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Home My Public Portal About6142 ROSEMEAD BLVD_Plumbing__ , WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby offirin that I have a'certificate of consent td self 20-0026 DPW 6/87 insure, or a Sertificate of Wdrkers' Compensation Insurance, 76A667A or a,certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS Policy No.WP893636mpany Fremont Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 6142 Rosemead Blvd. k � L- 9:1 Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM @ FEE tion department. LOCALITY :5-1Z) Progressive Plbg. WATER CLOSET o 5" Temple Cit Dote Appligant �� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ECCROSS ST. Lon den COMPENSATION INSURANCE OWNER (This section need not be completed If the work involved by MAIL SHOWER Da-Ari Development the permit is for one hundred dollars($100)or less.) i j LAVATORY 76C I a ADDRESS 678 W. Garvey I certify that in the performance of the work for which this permit is issued, I shall not employ an person in an manner SINK CC CITY TEL. NO. p P Y Y P Y � �� 7 Monterey Park so as to become subject to the Workers'Compensation Laws. 3, DISHWASHER5� CONTRACTOR Progressive Plumbincr Date applicant ] CLOTHES WASHER r c�'t� ADDRESS 4257 Auction Ave., #F NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY Baldwin Park TEL' N0962-2428 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER5 0 LICENSE NO. 478794 CLASS C-36 LICENSED CONTRACTORS DECLARATION � DISTRICT N(J , R D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEMOUTLETS 0( `/✓� r/( (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL /, AL TION a DATE L��•�` C License Number 478794 Lic. Class C-36 Progressive Plbg —� sY ALd/ l C Contractor bate ❑ 1 am exempt under Sec. C B.BP.C. for this reason Plan check fee ® er Date. PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant r SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Name 'A,. 7° x I hereby affirm that I am exempt from the Contractor's License i ' 4 Law for the following reason (Section 7031.5, Business and Address .FFI-7 _�I, cj Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the 1 TTE__r_E structure is not intended or offered for sale (Section ��s o ��, 7044, Business and Professions Code). � ® !��-h�L CHECK 35 1 CONSTRUCTION LENDING AGENCY I ~°c.� ..w I hereby affirm that there is a construction lending agency for CHANGE °01 t the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name 9093-3031 7/ j1/9L Lender's Address 16577 i1 993--4 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 of this County to enter upon the i Qnntionedropertyforinspection purposes.^ SEE REVERSE FOR EXPLANATORY LANGUAGE R �a of Permittee Date vd9am 17 a-so I® APPLICATION :FOR PERMIT ' DEPARTMENT OF BUILDING AND SAFETY � � - - COUNTY OF LOS ANGELES WILLIAM_J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN. DISTRICT NO. GROUP NE PERMIT NO. PLU71 - TEL. uperi.or 7 Lm.b . REsp BY FIRST INSPECTION, l READY FOR AT�� ADDRISSUED �nJl1T �1 -nd •L� VBUILDING � CITY El Nonte COUNTY �? .NO.FO 0-1e9�63 ADDRFSS 7 �f L CENSE NO. 5109®111 EXPIRES .6-�30-52 LOCALITY. Temple V•�lt� NEAREST PERM FEES CROSS ST. Langdeft NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER Celeste Cons.truc.ti on MAIL .WATER CLOSET (TOILET) Q 0.50 S ADDRESS BATH TUB O.SO CITY TEL. NO. SHOWER . @ '0.50 1 -HEREBY ACKNOWLEDGE THAT t HAVE READ THIS LAVATORY (WASHBASIN) .