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Home My Public Portal About5946-5946 1/2 TEMPLE CITY BLVD_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT ►J Fn y'4iffir%.that 1 have a certificate of consent to self 76A667A �. in e, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certibft copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES _ BUILDING AND SAFETY Policy No. Company i Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS V ZLp T� . � lk_+66 M Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM (off FEE 9 LOCALITY e, . 6, Date l/ '94Appligant WATER CLOSET CNEAREST ROSS ST. CERTIFICATE OF EXEMPTIO FROM WORKERS' BATH TUB COMPENSATION INSURANCE SHOWER OWNER ��. ��,y' (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which thi's permit is issued, I shall not employ any person in any manner SINK r CITY TEL.NO..? so as to become subject to the Workers'Compensation Laws. DISHWASHER -r+ CONTRACTOR A) �� Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of a /1! / Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY �d��'�Si; TEL. NU -® with comply with such provisions or this permit shall be STATE > LIC. �J .c„� deemed revoked. WATER HEATER LICENSE NO. [ V y� CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (� r (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ,/ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATI License Number • �.�' 1fG Lic. Class DATE — 6 0 �ie? C �b Contractor%/ Ad ��1" �9ate BY1,2 ❑ C I am exempt under Sec. F B.&P.C. for this reason 4 Plan check fee p PLUMBING PERMIT ISSUING FEE$ �(� 2 Signature ,�O TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). pop 9 5 8 a 8 A CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for # 0 0 0 0 0 5 the performance of the woik for which this permit is issued (Sec. 3097, Civ. C.). I o - 4650 Lender's Name o o 0 4650;-J Lender's Address ( 1.06-86 1 certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-m9ptioned prop rty for inspection purposes. � SEE REVERSE FOR-EXPLANATORY LANGUAGE. Sign ure of Permittee - l �Date fl— 78A867C (CE-817B( -875• APPLICATION FOR PLUMBING PERMIT. BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDINGjr NUMBER FIXTURE OR ITEM @ FEE ADDRESS /7'l0 , s►��G LOCALITY WATER CLOSET NEAREST BATH TUB CROSS ST. SHOWER OWNER T247 SWAT LAVATORY MAIL `S/y• ADDRESS /7Tp e SINK CITY TEL. NO. DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS A16SWIMMING POOL RECEPTOR CITYTEL. LAWN SPRINKLER SYSTEM STATE LIC �lG �� WATER HEATER LICENSE NO. 2 444 7 Coe/ CLASS 0 .GAS SYSTEM OUTLETS DISTRICT NO. GROUP ZONE OC �Eb BY OUTLETS OVER I v 5 PER SYSTEM INDUSTRIAL / ' d WASTE APPROVAL rn INSPECTION RECORD Z Plan check fee PLUMBING PERMIT ISSUING FEE $ TOTAL FEE 7 Plan check applicant Name APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel. NO. GAS PIPING IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGIS AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED Y LO ANGELES COUNTY NO TATE OF GAS TEST CALIFORNIA OR THAT I T EGAL OW R OF' D I TEND TO RESIDE IN THX ABOVE DE C I RESIDE I ' PROPE Y UTILITY CO. NOTIFIED SIGNATU RE .'' OF PERMITTEE r�� / FINAL ? 76. PLAN f � �"�S PLAN CHECK VA ATION CK. M.O. CASH PERMIT VALIDATION K. M. CASH 8 75 AUG 25 -5 @ 7.5 0 amt 76AG67A ICE 817B)-11/76 APPLICATION FOR PLUMBING PERMIT BUIL G AND SAFETY DIV S N' FOR APPLICANT TO FILL IN(PRINT OR.TYPE) BUILDING "1,06 NUMBER FIXTURE OR ITEM FEE AIL WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. SHOWER OWNER y� LAVATORY ADDRESS ,7 dvgC I Ae,0e SINK CITYa. TEL.NO. DISHWASHER CONTRACTOR' CLOTHES WASHER ADDRESS Ac)., 60kej„& SWIMMING POOL.RECEPTOR CITY ,� TEL.NO: A dJg -3 S'Z LAWN SPRINKLER SYSTEM STATE / LIC. WATER HEATER LICENSE.NO. �L. 7 '/ CLASS. .12 3 GAS SYSTEM OUTLETS DISTRIgNO.O.