The URL can be used to link to this page

Home My Public Portal About6201 A & B TEMPLE CITY BLVD_Plumbing__ WORKERS'COMPENSAT.IOP DECLARATION 76AG67A I K-Kby affirm that I have,a' certificate of consent to self CE 617 (.2-6e) APPLICATION FOR PLUMBING PERMIT insurr a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec..3800,Lab.C.) + COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDIN ❑ NUMBER FIXTURE OR ITEM • FEE ADDRE /� Certified copy is filed with the county building inspection LOCALITY department. Date Applicant WATER CLOSET NEAREST _ BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM FROM WORKERS' COMPENSATION INSURANCE SHOWER ]OWNER LAVATORY MAIL / - (This section need not be completed if the work involved ADDRESS by the permit is for one hundred dollars ($100) or less.) >- SINK CITY TEL.NO. O 1 certify that in the performance of the-work for which this DISHWASHER V permit is i ued I shall not employ any person In any manrLer CONTRACT so as to eco spbject to thele ers'' o pensatio Laws. CLOTHES WASHER �f ADDRESS O Date Applicant y SWIMMING POOL RECEPTOR (~j NOTI E APPLICANT: If, after making this Certificate of CITY tv TEL.NO. W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Coniperisation provisions of the Labor Code,you must forth- LICENSE N CLASS �. Z with comply with such provisions or this permit shall be WATER:HEATER _ deemed revoked, DISTRICT NO. PROC SED BY GAS SYSTEM OUTLETS LICENSED CONTRACTORS DECLARATION - OUTLETS OVER L O I hereby affirm that t am licensed under provisions of Chapter 5 PER SYSTEM' 0 (commencing with Section 7000)of Division 3 of the Busi- FINAL ness and Professions Code, and my license is in full force'and DATE VALIDATION' effect. �D FINAL License Numb Lic.Class- BY ' Ctfn ra Date 13 I am exempt from the.licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer acting in my professional capacity.(Section'705'1, Bus- iness and Professions Code). TOTAL FEE �Q.(lam Lic,or Reg.No. Date Plan check applicant HOMEOWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason,(Section.7031.5., Busi- City Tel No. ness and-Professions Code): 'I, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY -21 25.3'A . I hereby affirm that there is a construction lending agency # 0 0 0 0 0 for the performance of the work, for which this permit is issued(Sec.3097,Civ,C.). Lender's Name 2. o o•1 0.00 Lender's Address o 0 0,1 000'0 I certify that I have read this application and state that the. �'7 1 •5_ Q above.information is correct.I agree•to comply with.all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- do p oy for' spect'on purpops 71-1?lko Signature oT Permittee. Ddte 1 WORKERS'COMPENSATIO14 DECLARATION 7GA667A 1111;--by aWirrdi thAt 1. have,a' certificate of consent to self CE 817 (2_66) APPLICATION FOR PLUMBING PERMIT insu'V;;.v a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY ; Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDIN FD/ �A ❑ NUMBER FIXTURE OR'ITEM • FEE ADDRE Q.Gyi Certified copy is filed with the.county building inspection department. WATER CLOSET LOCALITY Date Applicant NEAREST .CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE SHOWER a. ADDRESS NER LAVATORY IL / (This section need not be completed if the work involved } by the permit 'is for one hundred dollars ($100) or less.) SINK CITY TEL...NO. � 'O I certify that in the performance of the work for which this DISHWASHER 0 permit is i ued .I shall not employ any person in any manger CONTRACT so as.to eco subject to theJr pepnsation�Laws. Cf s CLOTHES WASHER ADDRESS � ODate Applicant �U SWIMMING POOL RECEPTOR. NOTI E .APPLICANT: If, after making this Certificate of CITY TEL.NO. lL Exemption, you should become subject to the Workers' LAWN SPR INKLE.R SYSTEM STATE LIC. N Compensation provisions of the.Labor Code,you must forth- LICENSE N CLASS ® Z with comply with such provisions-or this. permit shall -be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROC SED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER , a I hereby affirm that'I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL. VALIDATION ness and Professions Code,and my license'is in full force and DATE effect. G Z�: FINAL License Nu.m Lic.Class �-� BY Vtfn ra ° Date 71 I am exempt from the licensing requirements as I am a Plan-Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE /Q Ac.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section.7031.5, Busi- City Tel.No. ness and-Professions Code): ❑ I, as owner of the property, am. exclusively contracting l' with licensed contractors to construct the project (Section 7044,Business and Professions Code). CONSTRUCTION LENDING AGENCY 21 2 a 3 A I hereby. affirm .that there is. a construction lending agency for the performance of the work for which this permit is # o o 0 o o 5 issued(Sec.3097,Civ.C.). Lender's Name 2.0 0•1 0,Q.Q Lender's Address 0 0 0 1 0,0 0�. I certify that I have read this application and state that the Q.7 5-8& above information is correct.I agree to comply with all County SEE REVERSE.FOR EXPLANATORY LANGUAGE' ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the �above,wdo p operty for' spect'on purpo . Signature of Permittee Ddte 76A6G7-CEB17-8-57 APPLICATION FOR.-PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS620 -62O LTem le Cit BLV IOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY Temple City FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY TEL.NO. LAVATORY CONTRACTOR Fontana Plbg. Ca- SINK ADDRESS DISHWASHER CITY TEL.NO. LAUNDRY TUB REGISTRATION NO. C36-96496 COUNTY ❑ CLOTHES WASHER DISTRICT NO, GROUP ZONE READY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD f eco - PRY P� _n in s l!WW' APPROVALS �pf; @ $1.00 PER ITEM �J DATE INSPECTOR'S SIGNATURE / OR FIXTURE $ ��/ UNDER SLAB WORK r /� ROUGH PLUMBIN p` }Z�''. !i PERMIT $ 1 00 G�5 PIPING '� yf s'TI•', 4'`1'�'' I >Pr.i A TOTAL FEE G'AS VENT 1 , 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER' -5 / /, l.KJ•�!•� . AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL PLUMBING. COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES 10-7-419 a-'l jlmAl �'f` f 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST tl�: '.�;T LICENSED AS REQUIRED BY LOS ANG COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GA UTILITY CO. NOTIFIED OWNER OF THE ABOVE %t1 J DESCRIBED RESIDENTIA ROP RT SIGNATURE /B.aZ- /'� - , A? OF PERMITTEE. FINAL V J ,[/ ROBERT A. WOOD, es VALIDATION SUPERVISING MECHANICAL ENG'R CK. N.O. CASH O782OR MAY 12 3 A . 15.00 7