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HomeMy Public PortalAbout4805 TEMPLE CITY BLVD_Plumbing__ �s>:m�asO APPLICATION FOR PLUMBING PERMIT COF LOS ANGggIM� DEPARTMEOUNTY INGNT��rOmF OUNTY ENGINEER /meq]Al � ADDRF�BuIlData �40ZWILLIAM A JENSEN. SU►T Or BUILDINGIACALiTYFoa APPIicANT To Fat asvNUMBER FIXTURE OR ITEM OWNERWATER CLOSET MARBATE TDB ADDS= CRY TBT. NO. SHOWER LAVATORY CONrRWW ierra lumlm ERGADDEW DIERWA� CliYLAUNDRY TOB REGISTRATION NO./YO 2, � CLOTHES WASWM DISTRICT NO GROUP I ZONE PRPQMED BY WATERIBiATER — Z DMUSTRIAL (^ WASTE APPROVAL y, I 11aa CESS eo/ I 'l 0 , 0, b U .c NCI C 1� V n O 91PmDe'T' § APPROVALS AT INa►[OTOR B BIaNATum PERMIT § p OO UNDER SLAB WORK E ROUG TOTAL FE H PLUMBING GAS PIPING 1 HEREBY ACFNOWLNDa[ THAT 1 HAVII R[AD THIG APPUuTION AND 11TAT[ THAT THi "OV¢ III CORM= AND AGRi6 TO COMPLY GAS VENT WITH ALLCOUNTY ORDINANCE AND RAT[ LAWS REOU"TINO PLUMBING HOT WATER HEATER _ �{ 1 UTHAT HOIY =R JFY AT I AN ►RowERLY ualRTneiD AND/OR PLUMBING FIXTURES LICENiiD AS REQUIRE B LOi AKGZL S COUNR AND JITAT OP GAS TEST CAL"ORN1A OR THAT I T LEGAL OWN" Or THi ABOVi DRBcwIBiD REIOi O UTILITY CO NOTIFIED TTT— SIGNATURE OF PERMIT9'E FINAL --VALIDATION ROBERT A WOOD CK M O CASH SUPERVISING MECHANICAL ENG R Ltr�5 1 7 E. � ;0v 1 6 5 9 C {J r WORKERS COMPENSATION DECLARATION DPW etas I hArabt'e111nn tk�1 I have scertifioete off consent APPLICATION FOR PLUMBING PERMITnt to self insure, � or a certificate of Worker a Compensation Insurance or a certified r copy thereof(Sec 3800 Lab C) - - - ' y COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBUC WORKS DIV Pok❑ Certified copy Is hereby furnished AVO- department FOR APPLICANT TO FILL W(PRIM OR TYPE) At')= Q� ❑ Candied copy Is filed with the county building Inspection IN w•••+Qy department NUMBER F0(TURE OR ITEM A_ FEE LOCALITY Dale Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERSCROSS ST IO COMPENSATN INSURANCE BATH TIB ASSESSOR (This seti con need not be completed If the work Involved by the SHOWER MAP BODO( �Q� PAGE PARCEL permit Is for one hundred dollars(3100)or less) LAVATORY - OWNER OU I cantly that in the performance of the work for which this permit ' is issued I shall not employ any person in any manner so as to �1' K b ADDRESS �6D MAIL become subject to the Workers Com natation Lewy n�n$ •fes //,, �f�r� ✓ I D6WASHER CITY TEL ]bf_On/ Date Z2Applkanl ✓ CLOTHES WASHER CONTRACT GDf �i NOTI E TO APP CANT If eller making this Certificate of _ tj Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provlewna of the Labor Code you must forthwith comply with suchVIA provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM ,w LICENSED CONTRACTORS DECLARATION CRY TEL NO l,hereby affirm that I em licensed under provisions of Chapter g WATER HEATER I >�� ¢ ` (commencing with Section 7000) of Division 3 of the Business and STATE GAS SYSTEM OUTLETS LICENSE NO 3 LJ CLAS /.sA- Prclesabna Cade and my license Is In full force and effecttOUTLETS OVER DISTRICT NO BY a PER SYSTEM - LrnNumber- �Lic Class t0h cose © - V FINAL DATE V fiION yW Conrra,vaxl�4�t't- (urSr�pate., 3-1,b'a ❑ I am exempt under Sec gym IL 1 ITEM: B 8P C for this reamn '- - TOTAL 59 - 35 Date Plan check tee ► CHECK c.7 Signature TOTAL PERMIT ISSUING FEE$ ❑ TOTAL FEE CHANGE CIt SINGLE FAMILY Plan check applicant 13000-1113+71 1/24/95 HOME OWNER BUILDER DECLARATION Hartle _ I hereby affirm that I am exempt from the Contractors License Lew 0]2 2 1 AM 1U;1l for the following reason (Section 7031 6, Business and Profes iloru Atltlresa 7�� N Code) ❑ city Tel No 1 as owner of iM property MO do the work end nruofure Is not Intended or offered for agile(Sectlon 7044the Bueineee � and Professions Code) , CONSTRUCTION LENDING AGENCY I hereby affirm that there In a construction lending agency for the performance of the work for which this permit Is Issued (Sec 3007, - 1 Civ C) Lends a Name Lends a Address I certify that I have read this application and state that the above ► information Is correct I agree to comply with all County ordinances and Slate laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above mentioned property fore a ion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE - - —8"9001 Permittee Date