PERMIT I hereb}Faffum that I hove a cer/ificote bf consent 10 self 76A667A insure ar a certificate of Workers Compensation Imurance CE 817(REV 10/81) of carry r^Rpts�� COUNTY OF LOS ANGELES BUILDING AND SAFETY Poli N 1T/ 3 0 Certified copy is hereby furnished x FOR AFRICAN TO FILL IN(PRINT OR TYPE) BURDR'IG l�L�gp Certified copy a filed with the county buJdm mspec- ADDRE v NUMBER FIXTURE OR ITEM ® FEE LOCALITY �/ APpI WATER CLOSET NEAREST y�! f CERTIFICATE OF EXEMPTION FROM WORKE BATH TUB CROSS ST JJ sV/ COMPENSATION INSURANCE OWNER (This sedlian need not be completed If the work Involved by SHOWER the permit Is for one hundred dollars ({100)or leu) MAIL LAVATORY ADDRESS d 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 CITY TEL NO so as to become subject to the Workers Compensation Lows DISHWASHER CONTRACTOR J Date Applicant CLOTHES WASHER ADO NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL N Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM �/ with comply with such provisions or this permit shall be STATE yes / LIC deemed revoked WATER HEATER LICENSE NO d7CLASS LICENSED CONTRACTORS DECLARATION GAS SYSTEM S �DISTRICT Np By I I hereby affirm that I am licensed under provisions of Chapter 9 f U � (commencing with Section 7000)of Division 3 of the Rumness OUTLETS OVER ann�„erofgssigns Code nit license a in full face and effect. 5 PER SYSTEM d ` 24 y S(�G 2 G DATE VALIDATION � Llrmse Number L�< Class J aC 0009210�re� &I FIN O n t 'Q.k Gif/ BY ❑ W I am exempt under Sec N B &P C for this reason Z Plan check fee Date PLUMBING PERMIT ISSUING FEE f Signature 14 2931.6A TOTAL FEE Plan check applicant # e e s s e 5 SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name I I e l 7 8 5 0 I hereby affirm that I am exempt from the Contractors License Address Law for the following reason (Section 7031 5, Business and e -,1 7 8 5 0 5 Professions Code) City Tel No ❑ I as owner of the Property, will do the work and the 06' 05-88 structure is not intended or offered for sale (Section 011.704, 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 Larder s Address I cenrfy that I have read this application and state that the 10.above information is correct I agree to comply with all Count' ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the aboo ntioned proper for in purposes SEE REVERSE FOR EXPLANATORY LANGUAGE �iT Signature of Permittee Date [/-5--ipts