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Home My Public Portal About5624-5626 ROSEMEAD BLVD_Plumbing__ t. D.B.S.-17 25M SETS 1E-45 APPLICATION FOR PERMIT DEPARTNT OF BUILDING AND SAFETY CO �� COUNTY OF LOS ANGELES WM.J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE 6 I `1 44'60 i� '•, HEATER CESSPOOL I�SEPTIC TANK RECEIVJrD BY READY FOR DATE ISSUED FIRST INSPECTION ell_, GAS MISCELLANEOUS APPLICANT FILL IN HEAVILY✓OUTLINED PORTION ONLY - JOBB '' �y' / a NAME _ADDRESS2_l3 V J �! /.-- 1 7 ADDRESS LOCALITY/ ✓ a ` l / 0, NEAREST CITY j TEL.No. ,+•� �._j CROSS ST i"- �� COUNTY f�++"r+ / I CERT.No.ski 6 EXPIRES NAME LOCATION OF SEPTIC TANK, OR CESSPOOL 3 ?#AILADDRrSB NORTH O CITY TEL.No. IAM THE LEGAL POSSESSOR OF THE A I3VE LOS ANGELES COUNTY CERT�T OF UALIFICAT :mss PLUM ER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. � OWNBR CORRECTIONS SOUTH a DESCRIPTION OF WORK ATH TUB FURNACE SHOWER -DISHWASHER 0 _LAVATORY v SEFRIGERATOR i ITCHEN SINK'/` WATER SOFTENER FLOOR SINK SAND TRAP LOP SINKFLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE �l I�NS`PEcTof•o NAME WATER WTER DENTAL LAVATORY ROUGH PLUMBING I O -��'7 7 I f/ v a/�f' METER [�f SAB SODA FOUNTAIN I I OUTL C%AS PIPING GAB VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOL------SEPTIC TANK SEWER I � -- o- y71 4 UTILITY CO.NOTIFIED TOTAL FEE �S u' FINAL 76A66 DBS-17 12.34 APPLICATION FOR PLUIVIBl� kI-- DBS-17 DIVISION OF BUILDING AND SAFETY ee=tment of Coua �iaee -- cao of I.os galea 1 �/ WM.J. FOX. COUNTY ENGINEER BUILDING y G U- ADDRESSO CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST / CROSS ST. .i"- c`' OWNER - g (STRICT NO. GROUP READY FOR INSPECTION MAIL C -/ ADDRESS J , ZON' �1"'•/ INDUSTRIAL CITY ^rL. NO. WASTE APPROVAL PLUMBER -fir°-tom INSPECTION RECORD dL'.tit.�'G.Sc +/)t% ADDRESS - � S- ..,'1,�.� .sd C' ',��4/• f - CITY TEL. NO. y. LICENSE NO. r NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) $ BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY CLOTHES WASHER TOTAL NO. @ 0.80 APPROVALS DATE INSPECTORS SIGNATURE GAS SYSTEM OUTLETS @ 1.00 WATER HEATER @ 1.00 UNDER SLAB WORK ROUGH PLUMBING PERMIT $ I 1 00 GAS PIPING TOTAL FEE GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO. NOTIFIED CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PR PERTY. !' SIGNATURE OF PERMITTEE sd {`{. /"`�. . if/ ''FINAL (� C. r C ...i,,i'•jl._.. - Nmiili�-- WILLIAM J. FOX, COUNTY ENGINEER VALIDATION ]C0 4 3 6 7121 JUN 6 3 1 .8 D in BY ) 1�� . DEPUTY _ arri.ar„�rrivn"��crrlriarur • - DEPARTMENT OF BU AND SAFETY " V. COUNTY OF LOS ANGELES PLUMBING WM.•J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT No. GROUP ZONE //P T NO. . ROUGH FDXTURES COMPLETE Y`•k-. ff HEATER CESSPOOL SEPTIC TANK READY FOR' REC6IYFA BY DATE ISSUED FIRST INSPECTION FA18CELLANEOU APPLICANT FILL IN HEAVILY OUTLINED PORTION Y JOB Gdler:p .�)^_-bo DDRESS VS 9 J�/ � �� LOCALITY NEAREST 00 ,r. TEL.No. CROSS ST.!. \.,/ t EXPIRES tr NAME � W LOCATION"OF SEPTIC TANH, OR CESSPOOL, z MAIL 3 ADDRESS NORTH O CITY TEL.No. I AM THE LEGAL POS IF BOR OF THE ABOVE LOS ANGELES COUNTY CERTIFI AT OF ALIFICATION. PLUMBER D AM THE LEGAL OWNER OF THE PROPERTY DESCRIBL' ABOVE. ,= OWNER CORRECTIONS 11 s U cr. SOUTH DESCRIPTION OF WORD . z BATH TUB FURNACE Q' SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK BAND TRAP ' SLOP SINK FLOOR DRAIN WASH TRAY _ URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER - DENTAL LAVATORYI I ROUGH PLUMBING METER GAS SODA FOUNTAIN GAS PIPING I I OUTL GAS VENT _ CESSPOOL as TOTAL NUMBER OF FIXTURES `'` SEPTIC TANK I I —_CESSPOOL SEPTIC TANK t' SEWER _ _ UTILITY CO.NOTIFIED ' I ' TOTAL.FEE FINAL _ l •�D.B.S.-lb SSM SETS,17:46 DEPARTNIIlNT.OF AND SAFETY COUNTY OF LOS ANGELES _ WM.•J.FOX.CHIEF ENGINEER PLUMBING NATURE. OF INSTALLATION l8TRlNO. GRIDuP ZONE PERMIT NO. . ROiIGH. FIXTURES COMPLETE 4/0 f 7- HEATER HEATER CESSPOOL BEPTIC.TANK. RECEIVED BY READY FOR D ATE ISSUED jj y /- ,FIRST INSPECTION GAS AllOBSESSES 8CELLANEOU APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY 9 . ' JOB a NAME �,� ., rs 44 s ADDREBB 10 m 'ADDRESS / 9 Y/ LOCALITY / NEAREST d CITY TEL.No. ! CROSS ST. COUNTY CERT.No, t/ L EXPIRES CM NAME LOCATION-OF SEPTIC TANS, OR CESSPOOL Z MAIL 3 ' ADDRE86 NORTH O CITY TEL.No. a I. AM THE LEGAL POB SOR OF 'THE ABOVE LOS ANGELES.COUNTY CERTIF19M OF ALIFICATION. PLUMBER / I.AM THE LEGAL:OWNER OF THE PROPERTY DESCRIShd ABOVE. . .OWNER .. . i - - CORRECTIONS ,rte JZZ- SOUTH J DESCRIPTION OF WORK . z_ BATHTUB FURNACE BOWER - DISHWASHER 17 -LAVATORY REFRIGERATOR -KITCHEN SINK. WATER SOFTENER .