HomeMy Public PortalAbout6270 ROSEMEAD BLVD_Plumbing__ 76AB67-CE#817 10-62
APPLICATION FOR PLUM ING PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
S 6270 Rosemead Blvd
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A. JENSEN, SUPT OF BUILDING
TY Temple City
FOR APPLICANT TO FILL IN T. Congdon
NUMBERFIXTURE OR ITEM EACH FEE
Shell Oil Co
3 WATER CLOSET $1.25 3 75MAIL
BATH TUB 1.25 ADDRESS 2430 W `ilameda Street:
SHOWER 1.25 CITY Burbank TEL. NO. 546-9151
2 LAVATORY 1.25 2 50 CONTRACTORSpencer & Jones
1 SINK 1.25 1 25 ADDRESS N ' Hoyt .Ave
DISHWASHER 1.25 CITY El Monte TEL. N . 64
LAUNDRY TUB 1.25 CONTRACTOR'S STATE REGISTRATION NO. 184669 COUNTY ❑�
CLOTHES WASHER 1.25 DISTRICT NCO.. GROUP ZONE PROCESSED BY
WATER HEATER 1.50 p �7
GAS SYSTEM OUTLETS
1.50 INDUSTRIAL
WASTE APPROVAI ;44n. e.
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECO
1 Sand trap 1 50
00
1 urinal 1 25. 0.
1 coke drain 1 25.
APPROVALS DATE INSPECTOR'S SIGNATU ft
PERMIT s 2 00 UNDER SLAB WORK id;�I --/ n /
ROUGH PLUMBING
TOTAL FEE 18 r) GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. \A -
I HEREBY CERTIFY THAT 1 AM PROP LY REGISTERED AND/OR PLUMBING FIXTURES
CE
LINSED AS REQUIRED LOS GE S COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT r M TH GA OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE ES RI ARES DENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE
FINAL -747 0'r
LIDATION ROBERT 4. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENG'R
LAU0 5 5 5 2% NOV 4 5 D 18.50- v
- -a
wWORKEH�'.COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I.hiart;Er2,zirr trtat I have a certificate of consent to self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
OcyNo.80011088 comp.,, ransamerica Ins. Co.
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING .
Certified copy is filed with the county building inspec- ADDRESS 6270 Rosemead Boulevard
tion department. NUMBER FIXTURE OR ITEM @ FEE
LOCALITY
Date 9i?niRS� S-.e h Cadilli Plh ( o, 1 WATER CLOSET U
-r-.----t--- � � �- NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved by D
the permit is for one hundred dollars $100 or less. MAIL
P ( ) ) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK 00 CITY TEL. NO.
so as to become subject to the W kers'Com ens 'ton Laws. DISHWASHER
CONTRACTOR
0 Jospph Cadilli PlIlmhinn rf)
D e l� Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, ma g this Certificate ofE Garvey Avenue
Exemption, you should c me su ject to,the Workers' SWIMMING POOL RECEPTOR e
Compensation provisions f e Labor Code, the
must forth- CITY TEL. NO.
p p y LAWN SPRINKLER SYSTEM Rosemead Calif. 280-4201
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER F LICENSE NO. CLASS C-36
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCES ED BY
I hereby affirm that I am licensed under provisions of Chapter 9 1 GAS SYSTEM 1 OUTLETS d �CJJ7T^
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM
FINAL / VALIDA ON
License Number 13 .19.35 Lic. Class r_2� 4 '.`Dental Ch i'rs ®� DATE/! ZI—e S U
Contractor
Joseph Cadi 11 i P1 bg. Date 9/20/85 B N z9296. 1 A �
❑ I am exempt under Sec. rte"
# 0 0 0 0 0 5 q
B.BP.C. for this reason
Date:
Plan check fee I - 0 70,50
Sinature PLUMBING PERMIT ISSUING FEE$ 5-0a
Signature TOTAL FEE 10S ) o o.o70,5050
SINGLE FAMILY
Plan check applicant 2 O '_85
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.
❑ 1, 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
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 ►
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
out orize representotives of this County to enter upon the
OEignat�ure
-ment�pertyection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Da e