� G jj�NE1( PR ESSED Y OUTLETS OVER 1. 5 PER SYSTEM INDUSTRIAL -'y WASTE APPROVAL INSPECTION RECORD 1b Plan check fee PLUMBING PERMIT ISSUING.FEE$ TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING I HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION AND STATE GAS'VENT THAT THE ABOVE IS CORRECT AND AGREETO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED A. %LICENSED AS PLUMBING FIXTURES ' REQUIRED BY LOS'ANGELES COUNTY AND STATE OF.CALIFORNI OR AT I.AM THE GAS TEST LEGAL OWNER OF,AND I ND T ESABOVE DESCRI ESIDENTIAL PROPERTY. // UTILITY CO.NOTIFIED SIGNATURE ry OF PERMITTEE FINAL r 7J /,,Y�i�•"'-tea PLAN 7C (DATION CK. M.O. CASH PERMIT VALIDATION CK. M:O. CASH :12 l SE z9 5 ® 7.5 0 A!�d A ;ISA 667AC E-817)-8-71 -2 —1-ellc -195S7 Ce APPLICATION R PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIN �(/ ADORES �7 LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM @ FEE / WATER CLOSET 1.75 OWNER MAIL BATH TUB 1.75 ADDRESSS1y y , SHOWER 1.75 CITY t TEL. NO.21n— W LAVATORY 1.75 CONTRACTOR vl��+-saClr SINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. N ��Z CLOTHES WASHER 1.75 STATE LIC SWIMMING POOL RECEPTOR 1.75 LICENSE NO. CLASS -Z-Z > DI TRICT NO. GROUP ONE PRO SSE BY LAWN SPRINKLER SYSTEM 1.75 ~ �J �WATER HEATER 1:75 INDUSTRIAL 4� WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD 0 OUTLETS OVER 5 PER SYSTEM .30 Z f8A 6 UP z Plan check fee See reverse. PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE CJs APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I HEREBY ACKNOWLEDGE THAT I HLF.RFArTHIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES ANAWS REGULATING PLUMBING. GAS TEST —4 y ��. � 1 HEREBY CERTIFY THAT 1 AM PPGISTERED AND UTILITY CO. NOTIFIED LICENSED AS REQUIRED B LOS ANGTY AND STATE OF CALIFORNIA OR THAT I HE LEGAF, AND INTEND TO RESIDE IN THE ABOVE D 3 IBED RESROPERTY. FINALZi SIGNATUREOF PERMITTE PERMIT VALIDATI N CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH � q/ 704FEB .5 U N//� 4.75 �� 76A667-CE#8.17 2-86 ��w�z ( /r J APPLICATION FOR .PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / T JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS i COLEMAN W.'JENKINS. SUPT. OF BUILDING LOCAISTY FOR APPLICANT TO FILL IN NE1'�ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 BATH TUR 1.25 NAM ESS s/+ omm- SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR x/G ,rr ./2 XI Cd NIS, SINS 1.25 ADDRESSGAlo DISHWASHER 1.25 CITY f-/� G� TEL.NO. LAUNDRY TUB. 1.25 STATE LIC LICENSE NO. 0 2-- CLA86 Z6 CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCE EO BY WATER HEATER 1.50 I.50 INDUSTRIAL GAS SYSTEM�OUTLETS WASTE APPROVAL p OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD c-D O F - v W CL CA Z APPROVALS :DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE e3 5-0 GAS PIPING /� I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT ' AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY - WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER _ PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRE Y LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR 1 A THE LEGAL OWNER OF,A INTEND TO �. RESIDE IN,THE VE D CRIBED RESIDENTIAL PR PE r. UTILITY CO.NOTIFIED ' SIGNATURE OF PERMITT FINAL AIMATION JACk R.ALL•EN CK. M.0. CASH SUPERVISING MECHANICAL ENG'R. L 0 1 8 4m AbG2.2 5 D 3.50- 9