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HomeMy Public PortalAbout6333 TRELAWNEY AVE_Plumbing__ DEPARTMENT OF OOUWTY ENGINEER PLUMBINGr 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION OOUNTY OF LOS ANGEIT BUILDING WILLIAM J FOX, COUNTY ENOINE[R ADDRESS X33 3 FOR APPLICANT TO FILL IN LOCALITY NEAREST BUILDING CROSS ST ADDRESS 6333 Trelawney Ave,' DISTRICT NO GROUP 20NE PER YIT NO LOCALITY Temple City, Calif• 5 �_� �� CROSS 8T Lemon Ave• RECEIVED BY Rov*for Inap"u" DAT[ISSUED OWNER George L, Simmers. 6AiajQA I I) -MAILZ� `S INDUSTRIAL ADDRESS 9515 E, LOnl;den Ave:' WASTE APPROVAL CITY Temple City, TELNO AT 6 8683 INSPECTION RECORD PLUMBER Simars & Baker ADDRESS 4445 TelegraPh Rd, CITY LOs Angeles TEL NO AN 05 STATEA?4 40;14 LICENSENO It 140061 C 36 1-7 COUNTY PERMIT FEESPL <_ RUNNER WFIE OF rlM M OR ITEM ` I[[ Q 2 WATER CLOSET(TOILET) 0 OFB sl 60 a BATH TUB 0 080 0 _ 1• I /A I� PIA/ 1 SHOWER a 080 2 LAVATORY(WASH BASIN) 0 080 1 0 W-,rR �qrR ,( 1 KITCHEN BINK 0 080 LAUNDRY TUB OR TRAY 0 080 C'= n SLOP SINK 0 0,0 / f CA VD FLOOR SINK ® 080 FLOOR DRAIN 0 080 a 'D l DISHWASHER 0 080 C P /T- DRINKING FOUNTAIN 0 080 0 rr — ( SRI G- URINAL 0 080 GASSYSTEM _ _OUTLETS 0 1.00 1 00 1 WATER HEATER 0 100 1 00 MISOELLANEOUS Automa7tic Washer 80 APPROVALS _ DATE INSPECTOWS SIGNATURE UNDER SLAB WORK PERMIT j 1 00 ROUGH PLUMBING .. -`) ri TOTAL FEE Itio 2oGAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• OASVjNT CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING pLUMB1�ITG F1%TURES 1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND STATE OFBCAL FO NIIA OR THAT I AY THE LEGALOOWN. G�By 4` / ER OF THE ABOVEI !D REBID NTIA ROPERTY UTILITY CO�rROTIFI[D "-/Ll cffkkt SIGNATURE �!j/d//" OF PERYITTE _I FINAL ISA807 ORBIT, 2/00 DEC TION WORKERS t I have aceriN cafe of corse APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of convent to self 76A667A ins e, or otter cafe of Workers Compensation Insurance, CE BV(REV 10/81) or a certifi opy thereof (Sec 3800, Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy Company Certified copy is here urnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified co is filed w o ry ddmg mspec ��/ �� EL4wrv�Y bond tit NUMBER FIXTURE OR ITEM ® FEE LOCAUTr7F",04,E C(7 7Y Date App ant WATER CLOSET NEAREST CERTIFICATE OF EX RKERS' BATH TUB CROSS ST 404EiT-IR COMPENSATION INSURANCE OWNER (This section need not be completed N the work Involved by SHOWER the permit Is for orta hundred dollars($180)or lass ) MAIL I certify that in the performance of the work for which thisU4VATORv ADDRESS - permit is issued I shall not employ any person in any manner SINK CITY . TEL`NO so as to become subject to the Worker/Compensation Laws DISHWASHER CONTRACTOR �.QA�! /[(Q S�I//CFI Date Applicant CLOTHES WASHER ADDRESS 63 NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Worker CITY ,S I I�� A�.,s Y�� Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM .J�P. ;A TEL No 4f�A, 7-A with comply with such provisions or this permit shall be STATE LIC deemed revoked WATER HEATER LICENSE NO 9,i A LICENSED CONTRACTORS DECLARATION OrMI T Nq BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS o (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER15, and Professions Code and my license is in full force and effect 5 PER SYSTEM IN ALIDATION C License Number Uc Claes V Q� FI K Contractor Dote BY ❑ 1 am exempt under Sec B 8P C f«this reason N Plan check fee = Dote - Pilo PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name E-, 4S,40&A_-,4 1&4 72FQ dp ;2 31 7.6 A I hereby affirm that I am exempt from the Contractor s License address 2S /C/(XJiI/TiO/7l� ///ELt/ ST f« the following reason (Section 7031 5, Business and Professions Code) City f7�L/j7EylJiQ L'4 Tel No x!3 # 0 5 ❑ 1, as owner of the property will do the work and the 1 • • 1 6 5 0 structure is not intended or offered for sale (Section 7044 Business and Professions Code) , • • • 1 6 5 0 6 CONSTRUCTION LENDING AGENCY I Q 1 6—8 5 I hereby affirm that there is a construction lending agency f« the performance of the work for which this permit is issued (Sec 3097, Cw C ) Lenders Nome Lender's Address I certify that I have read this application and state that the 11110above informotion is correct I agree to comply with all County 4nrcrs,and Statelowsregulrntatives of thisned propertyforinspection pu / $EE REVERSE FOR EXPLANATORY LANGUAGE iaee to