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HomeMy Public PortalAbout5676 ROSEMEAD BLVD_Plumbing__ 7aa667-cEae17, 10-67 % '�'� t. — p .. APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS "M PO4 JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temp) • FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST CROSS ST. L 4— Ta1vA,-.,S NUMBER FIXTURE OR ITEM EACH FEE OWNER COD MAIL AAA 1 WATER CLOSET 1.50 aC3 MAIL BATH TUB .1.50 ADDRESS SHOWER .1.50 CITY TEL. NO. LAVATORY 1.50 CONTRACTOR t •SINK 1.50 'ADDRESS DISHWASHER 1.50 CITY ):3 y4- TEL. NO. J? Qr 1051 CLOTHES WASHER 1.50 r%WA NO. � e CLASS SWIMMING POOL RECEPTOR 1.50 CT NO. GROUP ZONE PRO E BY LAWN SPRINKLER SYSTEM 2.00 p © F: O WATER HEATER 1.50 PROVALC O S —70 GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD V OUTLETS OVER 5 PER SYSTEM 30 �QYY Q Y y �1 J FWq mrwovioi :r Plan check.fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 00 , TOTAL FEE u(,O. SOI APPROVALS ATE sP CTOR'S G ATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING 779770 - Address GAS PIPING GAS VENT City. Tel. No. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING .GAS TEST ' PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DE CRIBED (DENTIA OPE FINAL SIGNATURE JACK R. ALLEN, SUPE VISI ECH ANICAL ENG'R..- OF PERMITTEE • PERMIT VALIDATION c M.o. cases• PLAN CHECK VALIDA ION CK. M.O. cases t fir. 4 3 7 5P APR 7 5 D 2 0.5 0- .. WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 1,'heFeby affirm that I have a certificate of consent to self .I 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76AG67A ' f or a certified copy thereof(Sec. 3800,'Lob. C.) I COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No. Company � , Certified copy is hereby furnished. I' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGADDRESS 0' Certified copy is filed with the county building inspec- tion department. NUMBERFIXTURE OR ITEM @ FEE WATER CLOSET LOCALITY lot?[L Date Applicant � NEAREST � C76m�ERTIFICATE OF EXEMPTION FROM WORKERS' BAT}I'T118 CROSS ST:�,q$ COMPENSATION INSURANCE SHOWER OWNER o' (This section need not be completed If the work involved by MAIL the permit is for one hundred dollars($100)or less.) 97, LAVATORY ADDRESS I certify that in the performance of the work for which this , permit is issued,I shall not employ any'person in any manner SINK CITY TEL. NO. so as to become subject to theWorke Compensatio Laws. DISHWASHER CONTRACTOR D V Date —JIU—qJApplicant CLOTHES WASHER ADDRESS OS NOTICE TO APPLICANT: If, of making this Certificate of Q l.� Exemption, you should befee subject to the Workers' SWIMMING POOL RECEPTOR p y I CITY TEL..NO, Z Compensation.provisions of t e'Labor Code, you must forth- LAWN SPRINKLER SYSTEM 13 v with comply with such provisions or this petmit'shall be STATE `O ,Z LIC. deemed revoked. WATER HEATER LICENSE NO. 6 C LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm-that I am licensed Under provisions of Chapter 9 GAS SYSTEM OUTLETS �O d (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER Q and Professions Code,and my license is in full force and effect. 5 PER SYSTEM. FINAL 1-5 + VALIDATION C �OSIw PIU V /� /O a2 0 DATE- Z C License Numb. r -Lic. Class` Cs _ t FINAL[A a, Iz Contractor j a Date BY C Moe slhh� .7 I am exempt under Sec. W B.BP.C. for this reason a Plan.check fee er Date PLUMBING PERMIT ISSUING FEE$ Signature— I TOTAL FEE G O Plan check applicant SINGLE FAMILY J HOME OWNER-BUILDER DECLARATION Name 'S PhU­"bino ANT 6 I'hereby affirm that I am exempt from the Contractor's License Address0� Law for the following reason (Section 7031.5, Busirie'ss and Q _ Ycu�Mo J,:, 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 ® DID&7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY t.•f{`Uf:' iU�o CJI: I hereby affirm that there is a construction lending agency for AN;}� r- the performance of the work for which this permit is issued H. GE (Sec. 3097, Civ. C.). LeAder's Name I_li]I,I —{}I1131 1 /25 19'1 Lenders Address Int ,�. i (�('( '':Cr, 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 representatives of this County .to enter upon. the ab mentioned' perty for inspection purposes. q SEE REVERSE FOR EXPLANATORY LANGUAGE t nature of'PlErrilttee Date 01