HomeMy Public PortalAbout6230-6236 ROSEMEAD BLVD_Plumbing__ 76A667-CE8617 5/63
CITY OFTE �IPLE CIT
A PPr�I$P�I-PAR-PL.. M B[NG PERMIT'
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A.LAM13IE. COUNTY ENGINES ADDRESS 6230 N. Rosemead
WILLIAM A.JENSEN,SUPT OF SUGINE ! R972
LOCALITY Temple/ City
FOR APPLICANT TO FILL IN NEAREST
CROSSLo den
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSES $1.25 OWNER GrosberMAIL
BATH TUB 1,25 ADDRESS
SHOWER 1,25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR G E DS E R A L ILMSTALLMON C .
SINK 1.25 ADDRESS 6558 HEST BLVD.
DISHWASHER 1.25 CITY L.A. TEL. NO. PL3-254.1
LAUNDRY TUB 1.25 REGISTRAATION NO. C36 151839 COUNTY 0
CLOTHES WASHER 1.85 DISTRICT GROUP I ZONE, P CESS D BY
WATER HEATER 1.50 }
GAS SYSTEMOUTLETS 11.50INDUSTRIAL
ASTES APa
APPROVAL O
OUTLETS OVER 5 PER SYSTEM .80 U
INSPECTION RECORD
i 1 0
Ready fnr Tnapection now �
e ced c�
a
Vi
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT 5 2 00 UNDER SLAB WORK
fi ROUGH PLUMBING
TOTAL FEE s GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
ANO STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS 1{EGULATING
PLUMBING. HOT WATER HEATER
i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOB ANGELS NTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL NER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESI NTIA ROPERTY. UTILITY CO.NOTIFIED
SIGNATUREf/
r
OF PERMITTEE - FINAL
,,—' ALIDATION ROBERT A.WOOD
CK.
m.0. CASH SUPERVISING MECHANICAL ENG°R
;3. 0.8 Q AUG 2 0 5 fl_
325- 4
76A667 17 11-49 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES i 1
'WILLIAM J. FOX, CHIEF ENGINEER PLUNIBING
DISTRICT GROUP O .
FOR APPLICANT TO FILL IN 9 0
A�2 22 FIRST INSPECTION
PLUMBER kRECE�IVED BY READY FOR DATE ISSUE
ADDRESS -n -s- Q,�Q� � �
4BUILDING p
CITY Na. ADDRESS
P
to
COUNTY a fy e�' LOCALITY
LICENSE NO. EXPIRES 40 !1 I
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER C]
MAIL 7
WATER CLOSET(TOILET) @ 0.50 S ADDRESS
BATH TUB @ 0.50 CITY g rs9 TEL. No.
SHOWER 0.50' I , REBY ACKNOWLEDGE THAT 1 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 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ® ANGELES COUNTY LICENSE, OR 1 AM THE LEGyyL OWNER
OF THE RESIDE L PROPERTY DESCRIS $'OVE.
GAS SYSTEM OUTLETS c 0.50 4�
SIGNATURE OF
WATER HEATER @ 0.50 PERMITTE
SLOP SINK @ 13.50 INSPECTION RECORD
FLOOR SINK 0.50
FLOOR DRAIN @ 0.50
DISHWASHER 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 J
Q
HOUSE SEWER @ 0.50 _Z
MISCELLANEOUS I a
0
APPROVALS
DATE INSPECTOR-0 NAME/n�
ROUGH PLUMBING I 1' .-/
GAS PIPING o=�
GAS VENT f
1 Vd
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) (9Z 1.00 SEWER
PERMIT .
1.130 GAS TEST / -* . 34
UTILITY CO.NOTIFIED
TOTAL FEEIs cso l FINAL ulw r I
1 '
��W�RKERS'_COMPENSATIONq?;CLARtaTION" 20.0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT
:lrM t14at I.have a certificate of,consdnt to self in- 76A667A
sure,dr o cetificate of Workers'Compensation Insurance,or a CE 817(REV.8/86)
•'certified copy thereof(Sec. 3800, Lab. C.) LLLJJJ
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company
Certified copy Whereby furnished. BUILDING 1�34- `�D
FOR APPLICANT TO FILL IN(PRINT OR TYPE) /a?Cj
Certified copy is filed with the county building inspection ADDRESS cv J ) S�'/71e4d
department. f� fp I/^) NUM/B_ER FIXTURE OR ITEM @ FEE n LOCALITY
Date 1 I-2-/-6u Applicant K)7I•� �+i �� ((� WATER CLOSET(TOILET) (l NEAREST
y
CERTIFICATE OF EXEMPTION FROM WORKERS' P t'S' BATH TUB � CROSS ST. L 0.4.4 d&14
COMPENSATION INSURANCE OWNER J L
IQ I SHOWER v /�( q. o�d
(This section need not be completed If the work Involved by A' MAIL
the permit Is for one hundred dollars($100)or less.) e3 LAVATORY /d (,v ADDRESS l L(}I IJ VAL la &ria. .20 /
I certify that in the performance of the work for which this per- SINK
mit is issued, I shall not employ any person in any manner so CITY - TEL. NO.3o Sz
as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR `C 1
"
Date Applicant CLOTHES WASHER 2 ADDRESS 5?S /.� G ;� ,q/,tp, #f-
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY t5#11W`' �M1G TEL. NO.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE '7 0-� LIC.
ed. WATER HEATER LICENSE NO. lel/O �� CLASS
LICENSED CONTRACTORS DECLARATION kL DISTRICT O. _ ! P ESSED B
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER U
fed,Professions Code, and my license is in full force and ef- /� 5 PER SYSTEM FINAL L J/ V ATION
n G(, /� ra 1rt1A�'J t @ DATE `f O
IL
License N,,uyymb��er 7?7 / Lic. Class ` '36 V
Contractor 15,s/ Date �f`?� FI O
I am exempt under Sec. W
B.BP.C. for this reason ►
Plan check fee CID
Date: PLUMBING PERMIT ISSUING FEE$ V U c1 1 7.8 A
Signature TOTAL FEE 175-1
_S # 0 0 0 0 0 5
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant I o 9 5 8,5 O
I hereby affirm that I am exempt from the Contractor's License Name c o 95a5,O 5
Law for the following reason (Section 7031.5, Business and
Professions Code): Address ) 1.21 -88
❑ I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044,
Business and Professions Code).
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 N11110.above information is correct.I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
aut orize representatives of this County to enter upon the
o - e tioneci perty for inspection purposes.
, _ �_ SEE REVERSE FOR EXPLANATORY LANGUAGE
nature of Permittee Date —