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HomeMy Public PortalAbout6320 ROSEMEAD BLVD_Plumbing__ 76A667-CE#817 2-66 APPLICATION FOR PLUMBING PERMIT C COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING 2 JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS v GSL L COLEMAN W. JENKINS. SUPT, OF BUILDING LOCALITY _L ( l FOR APPLICANT TO FILL IN NEAREST ^^ CROSS ST. C��> -C G c �' NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET ;1.25 } MAIL BATH TUB 1.25 ADDRESS SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR ?J¢ SINK 1.2S I Z� ADDRE r 7 i/f DISHWASHER 1.25 CITY (_� 'L�)(Lj �/ETEL. NO. t) STATE /y LIC LAUNDRY TUB 1.25 LICENSE NO. II / CLASS CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY WATER HEATER 1.50 ` /U �� �- 1.50 AL INDUSTRIAL `Q Mme. Q o GAS SYSTEM OUTLETS WASTE APPROVAL 44-jT �O OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD v 0 U L Z w i f i A• APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WO ROUGH PLUMBING TOTAL FEE I 151 GAS PIPING I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER yt ' PLUMBING. _ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES t; LICENSED AS REQUIRED BY LOS ANGELES CO NTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OW OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED R/E//SIDEN PROPERTY. UTILITY CO.NOTIFIED r SIGNATUREgio 3130 IV OF PERMITTEE FINAL � LIDATION JACK R. ALLEN CK. M.0. CASH SUPERVISING MECHANICAL ENG'R. j, ,5 9 o a S Nov 18 5 © -15.00- N 76A667A CE 817(REV.6/78) O S., LLL444 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING ADDRESS + ,St "C14y NUMBER FIXTUREORITEM @ FEE LOCALITY its ih ' WATER CLOSET � -� NEAREST BATH TUB CROSS ST. L U h do .1 q V L, SHOWER OWNER M P`G e- F+ C O h t�`LAVATORY MAIL 6ADDRESS P O B U � / 1SINK CITYTEL.N SDISHWASHER CONTRACTOR CLOTHES WASHER ADDRESSSWIMMING POOL RECEPTOR CITY Ue pO.� K TEL,NO.$ LAWN SPRINKLER SYSTEM rROUGH LIC. /^e WATER HEATER SG o 31 CLASS `-31 GAS SYSTEM OUTLETS DATE INSPECTOR'S SIGNATURE OUTLETS OVER K a- 5 PER SYSTEM S0.p-y�{tLQ It O GAS VENT u 09 HOT WATER HEATER 0 O PLUMBING FIXTURES V GAS TEST 0. Plan check fee UTILITY CO.NOTIFIED LSTATE LUMBING PERMIT ISSUING FEE$ TOTAL FEE Z FINAL PLAN CHECK VALIDATION eck applicant ^�;�� •� s /sy66 Tel.No. HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE - E ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ATE LAWS REGULATING PLUMBING. PERMIT VALIDATION HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS `'ED BY LOS ANGELES COUNTY'AND STATE OF CALIFORNIA OR THAT I AM THE OWNER OF.AND INTEND TO RESIDE IN THEA E DESCRIBED RESIDENTIALRTY. y4u_� 2 • • 220 (:TUREERMITTEE ♦ • • J LJi I.. r t [.. 0 DISTRICT NO. Q /'—PRQCESSED BY x fi 4 3 INDUSTRIAL WASTE APPROVAL WORKER'S COMPENSATION DECLARATION 200026 DPW 9/69 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby-affirm that I�have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thareof(Sec.3800 Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / ❑ Certified copy is filed with the county building inspection ADDRESS !v'� _ _ Ile department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date ApplicantWATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) ` OWNER _(���� � J v I certify that in the performance of the work for which this permit LAVATORY MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITY /• ` e�/.e g �) n l_.NO(&/ /Date ✓� 3 Applicant CLOTHES WASHER �S NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR �� c V Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. /�/ y CLASS O Professions Code,and my license is in full force and effect. DISTRICT NO. PROCESSED BY OUTLETS OVER 5 PER SYSTEM �/t� O License Number 59 0 ,�Lic.Class .8 ((�1w DATE FINAL ,� VALIDATION G� 7 �Contractor�f?..�.���.i/-t/7 L Date G �G a ❑ FINAL Z I am exempt under Sec. gY � B.&P.C.for this reason Date: 3 / Plan check fee , SignatureT�LefX' _4 4? PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE Val l — SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law a {7 40o65 for the following reason (Section 7031.5, Business and Professions Address Code): 1 !1 EMS ❑ City Tel. No. I,as owner of the property, will do the work and the structure TOTAL 40 m 65 is not intended or offered for sale (Section 7044, Business rt and Professions Code). CHECK, t •t trtJeL=t CONSTRUCTION LENDING AGENCY - CHANE ,Ill I 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.) _ .11J LC 1 Lender's Name 8747 o J. AM 9:07 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 authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date