HomeMy Public PortalAbout6242 TEMPLE CITY BLVD_Plumbing__ TeABeT ice-e1'APPLICATIO FO PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
MAKE CHECKS PAYABLE TO BUILDING
N nP�_ Gl13jC;
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY I g'/�FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEARESTCROSS STNUMBER FIXTURE OR ITEM ® FEEOWNERWATER CLOSET 1 75MAIL
BATH TUB 1 75 ADDRESS
SHOWER 1 75 CITY TEL NO
3 LAVATORY 1 75 ( CONTRACTOR SINK 1 75 D ADDRESSDISHWASHER 1 75 CITY ZQij�Y P9 f TEL NOCLOTHES WASHER 1 75 0STATE LCNSE NO �3/f/a/3 LIC
CLAS
SWIMMING POOL RECEPTOR 1 75
DISTRICT NO 'GROUP20NE CESS D BY
LAWN SPRINKLER SYSTEM 1 75 U --i- a*
WATER HEATER 1 75 00 IyASTE APPg0VVVAL H
GAS SYSTEM Q OUTLETS 1 75 00 INSPECTION RECORD CD
OUTLETS OVER
5 PER SYSTEM BD 3-17 /NFo r o
a
N
2
Plan Check tee See Revere*
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE IHa P[c+oK + eICNAT�R[
Plan Check applicant UNDER SLAB WORK 1-1,?-7d
Name ROUGH PLUMBING
Address GAS PIPING
City Tel NO GAS VENT
HOT WATER HEATER
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND !TATE THAT THE ABOVE I! CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAW! REGULATING
PLUMBING GAS TEST
I HERBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR UTILITY CO NO IED
FI
LICENSED A! REQUIRED BY LOS ANGELES COUNTY AMD !TAT! OF
CALI FORXIA OR THAT I AM THE LEGAL OWNER Of AXD INT[XO TO
RESIDE IN THE ABOVE a I [D RESIDE TIAL PROPERTY FINAL
SIGNATURE
OF PERMITTE
PERMIT VALIDATION CK M o cAlN
PLAN CHECK VALIDATION cK M o cAaN
91 1, Y; 28 5 D 5 2.5 U ,&="
/� r
TION
TION
Worm that
I have a cemifcale of corse APPLICATION FOR PLUMBING PERMIT
I hereby affirm shot I have a cerh6cate of consent to self 7y�67A -
insure or a certificate of Worker Compensation Insurance, CE S17(REV 10/81)
or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company P '
Certified copy is hereby furnished "
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING/
ADDRE$$ ,/ !•/ `
Certified copy is filed with the county building ipec
tion departmentNUMBER FIXTURE OR R _EM ® � LOCALITY
Dote Applicant WATER CLOSET NEAREST ! r , ♦ / '
CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB —.- SN' { -1C""' 4
COMPENSATION INSURANCE / SHOWER OWNI<R/ f♦. ,i f •+P -
(This section need net be completed R the work involved by _ »
MAIL
the permit Is for one hundred dollar($100)or len ) LAVATORY r DRESS
I certify that in the perfcrman of rhe work for which this -
perma is issued I shall not erw(loy or)y person m a d manner SINK Cm' j-'/" rr TEL NCIr
neo as to become subject to the Nor rs Compen on Laws
fY\ 1 ,r// _ f DISHWASHER CONTRACTOR
Dot le/, f r pl 41-x♦ �'�' +fes CLOTHES WASHER ✓
NOTICE TO APPLICANT after making SFis Cgrttfi to of ADDRESS
Exemption you should become subject toe , orkers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, 4ou must forth Gtr TEL NO
with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC
deemed revoked WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO SSED BY
I hereby offmn that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �` „-,-_�++ }
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER " ' L! d
and Profeuioro Code and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION O
U
License Number Lic ClassQATIEW
J
FINAL u.
Contractor Date BY Y
1 am exempt under Sec Q
K
8 8P C for this reason Plan Check fee d
Date w
.PLUMBING PERMIT ISSUING FEE$ f �J F
Signature
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 %W
❑ 1, as owner of the property, will do the work (Section
the poll" lyy to+�!Q��`-s`
structure is not intended or offered for sale Section r
7044 Business and Professions Codes)
CONSTRUCTION LENDING AGENCY '
I hereby affirm that there is a construction lendmg agency for
the performance of the work for which this permit is issued
(Sec 3097 Civ C )
+
Lender's Nome
Lender's Address ,
,,,���I certify that I have read this application and state that the ►
,r above mformation is correct I agree to comply with all County
/// ord,rwnces and State laws regulating Plumbing, and hereby
authorize represent9twes of this County to enter upon the
above-mentioned p Perty for inspection purposes
V' , / SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of rmtftee Date
r