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Home My Public Portal About6515 ROSEMEAD BLVD_Plumbing__ �r /1 i 1S e+ewee>w ac eh(111®r+ APPLICATION FO PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND AFETY FOR APPLICANT TO FILL IN IPRINT OR TYPE) BUILDING ADDRESS NUMBER FIXTURE OR ITEM B FEE ocnu v WATER CLOSET NEAREST BATH TUB CROSSST SHOWER OWNER LAVATORY MAIL ADDRESS — SINK CITY TEL NO DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL NO LAWN SPRINKLER SYSTEM STATE /1 LIC /L WATER HEATER LICENSE NO Y CLASS C.. BONN GAS SYSTEM OUTLETS APPROVALS C) TE INSPECTOR S SIGNATURE OVTIETSOVER UNDER SLAB WORK Tp 7 �WI/QdGZ-- 5 UEL SYSTEM ROUGH PLUMBING GAS PIPING O GAS VENT V HOT WATER HEATER O PLUMBING FIXTURES GAS TEST Plan check fee UTIUTYCO NOTIFIED _ PLUMBING PERMIT ISSUING FEE E TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDATION Name Addrai Cly Tel No I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAMN AND STATE 256-31 A THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY WITH ALLCOUNTY ORDINANCES p AND sr An LAWS REGULAnNG PLUMBING PERMITVALIDAT DIN _ M e,�,�'� ♦ 5 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE 2 e - 220 0 LEGAL OWNER Of AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTLLL PROPERTY ,.,( � " ' ^ e e B 22006 SIGNATURE A AR//q/ , �/YL/E/v/) OF PERMITTEE �R'AWS Q�� 2 UTA 7 Y D15TRICT NO P E55 BV �/ 7I/� INDUSTRIAL WASTE APPROVAL ce eTF(nev enei ms• APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY Al FOR APPLICANT TO FILL IN IPRINT OR TYPE) BUILDING L js d NUMBER FIXTURE OR ITEM 0 FEE ADDRESS WATER CLOSET LOCALITY 914 NEAREST BATHTUB CROSS T SHOWER OWNER _�� _ LAVATORY MAIN ADDRESS i SINK CITY TEL NO DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY TEL NO LAWN SPRINKLER SYSTEM LIC WATER HEATER LI ETNSE NO , 6 yOV CLASSc- .7-0 pp GAS SYSTEM OUTLETS OUTLET$ O APPROVALS DATE INSPECTOR 5 SN:NATURE ?KLETSWORK STEMR UNDER SLAB ROUGH PLUMBING GAS PIPING GAS VENT 1.1 as HOT WATER HEATER O PLUMBING FIXTURES GAS TEST Plan check fee UTILITYCO NOTIFIED _ PLUMBING PERMIT ISSUING FEE$ 17 OJ TOTAL FEE / ,9 O e FINAL Plan check applicant PLAN CHECK VALIDATION Name Address C `� City Tel No I HEREBY ACKNOWLEDGE THAT I HAVE BUD THIS APPUCATNIN AND STATE 6 3 fl 2 A THAT THE ABOVE IS CORIIECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION # e e e e e I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS !/ �QUIED BY LOS ANGLES CMNTY AND TATE LEGALROWNER OF ANDINTEND TO RESIDES SIN THE ABOVE DESCRIBED RESIDENTIAL 2 e e 0 O O PROPERTYI SIGNATURE _ A e e e (1 O O 5 OF PE RM ITTE /I O fl Cn fl asTq/CT NO 09 INDUSTRIAL WASTE APPROVAL WORKERS'COMPENSATION DECLARATJON IGAea7A 1 hereby affirm that I have a certificate of consent to sett Ca 817 (2410) APPLICATION FOR PLUMBING PERMIT msure, or a certificate of Workers'Compensation Insurance,or /I a certified copy thereof(Sec 3800,Lab C) r ` . COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No 'Compan)' El Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING p Certified copy is filed with the county budding Inspection NUMBER FIXTURE OR ITEM • FEE ADORE _ department LOCALITY WATER CLOSET Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER .� OWNER MAIL (I'hn islxnon need not be completed U the work involved LAVATORY 3 ADDRESS by the permit u for note hundred dollars ($100) or less) SINK 3 CIYV TEL N O 1 certify that to the performance of thew rk for which this DISHWASHER CONTRALTO U permit p Issued, I shell not em y r n in any manner 00 so eat b o subsea tot s mpensetion Laws CLOTHES WASHER ADDRESS r61O 4 Date Applicant SWIMMING POOL RECEPTORL 6r NOTICE TO APPLICANT If, after making this Certificate of CITU TEL N 6d'�QV ie. Exemption, you should become subject to the Worken LAWN SPRINKLER SYSTEM Compensation provisions of the Labor Code, you must forth STATE LIC Z wish comply with such provisions or this permit shall be WATER HEATER LICENSE NO CLASS deemed revoked I GAS SYSTEM OUTLETS DISTRICT NO PR ESSEPB