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Home My Public Portal About5723 ROWLAND AVE_Plumbing__ .Z6A667�,(CE-817)-8=71 T� ' ,�76�3 VAPPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUI7-72-4119YX ADO LOC � 7 FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST I (I NUMBER FIXTURE OR ITEM ® FEE CROSS ST.'�/ • OWNER W1 SOA/6- eU ,QS WATER CLOSET 1.75 MAIL BATH TUB 1.75 ADDRES 3Q &Ive iv q A- G y y SHQWER 1.75CfTY NO. Zr LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS107,64 DISHWASHER 1.75 CITY TEL.TEL. NO: CLOTHES WASHER 1.75 STATEIC C SWIMMING POOL'RECEPTOR 1.75 LICENSE NO6d/:r3 CLASS � DISTRICT O. GROUP ZONEI PROCESSED BY LAWN SPRINKLER SYSTEM 1.75 WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS. 1.75 INSPECTION RECORD V OUTLETS OVER 5 PER SYSTEM .30 Z P V W d Vl z Plan check fee See reverse. PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS PATE PECT.OR'9 IGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF;. AND INTEND TO ! RESIDE IN THE O�VE'DE��S777CpppRIBED RESIDENTIAL oPROPERTY. FINAL INK �• SIGNATURE `\] /�1� ./�! OF PERMITTE'E�y Aswan, �� /11 19 PERMIT VALIDATION Q CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 6 5.3, x --25 5 n 825- q 76,�667,,1Ct-817)-8-71 �� ' APPLICATION FOR P _ 'BINCRMIT c • C • COUNTY OF LOS ANGELES DEPARTMENT COUNTY ENGINEER BUILDING �3 Q �a BUILDING ANDD SAFETY DIVISION ADDRESS #6 LOCALITY F/yJ r FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST O� CROSS ST. NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1.75 ! IS, OWNER 6Q T L MAIL ,j ID-'3 /&kh- a BATH TUB 1.75 ADDRESS SHOWER 1.75 '�S CITY 'ojjyp T TEL. NO..j 9f.3O Y� LAVATORY 1.75 / 7,' C0NTRACTOR IN� SINK 1.75 ADDRESS 7-ay30 DISHWASHER 1.75 CITY 1/Aj,1AIj d 4,,&rW f TEL. NO.40�„t.eoyt) CLOTHES WASHER 1.75 STATE LIC SWIMMING POOL RECEPTOR 1.75 LICENSE NO. pZ 3s/ CLASS �- DIST 2 POCESSED BY LAWN SPRINKLER SYSTEM 1.75 /1 ICT NO, -77 GROUP NE �r WATER HEATER 1.75 INDUSTRIAL DD WASTE APPROVAL GAS SYSTEM OUTLETS 1 750 INSPECTION RECORD u OUTLETS OVER 5 PER SYSTEM .30 g O ' W O. Vl z 0 P!an check fee See reverse, PLUMBING PERMIT ISSUING FEE $ 3 . 00 TOTAL FEE [� APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name /ry�� 6 �l ROUGH PLUMBING Address :;I,-.7).1/30 A109Wqw ,r✓a GAS PIPING City /j Al7�F S Tel. No. 8o 0 GAS VENT I H REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST O 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL SIGNATUREQ OF PERMITTEE ' PERMIT VALIDATION cw M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH LACo 6 5D 10.00- q ! •WORKERS'COMPENSATION DECLARATION 76A887A I hereby affirm that I have a' certificate of consent to self CE Bf7(2-80) APPLICATION FOR P L' U M B I N G PERMIT insure,or a certificate of Workers'Compensation Insurance,or a certifiedco y thereof(Sec.3800 LabC.) ' 01110260762 9W,OF WAUSAU COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 5723 ROWLAND AVE. ADDRESS Ja Certified copy is filed th t ounty building inspec NUMBER FIXTURE OR ITEM FEE LOCALITY TEMPLE CITY 41,1V �en>$Q WATER CLOSET Date UU 77 Applicants NEAREST BATH TUB CROSS ST. —e4-fJ CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER LAVATORY MAIL SAME (This section need not be completed if the work involved ADDRESS } by the permit is for one hundred dollars ($100) or less.) SINKa CITY TEMPLE CITY TEL.NC$86-3278 0 I certify that in the performance of the work for which this DISHWASHERTME RUG U permit is issued, I shall not employ any person in any manner CONTRACTOR I Ir so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS 2034 N. PECK RD, 0 Date Applicant SWIMMING POOL RECEPTOR V NOTICE TO APPLICANT: If, after making this Certificate of CITY S. ELMONTE TEL.NC579-7982 w Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM d STATE Compensation provisions of the Labor Code,you must forth- WATER HEATER LCENSE NO. 2. 65094 CLASS C-20 with comply with such provisions or this permit shall be DISTRICT NO. PR ES deemed revoked. 1 ]. GAS SYSTEM 1 OUTLETS 3 OO SED BY .4f LICENSED CONTRACTORS DECLARATION OUTLETS OVER �srO I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL � VALIDATION ness and Professions Code, and my license is in full force and DATE I effect. License Number 265094 Lie.Class— C'^20 FI w Contract-TRME HCC Date 10-9-80 /nom.,, I am exempt from the licensing requirements as I am a Plan Check fee `��"�uJ licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ] QQ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031.5, Busi- City Tel.No. 2 5(�(j A ness and Professions Code): MI, as owner of the property, am exclusively contracting # o 0 0 0 o 5 with licensed contractors to construct the project (Section 7044,Business and Professions Code). Z o o 1-GOO CONSTRUCTION LENDING AGENCY 0 0 0 1 0,00=0 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 1 G09-80 issued(Sec.3097,Civ.C.). Lender's Name Lender's Address I certify that I have. read this application and state that the. I 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 presentatives of this Unty to enter upon the ov ntioned property for in tion p;p0os ��O— Sof Permittee Date