HomeMy Public PortalAbout5471 TEMPLE CITY BLVD_Plumbing__ 1
+1 w m APPLICATION FOA PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
COUNTY O£ LOS ANGELES
t WILLIAM J FOX CHIEF ENGINEER
k FOR APPLICANT TO FILL IN DISTRICT NCL GROUP ZONE PEN
11 ,PLUMBER r /� L r Rfi ED BY READY
DY FOR / DATE ISSUED
FIRST INSPECTION r�
ADDRESS ( JL J
3 BUILDING
CITY TEL NO ADDRESS
9 /5
COUNTY LOCALITY
L CEN C No O 2- E](PIRES
NEAREST
PM41T FEES CROBB ST
NUMBER TVP[OF Mi m OR IT[r PEE OWNER
MAIL
WATER CLOSET (TOILETI a 050 8 ADDRESS
BATH TUB O SO CITY TEL NO
SHOWER 0501 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY WASH BASIN) ® O SO APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN BINK a 050 STATE LAWS REGULATING PLUMBING
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB ORTRAY SO ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
OF THE REBIDENTIA P ERTY OffOrRIBQD ABOV
GAS SYSTEM OUTLETS O SO SIGNATURE OF
WATER HEATER O EO I PERMITTE
SLOPSINK O SO INSPECTION REt6,6RD
FLOOR BINK O EO
FLOOR DRAIN O SO
DISHWASHER O SO _
DRINKING FOUNTAIN O EO
URINAL O SOI \ ,J
HOUSESEWER O SOI Z
MISCELLANEOUS V
E' 0
I
APPROVALS
I DATE IN[P{CTOp{ "Us
ROUGH PLUMBING
GAS PIPING 'p
OAS VENT IG�U
CESSPOOL 100 CESSPOOL
Y.
SEPTIC TANK SEPTIC TANK
DRAIN ( ) PIT ( ) ® 1 00 SEWER
PERMIT 1 DG GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE
FINAL
RATION
WORKERS COMPENSATION De of consent 20-OM DPW 4/90 APPLICATION FOR PLUMBING PERMIT i
I hereby, affirm that I have a certificate a consent to self in- 76A667A
sure,or a certificate of Workers'Compensation Insurance,ora c I
certified copy thereof(Sec 3800, Lab C ) cul
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No Company
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRIM OR TYPE) BUILDItd(i 54 a
Certified copy a filed with the county building inspection
ion ADDRESS ll C,
department NUMBER FIXTURE OR ITEM ® Fff
LOCALITY
Dote Applicant WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS Si fd W
aW
_ COMPENSATION INSURANCESHOWER OWNER r L,
(This sectbn meed not be completed If the work Involved by MAIL -De
-
the permit Is for one hundred dollars($100)or leu) LAVATORY ADDRESS
I certify that in the performance of the k for which this per- CITY L NO
mit is issued I shall not employ any p n any manner o
as to become subject to the Workers' mi
DISHWASHER
CONTRACTOR
Date.5-1- CILPApplicant CLOTHES WASHER Cie ftkff1e==
NOTICE TO APPLICANT If, after making is Cemficate of E - ADDRESS
emption,you should become suact to the Workers'Compen- SWIMMING POOL RECEPTOR
CITY TEL No
canon provisions of the Lobar Cb e,you musth comp- LAWN SPRINKLER SYSTEMS
deemed
ly with such provisions or this permit shall be deemed revok- STATE LIC
ed WATER HEATER UCENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT N�,rO�(T BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS V U
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER U
and Professions Code and my license is in full force and ef- 5 PER SYSTEM FINAL VALI ATION
fect HOSE BIB DATE !
Ucense Number Lic Class—
Contractor
lairContractor Data BY ¢
❑ I am exempt under Sec
B 8P C for this reason Plan check fee
Dore PLUMBING PERMIT ISSUING FEE$ .3
Signature TOTAL FEE
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby off nm that I am exempt from the Contractor s license Name
Law for the following reason (Section 7031 5 Business and -
Professions Code) Address ,
....n-. I� In
I, as owner of the property will do the work and the City Tel No
structure is not intended or offered for sale(Section 70" 1 TTC Q
Business and Professions Code)
► TATN .0 Z .0 r'1
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 (`4t�klf.F fL7
(Sec 3097 C v C )
Lender s Name -M 5/20/96
Lender's Address 1 651.3' 1 AM 8:07
1 certify that I have read this application and state that the ,
above information is corrxt I agree to comply with all County
ordmancel opal Ptate laws regulate Plumbing, and hereby
authors r r ntFhves of a un to enter upon the
above- o prope in h purposes
J1 ,I Co SEE REVERSE FOR EXPLANATORY LANGUAGE
Si ture of ermittee Date t