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Home My Public Portal About6304 TEMPLE CITY BLVD_Plumbing__ T.AwvA (OR 41701 •4/7E APPLICATION FOR PLUMBING PERMIT BUIL.DI G AND SAP6TY DIV Lot#5 FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUADDILDING NUMBER ESS 6 e CA3 Blvd, NUMBER FIXTURE OR ITEM FEE �y WATERCLOSET LOCALITY Temp a City BATH TUB NEAREST CROSS ST SHOWER OWNER tavATORvADDRESS 8656 B. Huntington Drive SINK CITY San Gabriel TEL NO z DISHWASHER CONTRACTOR OWM BMS. Plumb •ne, CLOTHES WASHER ADDRESS 4265 g.-Belchrin Ave. SWIMMING POOL RECEPTOR CITY El Monte TEL NO "3-0078 LAWN SPRINKLER SYSTEM WATER HEATER LICENSE NO 231 7d,1 LIC C36-,20 GAS SYSTEM OUTLETS DISTRI NO �OgOUPP NE P SSED T� p�� \l/Y—/,G, (/Ly 5 ME"SYSTW INDUSTRIAL B WASTE APPROVAL INSPECTION RECORD 81f0 79 TP aur Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE D O Plan check applicant Name APPROVALS D TE MATURE UNDER SLAB WORK Addrm ROl1GF1 PLUMBING CM Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE BEAD THM APPLICATION AND STATE GAS VENT YHAT THE ABOVE M COMECT AHD AGREE TO COMPLY MRM ALL COUNTY ORDINAMCU AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR LICENSED AS PLUN$ING FIKNRES REQUIRED BY LOS ANGELES COUNTY AND STAR OF CALIFORNIA OR THAT I AM THE CPRS TEST LEGAL OWNER OFAMD 1 TO RESIDE M THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTIUTYCO NOTIFIED SIGNATURE OFPERMRTEE FINAL PLAN j4&K Z S COM�I?E GAWION PERMIT VALIDATION cK Mo cASII POLICYHOLDER: /L4,6l 'im 22 g 1) 4 0.0 0 e�% POLICY NUMBER: WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm That I have a certificate of consent toself 20-0028 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance 7GA667A or a certified copy thereof (Sec 3800 Lob CC/) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No �4&Company 11#40.0 Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING E21�Cerefiad copy is filed with the county building mspec- ADDRESS G lion depot NUMBER FIXTURE OR ITEM ® FEE LOCALITY � Date Appicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPT16N FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE OWNER L4 (This stolon need not be completed If the work Involved by SHOVER the permit Is for one hundred dollen REss ($100)or less ) LAVATORY MNL ADD I certify that in the performance of the work for which this Permit is issued I shall not employ any Person in any manner SINK CITUTKIZO so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS r NOTICE TO APPLICANT If, after making this Cenificate of Exemption, you should become subject to the Worker SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL NO with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION D JRICT NO SSED BY I hereby off em that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS , J� (commencing with Section 7000) of Division 3 of IM Business OUTLETS OVER F) yy.. and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION a /2G r DATE O License Number�8vx��Uc CIossS�L O oo II// yy✓✓r� zxI FINAL Contractor 2�y/�2 Dote a BY ❑ I am exempt under Sec / �'V� B 8P C for this reason Plan check fee to Z PLUMBING PERMIT ISSUING FEE$ Q Signature TOTAL FEE Plan check applicant SINGLE FAMILY S HOME OWNER BUILDER DECLARATION Name AI.CTx� 1 hereby affirm that 1 am exempt from the Contractor s License Law far the following reason (Section 7031 5, Business and Addfess 3307 20,511 Professions Code) City Tel No ❑ I, os owner of the property will do the work and the 1 ITEMS structure is not intended or offered for sale (Section 100TOTAL. 20.50 70", Business and Professions Code) CONSTRUCTION LENDING AGENCY CASH 20.50 1 hereby affirm that there is a construction lending agency for .00the performance of the work for which this permit is issued CKWA(Sec 3097, Civ C ) Lenders Nome 0000-0001 5/18/90 Lender's Address 0782 1 AM10:21 I 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 reprelentatrves of this County to enter upon the abov mentionedproper for inspection purposes SE! REVERSE FOR EXPLANATORY LANGUAGE Signature of Perm --_ V Dole