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HomeMy Public PortalAbout6276 ROSEMEAD BLVD_Plumbing__ D.B.S.-17 29M sETs 12-44- ••r, = - APPLICATION-FOR PERMT, - - _ DEPARtMENT OF AUILDING AND-SAFETY, 6 1 COUNTY OF LOS ANGELES' - PL 1G i -Wm.J. FOX. CHIEF,ENGINEER It NATURE OF,INSTALLATION r ' DISTRICT NO .GROUP ZONE PERMIT NO. r -ROUGH- FIXTURES COMPLETE f-� I READY,FOR ~HEATER CESSPOOL I`,SEPTIC TANK RECEIVED BY "FIRST INSPECTION DATE ISSUED ' 6A8 `} -- 'MISCELLANEOUS APPLICANT FILL IN,HEAVILY•: LINED-PORTION ONLY- NAM E NLY-NAME fT {{ ADDRI S a- Wo -s•C! -i CAD, - m _ADDRESS _b� • -t,/,. �l�py. �/ V 'LOCALITY, - 'E •D •` - _ r��g� ,(1; NEAREST ' J CITY-; ed, ,TEL. o. J 'CROSS ST. � IL ,COUNTY - _ - �.0 , �� •_ •y ,CERT.No. EXPIREBJ 3 K _ NAME Id r ,LOCATION.OF SEPTIC TANK, OR ESSPOOI]' 3 ADDRESS -549,- / O /`Ds4E ' - _ NORTH .`; CITY' .• _ .. 'T '+ _ - � � g �0 I AM TH[. GA SESSORWQC' BO r=LO ANGELES COON RTIFICATE OF F , •I MB - i-A OWN P ries RIB ABOV CORRECTIONS •- SOUTH - t, DESCRIPTION'OV WORK ' ATH,TU8 FURNACfi f SHOWER._ 'DISHWASHER 1 0 _ AVATORY •REFRIGERATOR' .e —KITCHEN SINK *.WATER SOFTEN ER -'OOR SINK= _: SAND TRAP ' LOP SINK. FLOOR DRAIN' WASH TRAY URINAL APPROVALS G WATER CLOSET- DRINKING FOUNTAIN DATE INsp¢eTop's NAa[ 'WATER HEATER ^ENTAL'LAVATORY ROUGH PLUMBINdl I + �METER__�GAS SODA FOUNTAIN GAS PIPING, IIO Y�v i71 I ` - OUTL ` - GAS VENT CESSPOOL _ TOTAL NUMBER OF FIXTURES, SEPTIC TANK I ••-CESSPOOI -• gEPTIC TANK,- - ,� SEWER UTILITY CO.NOTIFI[D -" TOTAL FEE- , FINAL- �J, ' DEPARTMENT OF COUNTY ENGINEER PLUMBING 1" DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES ! BUILDING �� ! �� IND. I WILLIAM J. FOX, COUNTY ENGINEER ADDRESS (� p FOR APPLICANT TO FILL IN V LOCALITY 717�P BUILDING // ` �/ NEAREST .� A ADDRESS [O 04 7d /!x'40 A40 S4e/)I�� CROSS ST ��t DISTRICT NO. GROUP ZONE PERLOCALITY �� C / �JNEAREST / �..d CROSSST A O�(j t�6A� RECEIVED BY Ready for Inspection DATEt �� OWNER /�Ji/� kl /u �/ � �� MAIL INDUSTRIAL V $ �` ADDRESS WASTE APPROVAL, CITY TEL.N0, INSPECTION RECORD PLUMBER, � ADDRESS O/ `f' CITY e',_ AZP,�'(�",e TEL.NO. �, d/ STATE LICENSE N0�'J V 0 COUNTY ��]/ 'If e PERMIT FEESa S gyp =z �LMRER TYPE OF FIXTURE OR ITEM FEE �f `m — 1 b_ /� WATER CLOSET(TOILET) @ 0.80 $' _® J)�` BATHTUB @ 080 SHOWER @ 0.80 LAVATORY(WASH BASIN) @ 0 80 � c_�► x+;7+ ; / � �� KITCHEN SINK @ 0 80 LAUNDRY TUB OR TRAY @ 0 80 SLOP SINK @ 0 80 FLOORSINK @ 080 FLOOR DRAIN @ 080 DISHWASHER @ 0 80 DRINKING FOUNTAIN @ 0.80 URINAL @ 0.80 GAS SYSTEM--- ..----. UTLETS @ 1.00 d WATER HEATER @ 1.00 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDERSLAB WORK PERMIT $ 1 00 ROUGH PLUMBING O GAS PIPING TOTAL FEE IHEREBY 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST AND STATE OF CALIFORNIA OR TIJAT I A161 THE LEGAL OWN. ER OF THE ABOVE DESCRIBED d4L PROPERTY. UTILITY CO.NOTIFIED _ • l SIGNATURE � t� OFPERMITTE _.. FINAL 7GA667 DBS 17 1/53 WORKERS'COIvIPEN$4T10t.4 DECLARATION APPLICATp®N FOR PLUMBING PERMIT .hereby affirm that I have a cei�ificate of consent to self 76A667A sure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certified copy thereof (Sec 3800, Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY 3 P❑ol cy No WC800110@�„pany Transamerica Ins. Co. �' Certified copy is hereby furnished j tk ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING — 'v Certified copy is filed wit he county builds Inspec- ADDRESS tion department NUMBER FIXTURE OR ITEM « FEE yr, LOCALITY Date Appli .n WATER CLOSET !Teample City NEAREST iI CERTIFICATE OF E PTION ROM WORKERS' BATH TUB CROSS ST Long Ar COMPE S ION I SURANCE = OWNER (This section need not be completed if the work involved by SHOWER Mr.. Sma 1 di n o the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS e I certify that in the performance of the work for which,this permit is issued, I shall not employ any person in any manner SINK ✓ CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR Joseph Cadi 11 i Mg. Co. Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS 7821 East Garvey Avenue Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR p�O Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY Rosemead CA. tl 71770 TEL Ncc80-4201 with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER t,J LICENSE NO CLASS _ LICENSED CONTRACTORS DECLARATION DISTRICT NO P SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 17 GAS SYSTEM OUTLETS t /6 60� (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect 5 PER SYSTEM I AL VALIDA ON V License Number ' 134935 Lic Class C-��i r ` t 5 v cJ,o,%ep,h Cadil9i P1bg: 6�te 511_5/85 1' `Hand 'Sink �6 00' BYAX __11 o ❑ .� ` - X12 0 U I am exempt under Sec N B&P C for this reason Plan check fee Date Signature PLUMBING PERMIT ISSUING FEE$ X 71,0 _-o, 2 2'3 8 2 A TOTAL FEE' ' SINGLE FAMILY Plan check applicant o5250 Ia HOME OWNER-BUILDER DECLARATION Name ' I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Address a o o 5 2 5 0 5 Professions Code) City Tel No 7.02-85 1,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 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit ,s 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 ,s correct I agree to comply with all County ordinances and State jaws regulating Plumbing, and hereby authorize presentatives of this County to enter upon the above- e boned proper y fo� coon purp es ' SEE REVERSE FOR EXPLANATORY LANGUAGE Si of P 7ttinf& Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 0,'1 herebytffirTn Thal I have a certificate of consent to self 76A667A iNsure, or a certificate,of Workers' Compensation Insurance, CE 817(REV 10/81) or a cern i d'co there ec 3800, Lab C ) � J COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company �`�'t1t�c�� Certifi�l copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING r 72 ❑, Certified copy is filed with the county building inspec- ADDRESS Dr's `csc`sdCq tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Dotes � Appligant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FOM WORKERS' BATH TUB CROSS ST. � ©dZ?_ COMPENSATION INSURANCE OWNER (This section need not be completed if the'work involved by SHOWER the permit is for one hundred dollars $100 or less. MAIL P ( � � LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK d CITY' TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR C/-r r Date Applicant CLOTHES WASHER ADDRESS ,p NOTICE TO APPLICANT If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY �(j�/f�o. TEL NO��ZTf LAWN SPRINKLER SYSTEMjf- with comply with such provisions or this permit shall be STATE 4t-70 �j��LIC ' deemed revoked WATER HEATER LICENSE NO -7-7 CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO R ES D Y I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM 'L OUTLETS d (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �t >' and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL ®. ct e2_ DATE Q VA ATION Ot) License Number ' "�� ` Lic Class " A9 FINA O Contracto Date' BY ❑ I am ex mpt under Sec to B &P C for this reason Plan check fee Date Signature PLUMBING PERMIT ISSUING FEE$ TOTAL FEE 4 2 6 Q 6 A SINGLE FAMILY Plan check applicant #,o o o o 0-5 , HOME OWNER-BUILDER DECLARATION Name 0 0 5 2 5 I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and o 0 o 5 2 5 p 5 Professions Code) City Tel No ❑ j, as owner of the property, will do the work and the 0 a07-85 structure is not intended or offered for sale (Section Poo , 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 jaws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE � Signatu6p, Permittee Date