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HomeMy Public PortalAbout6334 TRELAWNEY AVE_Plumbing__ TEMPLE CITY MUM-CM17 law APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARpTMENT/ OF COUNTY ENGINEER $OO Thi GLI��ttSiEP�coFi,Nrr�,+nolN °AD°QD°�° 4 1 WILLIAM A JENSEN, SUP T OF BUILDING LCHMX J Temple City FOR APPLICANT TO FILL IN �g� Longden NUMBER FIXTURE OR ITEM ° Miller & Price g WATER CLOS um 1 BATE TOB ADDRBM CGT TEL NO. SHOWER LAVATORY °ONTBALTOB Standard Plumbin Co. � DD ARESS 1 D>�WASRER My Bell TmNO 7-11 LAUNDER TOB BEGISTSAIION AO. 39243 CLOTHES WASHER DIBTRIOT NO OROU!• ZONE BY WATER REATAR GAR SYSTEM nmuSTRIAL WASE APPROVAL R%SPECTION RECORD O I i f r.2- 4p L✓vel o . eVl r5 /f • Elm PER REM 1G OR FErruEE s 15.50 CFATi / INSrv=OR S BIONS RE PERMIT S 2 1 00" UNDER SUIS WDRk' A /6Z- ." TOTAL FEE 1 50 ROUGH PLUMBING GAS PIPING r / 1 HEREBY ACIIMOV L GB THAT 1 HAVE BRAD THIS APPLICATION AND STATE THAT THE ABOVE IB CORRECT AMD ACRES TO COMPLY GAS VENT WITH ALL COUNTY ORDINAKCU AND STATE LAWS REGULATING HOT WATER HEAT I A PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTEIIED ANDIOR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OP GAS TEST i(I CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ASO E _ DESCRIBED RESIDENTIAL PROP RTY UTILITYCO NO IFIED Jf1ly ' df SIGNATURE �r OF PERMITTE FINAL 1 1 t OVMMATION ROB T A WOOD CK M O CASH SUP VISING MECHANICAL ENO R LA;D4 8 7 4Q 27 50 1 750, 7 401 / r WORKERS COMPENSATIONDECLARATION of once APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate o4 convent to self 76g667q ms,ure, or d certificate of Workers'Compensation Insurance, CE 817(REV 10/81) w a certified co ereof (Sec 3 Xq tab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY P cY Compony 94.�Cenfiiscl copy to hereby f ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certib cop s filed with o ry g Lnssp-�:c- ADDRESS ho rt tit NUMBER FIXTURE OR ITEM ® FEE LOCAUTr7,_r:,f4AT_.' Q V 7le- Dote Appltga WATER CLOSET NEAREST TIF CATE OF EXEMPT ERS BATH TUB CROSS ST COMPENSATION I CE OWNER (This section need rat be completed if the work hnelved by SHOWER the permit is for one hundred dollars($100)or loss) MAIL I certify that in the performance of the work for which this LAVATORY ADDRESS, permit a issued, I shall not employ any person in any monner SINK CITY - TEL NO w as to become wbiect to the Workers Compensation Lows DISHWASHER CONT1ZAROR0"AW yAf^VV/ea� Dote Applicant CLOTHES WASHER ADD Kaff �� NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become sublect to the Workers /,p�� p Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY " "�� TEL NC}�(��B with comply with such provisions or this Permit shall be STATE �-}�s LIC deemed revoked WATER HEATER 110ENSE NO J/V �/ CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO,ri BY I hereby offmm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (//)(,J( (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and effect S PER SYSTEM > FINAL ON VALIDATION C ATE License Number Lic Clow V FIN cc Contractor Dote BY 0 ❑ 1 am exempt under Sec rid B 8P C for this reason —4 31 7,4 A N Plan check fee ? Dote PLUMBING PERMIT ISSUING FEE S # e s s s s 5 Signature TOTAL FEE I • it 16650 Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name (414 B/P CU, e e e 1 6 5 0£S I hereby affirm that I am exempt from the Controctor's License Law for Address the following reason (Section 7031 5, Business and 3725 AE- /L/Qy! Ti��ik-� f���W 1 0 1 6—8 5 Professions Code) City P,475.4 A Tel No ❑ 1' 05 owner of the property will do the work and the structure is not intended or offered for sale (Section Poo Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there iso construction lending agency for r the performance of the work for which this permit is issued (Sec 3097 Ov C ) Lender's Name Lender s AAOdrm I cenify that I have rood this application and state that the ► l» a mformahon a carted I agree to comply with all County r nd State laws regulating Plumbing and he eby a hor ntotivea of this County to enter u the ed property for mspechon purp es SEE REVERSE FOR EXPLANATORY LANGUAGE Dote