• FLOOR SINK SAND TRAP LOP SINK FLOOR DRAIN WASH TRAY - URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATERNEATER DENTAL LAVATORY ROUGH PLUMBING I ETER AA9 - SODA FOUNTAIN OUTL IAB PIPING I I • GAB VENT 1 /2 CESSPOOL I/ — —! L � TOTAL NUMBER OF FIXTURES`"'` SEPTIC TANK I -CESSPOOL SEPTIC TANK S' �' `' SEWER I UTILITY CO.NOTIFIED I FINAL. WORKERS'COMPENSATION DECLARATION �PPLICATI®IV FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) 11 or a certified copy thereof(Sec..3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tiomdepactrnent. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Date Appli4ant ciap?/a� WATER CLOSET ✓ NEAREST VCERa� CER FICATE OF EXEMPTION FROM WORKERS' I BATH TUB ✓ CROSS ST. ]—A roVAIAC COMPENSATION INSURANCE I OWNER (This section need not be completed if the work involved by SHOWER t the permit Is for one hundred dollars($100)or less.) ATORY MAIL d Z /� L, ADDRESS I certify that in the performance of the work for which this O permit is issued,I shall not employ any person in any manner Vill CITY T TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. !I 7A CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED B I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the BusinessOUTLETS OVER �' IL and Professions Code,and my license is in full force and effect. I 5 PER SYSTEM FINAL VALIDATION DATE 9M i License Number Lic. Clas ��//��ff � p FINAL Contractollc QA ote U BY ❑ n- I am exempt under Sec. , a B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature 000,11P TOTAL FEE. Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 2.0 1,8-A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address 1' 0 0 0 ° ° 5 Professions Code): City Tel. No. ❑ I, as owner of the property, will'do the work and the 3�.5 0 . structure is not intended or offered for sale (Section 0 0 0. 3 Q, 5 0'x 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 6-83 1 hereby affirm that there iso 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 above information is correct. I agree to comply with all Countl ordinances and State laws.regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- entioned'p erty for inspection p rposes: n SEE REVERSE FOR EXPLANATORY LANGUAGE � /" ture o Permittee D to WORKERS'COMPENSATION DECLARATION APPLICATION�OR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A �— insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800, Lab. C.) i COUNTY OF LOS ANGELES r BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING ❑ /�D' Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET � 671& ,/ 00 Date AppliSant NEAREST ��,t 1 BATHTUB CROSS ST. t, CERTIFICATE OF EXEMPTION FROM WORKERS' . ' COMPENSATION INSURANCE OWNER L C� (This section need not be completed if the work Involved by SHOWER MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS �'° � /J/ I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY p� / TEL. NO. so as to become subject to the W FersComper�tion Laws. DISHWASHER _/ CONTRACTOR } �'t + •I , /��l'� �� f/F4�/r'i�✓ie� t �— CLOTHES WASHER w �`~ r r,� Date A lice t �e'ti NOTICE TO APPLICANT: f, a er making this Certificate of ADDRESS a� a � l_4 c1 b Al Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITYKin ��t.' TEL. NO. r-7,��'77 Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM tr - with comply with such provisions or this permit shall be STATELIC. deemed revoked. WATER HEATER LICENSE NO. CLASS ' LICENSED CONTRACTORS DECLARATION DISTRICT NO. P CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS J � (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION O License NumberS Lic. Class ' Uti DATE Id /�/� G{ �,pN�� FINAL O Contractor/ ✓�`�-a� `�R'��Date 7�/,—�"" BY - _ U ❑ I am exempt under Sec. to N B.BP.C. for this reason ► Pan check fee Date: PLUMBING PERMIT ISSUING FEE$ O (� Signature TOTAL FEE Plan check applicant SINGLE FAMILYA HOME OWNER-BUILDER DECLARATION Q� Name - C I hereby affirm that I am exempt from the Contractor's License Address ? u a o o a Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. o o 2 8 50 ❑ I, as owner of the property, will do the work and the ® a'a a ` c 0 structure is not intended or offered for sale (Section 7044, Business and Professions Code). ) _ .3 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 above information is correct. I agree to comply with all County Poo ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ab ve-mentioned property for inspection purposes. }'� � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date