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Home My Public Portal About4333 TEMPLE CITY BLVD_Plumbing__ 'l..••T DBa IT n-ED r APPLICATION FOR PERMIT DEY+ARTMENT OF BVII.DING AND SAFETY / COUNTY OF LOS ANGELES WILLIAM J. FOX, QNI[R ENGINEER \ B' FOR APPLICANT TLI FILL IN • D L Kisaell Ref. Co PLUNGER • • • • RECEIVED \FIRRTINSPEDTIoN D ATE 1®Um ADDRESS t S t BUILDING N CITY Los Angeles TEL ND RI 7-756 ADDRESS e auRrr a 1961 Z"IRKB Lmawurr Rosemead p� FEES HEAR �eTP� fl e & Temple NUMBER rr's or"x =DR ITL, FEE OWNER The Ross Sprinkler Coo MAIL WATER CLOSET(TOILET) @ ago R ADDRESS 4333 Temple City Blvd. BATH TUR @ mam CITY Rosemead \ TEL No F008728 SHOWER @ moo 1 HEREBY ACKNOWL[DG[�THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 050 APPLICATION AND STATE THAT,THE ABOVE IR CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 050 AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 P09®S THE ABOVE VALID LOB LAUNDRY TUB OR TRAY @ 050 ANGELES COUNTY LICENSE• DR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVL OAS BYaT[M_CUTLETS @ 0 SO SIGNATURE OF C WATER HEATER @ O SO POIMFTT[F SLOP BINK @ Ow INSPECTION RECORD FLOOR RINK @ Coo 12,o 30 FLOOR DRAIN @ Ma0 DISHWASHER @ MOO DRINKING FOUNTAIN @ ImSD ir,P2 AL ' URINAL @ Imam HOUSE REW[R @ CSO [� MISCELLANEOUSgas RiRing 1100 1 LL O APPROVALS DAT[ INF[ 0115 NAM[ ROUGH PLUMBING GAB VENT CESSPOOL @ IDO CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ( ) PIT ( ) @ 1 DD SEWER PERMIT 100 GAR TEST UTILITY CO NOTIFIED _ TOTAL FEE B 2 OO l / I DEPARTMENT OF COUNTY ENGINEER PLUMBING 1"- DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING .3 WILLIAM J. FOX, COUNTY ENGINEER ADDRESS 33 E E FORAPPLICANT TO RLL IN LOCALITY GTS E d BU I LDINO NEAREST G /Y �S� AD RE S.%3L 'TIIM'ftj C/TY PL✓O. CROSS ST DISTRICT NO GROUP I ZONEIIjI N� LOCALITYNEARES CROSS ST ?/VLAy RnIY for Immovoo D EISSU O am0/0072;---'/ = OWNER _ NAIL WASTE APPROVAL ADDRESS CITY TEL NO INSPECTION RECORD PLUMBER d,/ Np&dAA,0 z��/vK.f ADDRESS /171RIAw T S� LLe/ 2 CITY TEL.NO p STATE T _ CO "G..T iC /QiO+a.✓ LICENSE NO I G7 d'effuO ..[/7 5 PERMIT FEES _yr—sy 0T . b2 F W-z T NYM![q K OF FI%TIRE ON ITEM rm WATER CLOSET(TOILET) ! 080 i O BATH TUB • 080 SHOWER ® OMI LAVATORY(WASH BASIN) ® 080 KITCHEN BINK 000 LAUNDRY TUB OR TRAY ! 0 80 SLOP SINK 080 FLOOR BINK ® 080 FLOOR DRAIN ® 080 DISHWASHER a 080 DRINKING FOUNTAIN ® 080 URINAL ® 484 GASSYSTEM 7- OUTLETS f 100 D WATER HEATER 100 MISCELLANEOUS APPROVALS DATE INSPECTO "SIGNATURE UNDER BLAB WORK 3-1 00 PERMIT $ I DO ROUGH PLUMBING S I .P TOTAL FEEGASPIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI GASVENT CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE HOT WATERHEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUYBIN"FIXTURE I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AN LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAB TEST AND STATE OF CALIFO IA OR THAT I M TH LEGAL OWN- ER OF THE ABOV D flIBED RESIDER IAL P PERTY UTILITY 00 NOTIFIED SIGNATURE 'y(��^'��!/9 J OF PERMITTEE FINAL 7OA887 DBS if 1/ 'I ,� •COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT " i matby affirm that I•twve a certificate of consent to self 7&4467A7 iruure a a certificate of Workers'Compensation Insurance, CE 8n(REV 10/81) Aro certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING,AND SAFETY Policy N-1052379&tompany Framnnf:' Certified copy is hereby furnished r--r FOR APPLICANT TO FILL IN(PRINT OR TYPE) AD1U)I ' IW.1 Certified copy is filed with the county building inspec ADDRESS 4343 Tem le City Blvd. hon department NUMBER FUTURE OR ITEM ® FEE LOCALtry Temple City Dote 5-T 7-t5 Appliranl QWATI Rrne P_ Tho. WATER CST NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE — - OWNER _ (This section mild not b.campf.r.d If this work Irnrelved by--- - SHOWER Don Harvel -- -- - - Me pisrini Is for arse hundred dollars ($100)Pr�lew) LAVATORY MAIL 420 S. -Pine SINK I that m ADDRESS the performance of the work for which manner CITYSan Gabriel fJ0 99015 permitrmit 1 is issued I shall not employ any person in any nwnnm so as to become subject to the Workers'Compensohon laws - DISHWASHER cONrRAaoR Owen Bros. Plumbing, Inc. Date Applicant CLOTHES WASHER ADDRESS 4265 N. Baldwin Ave. NOTICE TO APPLICANT If after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Worked Off, NO withComcomply with such of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM MonteTEL 4 with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER UCENSE No 231 741 uAss C36-20 LICENSED CONTRACTORS DECLARATION DISTRICT