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Home My Public Portal About5646-5648-5650-5652-5654-5656 ROSEMEAD BLVD_Plumbing__ 76A667A ZL O b C£617 IREV.6/118) Os APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING D ADDRESS L NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET 6 G LOCALITY Thy �L� /C 7- NEAREST BATH TUB CROS ST. SHOWER OWNER LAVATORYMAI. 3 IF ADQ SINK CITY TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDR S SWIMMING POOL RECEPTOR F IT T .NO. LAWN SPRINKLER SYSTEM WATER HEATER LICENSE TAT NO. �� CLASS +3 GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES GAS ST Plan check fee UTILITYSCO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ o TOTAL FEE ..i FINAL — Plan check applicant PLAN CHECK VALIDATION Name Address City Tel.No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE TUAT THE ABOVE IS CORRECTAND AGREETO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INT D TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. O N O O O �D SIGNATURE O O O --" OFPERMITTEE — O ��DIS ICT ROCESSED BY 0 0 D �1 � O o �7 OD 0 O CJl 3:. INDUSTRIAL I CH WASTE APPROVAL (�� WORKERS'COMPENSATION DECLARATION 76A667A APPLICATION ,//�� //�� C I hereby affirm that I have a certificate of consent to self CE of 7(z-eo) A P P L I`s A T I®N r 0 R �YMBING PERMIT ifl insure,or a certificate of Workers'Compensation Insurance,ora certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company 0 Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) ABUILDING DDRESS �� 6 Nf' aLF' Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM A FEE department. WATER CLOSET LOCALITY Date Applicant NEAREST ACI-111144S c I `� BATH TUB CROSS ST. /f J ( � J CERTIFICATE OF EXEMPTION FROM WORKERS' I�� H rC� �xr; COMPENSATION INSURANCE SHOWER OWNER /F VP M l� LAVATORY MAI L (This section need not be completed if the work involved ADDRESS 3 / OAA CL by the permit is for one hundred dollars ($100) or less.) SINK CITY W Cf y TEL.NO� O 0 I certify that in the performance of the work for which this DISHWASHER lr permit is issued, I shall not employ a person in any manner CONTRACTORt Cd7 ��(��{(� O so as to become subject to the ers'Compe sation Laws. CLOTHES WASHER ADDRESS r Q(Q��[ — V Date -_0- -a°�Applicant SWIMMING POOL RECEPTOR ra , d NOTICE TO APPLICAN j f,aft making this Cer if3cate of CITY ®, ( JR�IJ EL.NO. t� -�� CO Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATEy� �J Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE N0.3t,J / Al C ASS with comply with such provisions or this permit shall be deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PRO ESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER 51 I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL .� ness and Professions Code,and my license is in full force and DATE .� r VALIDATION 12 r-�� effect. 15 r�r� y FINAL License Number` ( l( Lic.Class BY Contractor-fri atj Iva ��a a 5-0114- I -0114-I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE.$ ()(�d , acting in my professional capacity (Section 7051, Bus- 11 l iness and Professions Code). TOTAL FEE S� Lie,or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031.5, Busi- City Tel.No. 3 3 7 2 A ness and Professions Code): I, as owner of the property, am exclusively contracting 0 0 0 0 0 with licensed contractors to construct the project o o Z (1 (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency n -z ` _ L 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 SEE REVERSE.FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize re sentatives of this County to enter upon the above ent(on�d-property fo inspection purposes. a&� 3 `ignaturb of Permittee Date r WORKERS'COMPENSATION DECLARATION8A067A I hereby affirm that I have a' certificate of consent to self �E 817(z-ao) APPLICATION I'®R PLUMBING PERMIT insure,or a certificate of Workers'Compensation Insurance,or "fl 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 ADDRESS dS� Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ® FEE department. WATER CLOSET LOCALITY "�Q�� f f, --+ Date Applicant NEAREST BATH TUB CROSS ST. �� U��S CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER 47A/ MAI L (This section need not be completed if the work involved LAVATORY �p ADDRES ®45,!5�e� by the permit is for one hundred dollars ($100) or less.) SINK I certify that in the performance of the work for which this DISHWASHER V CONTRACTOR permit is issued, I shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER 0 ADDRg\15:/O �D O ilm— Date Applicant SWIMMING POOL RECEPTOR NOTICE TO APPLICANT: If, after making this Certificate of CIT TEL.N Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. / d. Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE N � CLA PGs AA with comply with such provisions or this permit shall be .20 deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER JG41 I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code,and my license is in full force and DATE effect. FIN License Numb ,yc�CIass �C^ BY AL p Contractor ate s z 7 I am a empt m the licensin require ants as I am a Plan check fee licensed archi ect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ` s s v e acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE 14-1 Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address r 5 1 tl 1 R License Law for the following reason (Section 7031.5, Busi- City Tel.No. ]2 0 0 0 o 0 5 ness and Professions Code): F1 I, as owner of the property, am exclusively contracting o - 2k50 with licensed contractors to construct the project (Section 7044,Business and Professions Code). n 0 o 2 6.°i C _ U CONSTRUCTION LENDING AGENCY I 072T-82 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 ab ' formation is correct.I v to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordina ces and State laws ng lum an hereby a ri represent tives f y to enter pon the ova- n r tion purpose$. S' store of Perini t ee Date