HomeMy Public PortalAbout6207 A & B TEMPLE CITY BLVD_Plumbing__ 76 A 667 - CE 817 7-69
APPLICATION FOR PLUMBING PERfT
COUNTY OF LOS.ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION D; $ 6 20 1 Temple City Blvd
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING OCALTfY
FOR APPLICANT TO FILL IN PR NT OR TYPE NEARESCROSS TT. LOn dOn
NUMBER ,FIXTURE OR ITEM EACH FEE
O
WATER CLOSET 1.50 WNER �r s o o.do Bryant
BATHTUB 1.50 ADDRESS 6201 Temple Cit" Blvd
SHOWER 1.50 . dInTemole City TEL..N0287-509
LAVATORY 1.50 CONtRACTORS++j o E. Graham
SINK 1.50 4DDRESS 9127 Las Tunas Dr
DISHWASHER 1.50 arry lremDle City TEL. NO286-9293
CLOTHES WASHER 1.50 STATE LIC
LICENSE NO. 104466 CLASS C--36
SWIMMING POOL RECEPTOR 1.50 1DISTRICT N GRO ZONE P O BY
LAWN SPRINKLER SYSTEM 2.00
WATER HEATEIre.plaCe •.1.50 1 150 INDUSTRW, it
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.50 ) INSPECTION RECORD
OUTLETS OVER
5 PER SYSTEM .30 Z.
O
i
W
z
I m
Plan check fee 25% of above. See reverse. J
PLUMBING PERMIT ISSUING FEE. S 2 00
i •
TOTAL FEE'
1 APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name !.ROUGH PLUMBING
Address GAS PIPING
GAS VENT
City Tel. No. 'HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND: STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND .STATE LAWS REGULATING 'GAS TEST
PLUMBING. )
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ;UTILITY CO.NOTIFIED
LICENSED AS REQUIRED 13Y LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM TS GF AND I
E LEAL OWNER ONTEND TO
RESIDE IN,T IE ABOVE DESCRIBED RESIDE NTIAL PROPERT IFINAL %
SIGNATURE;/�/J� I JACK R. ALLEN, SUPER ISJNG CHANICAL ENG'R.
OF PERMS 1 1; `
I PERMIT VALIDATION CK'. M.O. CASH i
PLAN CHECK VALIDATION CK. M.O. CASH
r.
7SA667-CE817-8.57
I•
APPLICATION FOR;PLUMBING PERMIT 1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ' FNEARE
6207"x` Temple Cit Blv
IOHN A. LAMBIE. COUNTY ENGINEER
CASSATT D. GRIFFIN,.SuP'T OF BUILDING pie city
FOR APPLICANT TO FILL IN
NUMBER FIXTURE OR ITEM
2 WATER CLOSET 2 BATH TUBSHOWER TEL.NO.
2 LAVATORY
1
2 - SINK ADDRESS
DISHWASHER CITY TEL.N0.
LAUNDRY TUB CONTRACTOR'S. STATE Ll
REGISTRATION NO. 6-9 649 6 COUNTY
CLOTHES WASHER DISTRICT NO.. GROUP ONE READY FOR INSPECTION
WATER HEATER ;Iaf i
2 GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
I
+
APPROVALS
v� $1.00 PER ITEM Ov DATE INSPECTOR'S SIGNATURE
sUNDER SLAB WORK
OR FIXTURE $
ROUGH PLUMBING—rQ,
PERMIT S 1 00 ��.
GAS PIPING )] il.,i P-.,:
TOTAL FEE d c) GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATERC2.
AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES "ay'�j � '2 �,
PLUMBING.
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST.
LICENSED AS REQUIRED BY LOS ANGEL. OUNTY AND STATE OF
CALIFORNIA OR THAT 1—Am THE LE L ER OF THE ABOVE UTILITY CO. NOTIFIED ^� 4e .
DESCRIBED RESIDENTIA P PE Y
SIGNATURE
OF PERM ITT_ FINAL
ROBERT A. WOOD,
UPs VALIDATION SUPERVISING MECHANICAL ENG'R
M.0. f CASH
f ; 07792 MY12 3 A 15.00 18
Is `•' WORKERS'COMPENSATION DECLARATION - APPLICATION FOR PLUMBING PERMIT NI
4;!,hereby affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers'Compensation Insurance, CE 817(REV.10/81).
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) ADDRESS i
❑ Certified copy is filed with the county building inspec-
tion department. NUMBER FIXTURE OR ITEM , FEE
LocAunr �
WATER CLOSET
Date Appli4ant NEAREST
BATH TUB CROSS ST;.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE OWNER
(This section need not be completed if the work involved by SHOWER
MAIL
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner I SINK CITY TEL. NO.
so as to become
�ssubject.to the Workers'Compensation Laws. DISHWASHER CONTRALTO
Dat/_::: i17 S Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT:tlf, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, youmust forth- CITY TEL. ��.1f
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall''be STATE LIC. /
deemed revoked. WATER.HEATER LICENSE Nj4 f CLASS V
LICENSED CONTRACTORS DECLARATION DISTW NO. P ESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS. l!
(commencing with Section.7000)of Division 3 of alae Business OUTLETS OVER (l 0.
and Professions Code,and m license is in fUll.force and effect. 5'PER SYSTEM 0
Y FINAL VALIDA ION 0
DATE
License Numb ✓ Lic. Class C �Q 29
aa p FINA O
C a Date ✓ O BY
❑ to
I am exempt under Sec. fA
B.BP.C. for this reason 2 1 4 5,2 A
Plan check fee
Date: `, Poo. # 0 0 0 0. 05
PLUMBING PERMIT ISSUING FEE$ (�
Si nature �' ldg �/
g —_ TOTAL FEE ( ° 0 1 6 5 0
Plan check applicant
SINGLE FAMILY o o 0 16505
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from.the Contractor's License 1.31 —8-5
Law for the following.reason (Section 7031.5, Business and Address
Professions Code): City Tel. No.'
❑ I, as owner of the property, will do the work and the
structureis not intended or offered for sale (Section ,
'7044, 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..).
Lender's Name
Lender's Address.
1 certify that I have read this application and state that the ,
above'infotmat'ion,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- ent)oned p ogerty"for inspection purposes.
/ SEE REVERSE FOR.EXPLANATORY LANGUAGE
ature of Per.
f Date