� 0.50. APPLICATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY WITH ALL C LINTY ORDINANCES AND KITCHEN SINK �' 0.50 -STATE LAWS REGULATING PLU NG. 1 CERTIFY THAT 1 P S THE ABOVE. VALID LOS LAUNDRY TUB OR TRAY Q 0.50 ANGELES COUNTY 'LIC I-AM THE LEGAL OWNER OF THE RESIDEN71 R DESCRIBED ABOV GAS SYSTEM 3 OUTLETS C(a 0.50 SIGNATURE OF 3 WAITER HEATER @ 0.5.0 PERMITT. - SLOP SINK ' Q o.SO INSPECTION RECORD FLOOR SINK 0.50 FLOOR DRAIN 0.50 DISHWAS14ER 0.50 DRINKING FOUNTAIN 0.50 URINAL , 0.50 - HOUSE SEWER 0.50 Q Z MISCELLANEOUS UI 0 APPROVALS DATE INSPECTOR'S NAMM ROUGH PLUMBING GAS PIPING GAS VENT . CESSPOOL @ 1.00 CESSPOOL . SEPTIC TANK: SEPTIC.TANK I._ . DRAIN ( ) PIT ( ) (a] 1.001' _ SEWER J� PERMIT . 1.00 GAS TEST a ) A-1,- '7-: 4 UTILITY CO. NOTIFIED fW--i9 t .I14-?a TOTAL FEE $' 0 5.Q I ? "" ✓e q. FINAL . SINGDEPARTMENT OF COUNTY ENGINEER : 1 PLUM DIVISION OF BUILDING"AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J. FOX, COUNTY EN13INEER ADDRESS [ '! `� �� -` (J��II(`✓--�" L}`�" FOR APPLICANT TO ILL IN' LOCALITY BUILDING /� NEAREST ADDRESS / L. a CROSS ST. �.�•l DISTRICT•N0. 'GROUP ZONE PERMIT NO." LOCALITY NEAREST CROSS ST. �� RECEIVED BY Ready for Inspection _ DATTE'ISSUEEDD OWNER MAIL f INDUSTRIAL ADDRESS K.CJ dr WASTE APPROVAL CITY TEL.NO. INSPECTION RECORD PLUMBER ADDRESS CITY TEL.NO. ❑STATE LICENSE-NO. d r J -PERMIT FEES 7'2•/ ,t U :yr: t f r!•-�-n —!Z G' r�/�.� Q Z NUMBER TYPE OF FIXTURE OR ITEM FEE (' WATER CLOSET(TOILET) IIS 0.80 $ - a BATH TUB @ 0.60 SHOWER @ 0.80 LAVATORY(WASH BASIN) @ 0.80 KITCHEN SINK @ 0.60 LAUNDRY TUB OR TRAY @ 0.80 SLOP SINK' @ 0.80 ' FLOORSINK @ 0.80 FLOOR DRAIN @ 0.80 DISHWASHER @ 0.80 DRINKING FOUNTAIN @ 0.80 URINAL @ 0.80 GAS SYSTEM..............OUTLETS @ 1.00 WATER HEATER @ 1.00 MISCELLANEOUS' . 07. .APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ I• 00 ROUGH PLUMBING G ' TOTAL FEE' AS PIPING I HEREBY ACKNOWLEDGE THAT 1 'HAVE READ THIS APPLI- GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE 'HOT WATER-HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING: PLUMBING FIXTURES. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER•OF. THEA VE DESC IB ESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE - OF PERMITTEE...__-.._.._.._. �d FINAL riG �a[. 78A667 DBS 17 1/53 76AS67 Das 17 7-51 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER DI R GR UP ZONE P . FOR APPLICANT T❑ FILL IN PLUMBER RECEIV€D BY READY FOR AT 188 ED FIRST INSPECTION ADDRESS �.. BUILDING OITY TEL No. ADDRESS COUNTY Wr NSE NO. EXPIRES LOCALITY ; y� NEAREST PERMIT FEES CROSS ST. NUMBER TYP[OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) a 0.50 $ ADDRESS BATH TUB Q 0.50 CITY TEL. No. SHOWER a 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0,50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY (� 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS 0.50 SIGNATURE OF WATER HEATER Q 0.50 PERMITTEE F -- SLOP SINK 0 0.50 INSPECTION RECORD FLOOR SINK ([') 0.50 !FLOOR DRAIN 0.50 DISHWASHER Ca? 0.50 DRINKING FOU14TAIN Q 0.50 URINAL Q 0.50 _ HOUSE SEWER 0.50 _Z MISCELLANEOUS ��, � .,,_ 19� APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TA DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT . . . . 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE `b- -7 ' ; L I FINAL