HomeMy Public PortalAbout10629 SPARKLETT ST_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department Of Engineer PLUMBING 1
DIVISIONSION OF BUILDING &c SAFETY
WILLIAM J FOX County Enpin"r
FOR APPLICANT TO FILL IN
PLUMBER VALLEY BO ' IVIED By fIR EINBPEOTION DATE ISSUED
ADDRESS 8300 EAST V 2'—.UILZA
y3
CITY ROSEMEAD TEL.No BARD G
COUNTYLICENSE O �1' / IRes 6,10- LOCALITY
J NEAREST
PERMIT FEES CROSS BT
NUMBER T Pic OF rIKTUBE ON ITEM FEE OWNER
MAIL
WATER OLOSET(TOILET) • O • ADDRESS
BATH TUB • D C CITY TEL No
SHOWER • O O 1 HEREBY AOKNCWLEOGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ O O APPLICATION AND STATE THAT THE ABOVE IB CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ O O AND STATE LAWS REGULATING PLUMBING
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY @ C ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
OF THE RESIOEMTIA PROPERTY DESORIB ABOVi
BAR BYBTE UTLETB • O O SIGNATURE OF
WATER HEATER @ O 53 PERMITTE
GLOP BINK @ O INSPECTION RECO
FLOOR BINK @ O
FLOOR DRAIN @ 05
DISHWASHER @ O 6
DRINKING ►OUNTAIN • Gelb
URINAL@ O J
a
HOUSE SEWER • O 2
MISCELLANEOUS �
O
APPROVALS
DATE INencmaR a NAM[
ROUGH PLUMBING
BAB PIPING /y /
BAB VENT
DESBPOOL ® 1 OO CESSPOOL
HEPTIC TANKSEPTIC TANK AL
DRAIN ( ) PIT ( ) @ I Do SEWER
PERMIT 100 GAB TEST
TOTAL FEE UTILITY CD NOTIFIED
FINAL
48A807 DBS#1T 6-58
TBAUTC (CU-St7b) ••/TB '
-APPLICATION FOR PLUMBING PERMIT {�
1
BUILDING ANDS ETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TY PEI BUILDING 1��flNAi1VT v+� cwn•
NUMBER FIXTURE OR ITEM ® FEE ADDRESS 29 cuYK of '
WATER CLOSET LOCALITY TDOX CITY
BATH TUB NEAREST
CROSS ST
SHOWER OWNER KWRMff
LAVATORY MAIL
ADDRESS
SINK CITY TEMPLE CITY TEL NO 444-2419
DISHWASHER CONTRACTOR TRAM HCC
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR 9034 N BECK HT)
LAWN SPRINKLER SYSTEM CITY S. TEL NO 579-7982
STATE LIC
WATER HEATER LICENSE NO 265094 CLASS C-20
1 GAS SYSTEM 1 OUTLETS 3 00
DISTRICT NO GRQUP P O ESS BY 4V
OUTLETS OVER OOa T CIC
5 PER SYSTEM �J$ CD
WASTE APPROVAL u
W
CIL.
INSPECTION RECORD Z
Plan check fee 0
PLUMBING PERMIT ISSUING FEE $ 4
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INR P[c TOR s BIGNArUR[
UNDER SLAB WORK
Address
ROUGH PLUMBING
City Tel NO GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBI NO
1 HEREBY CCRTI FY THAT I AM PROPERLY REGISTERED AMD/OR PLUMBING FIXTURES
LI CENIlO AS REOUIRCD BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THC LEGAL OWNER OF AND INTEND TO
RESIDE IM
THE ABOVE DESCRIBED RE91pCMT PR ERTY UTILITY CO NOTIFIED
SIGNATURE
OF PERMITTEE & AL
PLAN CHECK VALIDATION CK M 0 CASH PERMIT VALIDATION CK M 0 CASH
6 6 6PAPR 13 15 Y 1 0.5 0 ASS
Q�8
WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
affirm that I have a certificate of consent to self 76A667A
r o a certificate of Workers'Compensation Insurance, CE 817(REV 10/81)
or a certified copy thereof (Sec 38DO, ab C� COUNTY OF LOS ANGELES BUILDING AND SAFETY
P❑olicvmve_q , 19 Company
Certified copy is hereby furno3haff
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUI�SS de>z �i,9,ex
� ING
Cerndo copy is filed with the coup bwlding Inspec ADDRESS
�i"-�� non/d�eF/pn�ment NUMBER FIXTURE OR ITEM ® F£E LOCALITY
Date�. /`ApphSant WATER CLOSET FffAREST
CERTIFICATE OF EXEMPTION ROM WO S' BATH TUB CROSS ST '• "�^' \L1
COMPENSATION I URANCE SHOWER OWNER Ai'7�
(This section need not he completed R the work Inolved by
the peretH Is for ono hundred dollop($100)or Ins) LAVATORY MALI
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 CITY TEL NOJr-,�L37a/o
so as to become subject to the Workers Compensation Laws DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT If after making this Certificate of
Exemption, you should become subleci to the Workers' SWIMMING POOL RECEPTOR CITY +A�r TFL NO-7d-I% .
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM A) Y
with comply with such provisions or this permit shall be STATEo LIC
deemed revoked WATER HEATER LICENSE NO { 2-- CLASS J7
LICENSED CONTRACTORS DECLARATION DISTRICT BV
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER d
and Professions Code,and my license is in full force and effect 5 PER Sv5 FINAL
A0 DATE VALID ION
License Number Lic Clas!-�
FI
Controctw lMte BY
❑ IV
I am exempt under Sec d
N
8 BP C for this reason 2 934 A ?
Plan check fee
Dote
PLUMBING PERMIT ISSUING FEE I ST # e e e s is 5
Signature
TOTAL FEE ( * * 3Q50
Plan check applicant
SINGLE FAMILY • e s 3 0 5 O
HOME OWNER BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License
Law for Address the following reason (Section 7031 5, Business and 0 9. 17-85
Professions Code) City Tel No
❑ 1, as owner of the property will do the work and the
structure Is not Intended or offered for sale (Section Poo7044, 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 )
Lenders Name
Lender s Address
I certify that I have read this application and state that the 011111,above information is correct I agree to comply with all County
ordinances and State jaws regulating Plumbing, and hereby
authorize rept rooves of this County to enter upon the
abov ntion property for inspection purpogws .4
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signa if PeVr 7 Defte