NO SSED BY I her affirm that I am licensed under GAS SYSTEM OUTLETS Y hereby provisions of Chapter 9 (commenting with Section 7000) of Division 3 of the Business OUTLETS OVER Y and Professions Code and my license is in full force and effect 5 PER SYSTEM FFIIAN A VATION Q License Number P31 741 Lic Class, '3j.'2171 V If O Contractor Dw611 BrOST. Plb¢pate 5-17-85 BY ;92068A ❑ I am exempt under Sec / # e e . e e 5 N B BP C for this reason Plan check fee Z Date PLUMBING PERMIT ISSUING FEE$ I e e 2 8 5 0 Sigrwture TOTAL FEE • is • 2 8 5 0 SINGLE FAMILY Plan check applicant 04,20-85 HOME OWNER-BUILDER DECLARATION Nome I hereby affirm that I am exempt from the Contractor'3 License Address Law for the following reason (Section 7031 5 Business and Professions Code) City Tel No ❑ 1, as owner of the property will do the work and the , structure is not intended or offered for sole (Section , 7041 Business and Professions Code) CONSTRUCTION LENDING AGENCY - I hereby offirm that there iso construction lending agency for the performonce of the work for which this permit is issued (Sec 3897 Civ C ) 1 Lender s Name Lender s Address I certify that I have read this application and state that the poll information is correct I agree to comply with all County ordinances and Stale laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ve- ioaed pr er or inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE 5-17-85 gnoture of Perms s Dote r I WORKERS COMPENSATION D€terof consent APPLICATION FOR PLUMBING PERMIT = I hereby oHirm that I hove a certificate of consent to self 76g6e7A f insure, or a certificate of Workers Compensohgn Insurance CE BI7(REV la/BI) ' or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Nompany �OAt Pol � Certified copy is hereby furnished , , r� D FOR APPLICANT TO FILL IN(PRINT OR TYPE) AD= a TD ' 1 L Bl Certified copy m fled with the,county budding mspec tion department c w >„. a 4r r NUMBER FUOURE OR ITEM ® FEE LOCALITY CW .Dateq+17..6i�11; Applgont WATER CLOSET'$* NEAREST ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB t T CROSS ST COMPENSATION INSURANCE OWNERWa ` -`(TMs section need not be completed LF'the work In hied by ' _ _ SHOWER _ _ _ _ _ - MAIL t"Permit Is for ane hundred dollars($100)or�lns J LAVATORY e I certify that in the performance of the work for which this .I,. ADDRESS rL$° .� p t permit a issued, 1 shall not employ any person,n any manner SINK CITUSan Gatt"M& uTEL tKT so as to became subject to the Workers Compensation Laws y,,�� DISHWASHER CONTRACTOR�n CCI*., P • DoteAp ,cont �' 1 CLOTHES WASHER . T NOTICE TO APPLICANT If, after making this Certificate of - SWIMMING POOL RECEPTOR ADDRESS 4j Ks, AVAs t Exemption, you should become subject to the Workers - — - CITY Tg NO Compensation provisions of the Labor Code you must forth- LAWN SPRINKLER SYSTEM " 91 mmte 03,0078 with comply with such provisions or this permit shall be STATE ' UC 36-20 deemed revoked WATER HEATER LICENSE NO 1 CLASS LICENSED CONTRACTORS DECLARATION GAB SYSTEM ODISTRICT NO , ,PROCESSED BY OUTLETS I hereby affirm that I am licensed under provisions of Chapter 9 ,[ ✓. (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER IL and Professions Code,and my license,s,n full force and effect 5 PER SYSTEM FINAL VAUIdATION 0 _ t License Number 231 M L,c Class DATE T J FINAL u Contractor0lilA BM, P119sDote 5-17-83 BY 'i i�M Irt ac ❑ { 4 I am exempt under Sec O B 8P C for this reason Plan check fee + sd 4tf e e IS Date J , PLUMBING PERMIT ISSUING FEE$ �' r' �'r 1•- Signature t TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Nome I hereby affirm that I am exempt from the Contractor's Licenser Address Law for the fallowing reason (Section 7031 5 Business and Professions Code) r City Tel No ❑ 1 as owner of the property will do the work and the ' structure ,s not intended or offered for sale (Section ' ► I ' • 7044, Business and Professions Code) ' CONSTRUCTION LENDING AGENCY t „ 1 _ Thereby aff,rtn that there is a construction lending agency for the performance of the work for which this permit Is issued (Sec 3097, Civ C ) _ r• r Lender's Name v . _ •_-' -1".""" •L s.t Ty., ,1 , Lender s Address' ; 1 certify that 1 hove read Ibis application and state that the Poo. , above information ,s correct I agree to comply with all County ordinances and State jaws regulating Plumbing and hereby r� authorize representatives of this County to enter upon the r above-m; Boned proPert(�Tor inspection purposes r , ♦ .:, d t ' SEE REVERSE FOR EXPLANATORY LANGUAGE ^5 Signature of Permittee r Date '. r 0