HomeMy Public PortalAbout6105 SAINT JAMES DR_Plumbing_5/18/1965_ TaAaaT-c E[er> [iaa �
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF CO DDENGIITEEEt �°fS°
B IIAGLAFT�IE o�@NIU ION �OS Lot 1
WILLIAM A JENSEN Sup Tor BUILDIHO LOCALITY
FOR APPLICANT TO FILL IN CNEAREST
I
NUMBER FIXTURE OR ITEM EACH FEE OWNER
3 WATER CLOSET 1125 3 7 Baldwin Builders
1 BATH TUB I n MAIL
1 25 DRESS 4116 N. Baldwin
2 SHOWER 125 2 50 CITY El Monte TEL NO - 710
3 uveroeY In 3 7 coNrBAcroR Owen Bros Plumbing
1 SINE 135 1 25 ADDS 4265 N. Baldwin
1 DUMMASIM 125 1 :2T,crTT El Monte TEL No _0078
LAUNDRY TUB :125 aiO1SSTRATION NO 231741 COUNTY
1- CLOTHES WASHER 125 1 25 DIBTRI N� GROUP ZONE P l�BED BY
1 WATER HEATER ISO 1 0 Q
1 GAS SYSTEM OUTLETS
ISO
1 50 umORTR1AL a
WASTE APPROVAL 0
CUTLETS OVER S PER SYSTEM 90 INSPECTION RECORD V
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z
JA"LI�T
� APPROVALS DATE IN[P[cTO11 q�l N TUR[
PERMIT sQ UNDERBLABWORK
TOTAL FEE ROUGH PLUBINGGAS PIPING I
IN[RUY ACKNOWL[OO[ TNAT 1 HAV[ R[AD TNIIONANO [TAT[ THAT TH[ ACOV[ I[ coRReCT AND ACRELY GASVENT
WITHALL cOUHTY ORDINANC[[ AND [TAT[ LAWINa HOT WATER HEATER
PLUMBINGIH[RmvCERTIFY THAT I AM PROP[RLY R[cI[T /OR PLUMBING FI%TURESLIC[NB[D As RtOUIRED BY LOB ANO[L[B COUNTY oP GA6 TEST
GLIPOIINIA OR THAT I AM TH. "GAL OWN[R OF ATORUIO[ INTHE AB O[ [G R[.IO[HTIA P[ UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE r1
FINAL � µ
/��LIDATiON ROBERT A WOOD
C fl M o GBH SUPERVISING MECHANICAL ENG R
LAC01 7 6 1G MAY 18 5 D 2 0;00~ a
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OgAERS 'Oave a c TION DECLARATION APPLICATION FOR PLUMBING PERMIT
he ay aTfvm that'l have a certificate of consent to self m ��°�41W
sure orace/trficateof Workers Compensation Insurance ora CE 817(REV 8/8e)
Z9.61cop of ec 3800, Lob
y there
PWic Jo IS ComPa n L COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS -
Y
Certified copy rs hereby furnished -
ass
Certified copy.s filed with the county building mspectFOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
io ADDRESS D M{S
�d[e rtment NUMBER FIXTURE OR ITEM ® FEE LOCALITY /s,
� y WATER CLOSET(TOILET) ," p jr,t
Dote Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST s
T COMPENSATION INSURANCE SHOWER OWNER A2 9:- Ars A N
(This section need not be completed H the work Involved by MAIL
PJ
the persalt Is for one hundred dollars ($100)or less) LAVATORY ADDRESS Q
1 certify that in the performance of the work for which this per SINK CITY TEL NO _ g
mit is issued, I shall not employ any person in any manner so
as to become subject to the Workers Compensation Laws DISHWASHER
CONTRACTOR 6NNc I'L s ON
Date - Applicont r CLOTHES WASHER ADDRESS 3 r L/Ni
NOTICE TO APPLICANT If after making this Certificate of Es- SWIMMING POOL RECEPTOR
emption you should become subjecttothe Workers'Compen CITY / �Y(✓ TEL NJ?,/_
Whop provisions of the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEM /—
Ilywith such provisions or this permit shall be deemed revok STATE 7 CIS C �y
WATER HEATER LICENSE NO O 1.
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM 1 OUTLETS �(
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER dsi
and Professions Code and my license is in fullferc)n of 5 PER SYSTEM FDIANA VALIDA N >
fect /(7� T€l d
License Number yU�JS Lic Iosss. !�� ✓_� V
ContractorDocc
te `'� cZ 7 BY
El I am exempt under Sec - ~
U
W
B 8P C for this reason t LL
Plan check fee z
z
Date PLUMBING PERMIT ISSUING FEE$ s
Signature TOTAL FEE $0 3 7.8 A
SINGLE FAMILY # • • • • • 5
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby off nm that I am exempt from the Contractor s License Name ( e • , 5 0
Law for'the following reason (Section 7031 5 Business and
Professions Code) Address
• • '16505
ElI, as owner of the Property will do the work and the City Tel No
structure is nor intended or offered for vele(Sechon7O44 0a08-!,88
Busmes&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
Lenders Address
I certify that I have read this appLcohon and state that the t 10.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
obovyr}emio ed property sir trio pur a
L(�/ $— �g SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Dote