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