HomeMy Public PortalAbout4452-4454-4456-4458 TEMPLE CITY BLVD_Plumbing__ D¢¢1' I$-= APPLICATION FOR PERMIT
DEPARTMENT OFLOS TG AND SAFETY e
COUNTY OFF LOS ANGELES u
WILLIAM J. FOX. aHlc►ENGINEER
FOR APPLICANT TO FILL IN
PLUMBERW e READY fOR
[IV[D SY fIgST INSP[OTION DATE IMULVL
ADDRESS Q �
ODRffAgUILDING s QMOIL CTI/ V
airy L: t C TEL No ADDRESS
ODUNn LOCALITY
PERMIT FEES cR�4aR�. a w c /�'
NIINELR TYlE or rIKTDIIE an ITEM ME OWNER W
MAIL
�I WATER CLOSET(TOILET) @ mew B ADDRESS
I� BATH TUB @ am CITY C T TEL. ND A U
SHOWER @ 0.60 I Hgalcov ACKNOWLEDGE THAT I HAVE READ THIS
1 LAVATORY (WASH BASIN) @ DSO APPLICATION AND STATE THAT THE ABOVE IB CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK @ ago AND STAT[ LAWS REGULATING PWMBINC.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOB
I LAUNDRY TUB OR TRAY @ DSO ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
or THE RXSIDr IAL PROPERTY D[BCRIBED ABOVL
GAB BYBT[ UTLETB ® G 6O DiaNATIIR[ OF _
WATER HEATER @ O 6O P[RMITT[
SLOP BINK @ CSD INSPECTION RECORD
MOOR RINK @ 660
MOOR DRAIN @ MSG
DISHWASHER @ 050 �,pCT
DRINKING FOUNTAIN @ DSO �V T LJ P Tp v 'V cr
URINAL @ O SC 6�K0 v'CfbPT•N 7 J
HOUSE SEWER @ 0.60 FL. ✓1/N, �_
MlBOELLANECUS a —A% LIC.B 0f
0
APPROVALS
DAT[ NAM[
ROUSH PLUMBING
OAS PIPING
OAS VENT
C¢BBPOOL @ SOC CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 100 SEWER
PERMIT Ica GAB TEST
UTILITY CM NOTIrIED
TOTAL FEE • / ,rJS
(v �`' FINAL r
WORKERS COMPENSATION DECLARATION _ APPLICATION FOR PLUMBING PERMIT
Fir�/ I hereby affirm that I have a certificate of consent to self 76Ad67A
insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81)
or
0{�rphfieclopv then of f5�c ab C ) EST COUNTY OF LOS ANGELES BUILDING AND SAFETY
7 IJ �7 J4yto O1 iiY. (a A'�
Po icy o Company &.t iaO
0—Certified copy is hereby furnished C•
❑ FOR AFRICAN TO OILL IN(PRIM OR TYPE) BUILDING TE,f.
Certified ropy is filed with the county budin
spec-ipec- ADDRESS '
NUMBER FIXTURE OR ITEM LOCALITY
I department ® FEE ,T
Date _AppliSant WATER CLOSET hICAREST
CERT1 KATE OF EXEMPTION FROM WORKER#dr- 'A BATH TUB CR06S ST E
COMPENSATION INSURANCE �. SHOWER OWNER { L A/�as?'
(This section nail not be complNod If the work lmrolved by MNL
the pormH is for arse hundrod dollars ($1 9D)or Iws ) LAVATORY ALIORESS
I certify that in the performance of the work far which this At
permit is issued I shall not employ any person in any manner SINK CITY TEL NO _
so as to become subject to the Workers'Compensation Laws DISHWASHER
CONTRA OR
Date ApplicantJq CLOTHES WASHER G
ADDRESS 1b C�9L)M
NOTICE TO APPLICANT If after making this the Wo to of SWIMMING POOL RECEPTOR J
Exemption you should become subject to the Workers' CIN oMlt►s rCYae,( JEL 4
Compensation provisions of the Labor Code, you must forth LAWN SPRINKLER SYSTEM 10 -10-57
with comply with such provisions or this permit shall be STATE U ,.3. b
deemed revoked WATER HEATER LKZ5E NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO BY
I hereby affirm that I am licensed under provaions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000)of Division 3 of the Business CURETS OVER E >¢`
and Professions Code,and my license is in full face and effect 5 PER SYSTEM NAA x� 1 f'— NAL ATION u
License Number Lic Class DATE� G J
Contractor Date B "� YGytt
❑ I am exempt under Sec
B 8P C for this reason Plan check fee Vw=1
Date
PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE2 45.0 A
SINGLE FAMILY Plan check applicant # s a s s s 5
HOME OWNER-BUILDER DECLARATION Name I . 25050
1 hereby affirm that I am exempt from the Contractor s License Address Law for the following reason (Section 7031 5, Business and • • 2 5 Q 5 0 csi
Professions Code) City Tel No �
❑ 1, as owner of the property, will do the work and the 071 5-85
structure is not intended or offered for sale (Section pop70M, 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 ) ll
Lender's Name 6014kAJ aft, /� � � NK
Lenders Addrea, ,�_Sf[ ,(°�-
I certify that I have read this a4lication and st a that the pop
mformoeon 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
above-mentioned or for mspec ion purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
—I
J- 8
Signature of Permittee Date