LICENSED CONTRACTORS DECLARATION OUTLETS OVER 0 1 hereby affirm that 1 am licensed under provisions of Chapter S PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Bust FINAL '7—, 6 y9 VALIDATION nm and Professions Code, and my license is to full force and DATE U`. effect FINAL License Number � �U Lia Clan gY Contract i Date u I em exempt from the licensing requuements u I am a Plan Check fee �D r lice nised architect or a registered Drofesswnel enpneer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Buis loess and Professions Code) TOTAL FEE Lic or Reg No Date Plan check applicant HOME OWNER BUILDER DECLARATION Name 1 hereby affirm that 1 am exempt from the Contractors Address License Law for the following reason (Section 7031 5, Busi City Tel No $5 1 Q 5 A nese and Professions Code) ElI. as am We'Droperty, am exclusively contracting # • • • • • 5 with Wensed contractors to construct the prosect (Section 7044,Business and Professions Code) 2 • ' 1 9, 00 003 Cl NSTRUCTION LENDING AGENCY 19 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 0 607-8 1 issued(Sec 3097,Civ C) Lender's Name Lenders Address I certify that I have read this application and state that the above information is correct I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby au ze representatives ol this County to enter upon the e ov me wned inspection purpgsa� Signature of Permitt Date WORKERS'COMPENSATION DECLARATION 7SA947A n 1 hereby aMM that I have a certificate ofconseAt to self amain("*) APPLICATION FOR PLUMBING PERMIT Ica' Insure,or a certificate of Workers'Compensation Insurance,or �• a certified copy thereof(Sec 3800,Lab C) / / .. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified copy u hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS Certified copy is FIXTURE with the county building inspection NUMBER FfURE OR ITEM • FEE department WATER CLOSET LOCALITY Date Applicant NEAREST 10/ BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER (Thu section need not be Completed tf the work Involved MAIL ed ADDRESS by the Permit Is for one hundred dollars (SI00) or leas.) SINK CITY TEL NO CL O 1 certify that in the performance of the work to phteh this DISHWASHER U permit u mord, I shall not employ any person)i q manner 'CONTRACTOR de �! L) so as to become subject to the k :C o tion Laws CLOTHES WASHER ADDRESS + 0 Da[e ��7[DDIlcant SWIMMING POOL RECEPTOR CITY TEL NO D W NOTICE TO APPLICANT If after making the Certificate of , 7�7� a Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE Compensation promions of the Labor Code, you must forth LICENSE NO 07.5 715/ CLASS e�JrC Z with comply with such provislona or this permit shall be WATER HEATER deemed revoked GAS SYSTEM OUTLETS DISTRICT NO PROCESSED PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER ! O I hereby affirm that I am licensed under provisions of Chapter S PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Best FINAL //r�j VALIDATION ness and Professions Code, and my license Is in full force and DATE [�! o effect P FINAL License Number �Lic Class ` 3G BY Contractor Date /a —11A IF-- 1,�d 1 / 019--/49 F1 I am exempt from the licensing requirements as I am a Plan Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ S8 acting in my professional capacity (Section 7051 Bus mess and Professions Code) TOTAL FEE Lic or Reg No Date Plan chock applicant HOMEOWNER BUILDER DECLARATION Noma I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031 5 Bus, City Tel No 4 4 2 0 A ness and Professions Code) O1, as owner of the property, am exclusively contracting # • • • • • 5 with licensed contractors to construct the project (Section 7044, Business and Professions Code) 2 • • 1 6 5 0 CONSTRUCTION LENDING AGENCY • •i• 1 6 5 0 3 I hereby affirm that there is a construction lending agency t for the performance of the work for which this permit u <) 6 1 8-82 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mti ned Dro try fo w ction purposes , ifs 'Signature of Permittee Date