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HomeMy Public PortalAbout5675 ROSEMEAD BLVD_Plumbing__ D. B. 17 4- APPLICATION FOR'PERMITr 1� DEPARTMENT OF BUILDING AND SAFETY I COUNTY OF LOS ANGELES PLUMBING 2' WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT No. c....ROUGH �. c.... 2. z-o PLUMBING I/ FIXTURES' I COMPLETE RECEIVED BY READY FOR D TE SUED HEATER CESSPOOL 1SEPTIC TANK QVFIRST INSPECTION I 1 a GAS MISCELLANEOUS 1 ` 71 'L1L— APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB C NAME I ' /'� j� ADDRESS ADDRESS) U V ,2 / LOCALITY J / NEAREST CITY TEL No 6 / CROSSCOUNTY 16!5a CERT. NO. EXPIRES NAME LOCATION OF SEPTIC TANK, OR CESSPOOL c AD IL RES, NORTH CITY TEL No. I AM THE LEGAL P SSO O HE ABO LOS ANGELES COUNTY CER *THEROPERTY ALIFIC 10 1 r. M 1 AM THE LEGAL O NER ODES RIBED ABOVE. I- to a 3 i CORRECTIONS OWNER SOUTH W DESCRIPTION OF WORK _ BATH Tun FURNACE J D. SHOWER DISHWASHER LAVATORY REFRIGERATOR 13 KITCHEN SINK WATER SOFTENER [:::/::�:LOOR SINK SAND TRAP LOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET / DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING —METER—GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL 1 TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOL SEPTIC TANK SEWER $ O UTILITY CO. NOTIFIED TOTAL FEE 1 FINAL WORKERS'COMPENSATION DECLARATION '• 7"' APPLICATION FOR PLUMBING PERMIT v' 1 hcl`eby� Jfirm that I have a certificate of consent to self 76A667A insure; o-'a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) � c Aed so�of(Sec. 3800, Lab. CC..) COUNTY OF LOS ANGELES BUILDING AND SAFETY o icy No ompany prr 01 AaGer'ified copy it hereby furnished. BUILDING ❑ ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) s Certified copy is filed with the county building inspec- ADDRESS /`tio de ariment. � NUMBER FIXTURE OR ITEM Q FEE Date/IF IE 40E JZ IV Appli4anfTiy_,c 3 f LOCALITY WATER CLOSET / NEAREST ..�^ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. /'✓ S COMPENSATION INSURANCE SHOWER OWNER 'sr f�r (This section need not be completed if the work Involved by MAIL r �� the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS /� d dF OP I certify that in the performance of the work for which this SINK l Z CITY © TEL.NO �S permit is issued, I shall not employ any person in any manner / r so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRI:S53.� NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR ` Zo Exemption, you should become subject to the Workers' CITY "� TEL. N d y � 2 6 Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE '7 LIC. r deemed revoked. WATER HEATER LICENSE NO. or, LASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCFSSFD_E I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS --G Q (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 5C (/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL �1 VALIDAT 7y�Q� 9 r/ DATE // u d License Number—����/ Lic. Class O _-0-97 FINAL (j Contractor Date �� BY a. 1 am exempt under Sec. U B.BP.C. for this reason , OW Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 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. ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY ;15 S a3 A I hereby nffirm that there is a construction lending agency for the performance of the work for which this permit is issued # ° ° ° • • 5 (Sec. 3097, Civ. C.). ' • - 7650 Lender's Name ° o ° 7 6,5 05 L'ender's Address ( 1,06-86 1 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 representatives oft 's County to enter upon the \ above- tion nspection purpos SEE REVERSE FOR EXPLANATORY LANGUAGE \ ignaf� o i to