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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