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Home My Public Portal About9630 VAL ST_Plumbing__ TBAIILL V�[ BOB) -Ilii APPLICATION FOR PLUMBING PERMIT BUILDING FEW DNISION FOR APPLICANT TO FILL IN I PRINT OR TYPE) BUILDING NUMBER FIXTUREOR ITEM B FEE ADDRESS 9630 Val St . WATER CLOSET LOCALITY Temple Cit BATH TUB NEAREST CROSS ST SHOWER OWNER Harvey u geon LAVATORY D(Lm 9630 Val St . SINK 'I,'- - CITY Tem leC1t TEL No44 -1290 DISHWASHER CONTRACTOR Universal P umbing CLOTHES WASHER ADDRESS 2631 Lee Ave . SWIMMING POOL RECEPTOR CITY So . El Monte TEL No 575-360 LAWN SPRINKLER SYSTEM STATE 316018 LIC WATER HEATER LICENSE NO CLA55 GAS SYSTEM - OUTLETSi DISTRICTINOa g G57 ZONE 0.0CE55 D BY 5O PERSYSTEM �l3` "`/'D\ INDUSTRIAL WASTE APPROVAL C INSPECTION RECORD N Z Plan check fee PLUMBING PERMIT ISSUING FEE S TOTALFEE Plan check applicant No" APPROVALS DATE UMPECTOR 5 SIGNATURE UNDER SLAB WORK , Address ROUGH PLUMBING City M�I..tas. Tel NoGAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE REM THIS APPMAANDTE GAS VENT THAT THE ABOVE IS CORRECT AND M"E TO COMPLY WITH ALL COUES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CEATIFY THAT I N PROPERLY REGISTERED ANO/OffAS PLUMBING FIXTURES REDUAED W LOS ANGELES COUNTY STATE OF CALIFORNIA ORE GAS TEST LEGAL OWNER N ANG INTEND TO a DI THE ABOVE DESCRIL PROPERTY AL UTIUTYCO NOTIFIED SIGNATURE OFPSRMITTEE FINAL -- lm PLAN CHECK VALIDATI N r CO PERMIT VALIDATION �L—M D CASH POLICY HOLDER,.- 5 5 2 mLt4AY 22 S D 1 8.0 O •°S POLICY NUMBER: W N, 7,,F- S,x 1.*3 (g> L'/G-) WOi(ICERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1 have a certificate of consent to self 76Ae67A 'insure or a certificate of Workers' Compensation Insurance CE 617(REV 10/81) gr a certified copy thereof (Sec 3800, lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished ❑ f-0R AFRICAN!TO FILL IN(PRINT OR TYPE) AAOO I Q Y0_ tion copy a pled with the county budding rnapec- hon department NUMBER FIXTURE OR ITEM ® FEE LOCALITY �•7' WATER CLOSET Date Applicant�f(fq.}{(t -�v NEAREST ./ CERTIFICATE OF EXEMPTION FROM RKERS' BATH TUB CROSS S7 / G� Js� COMPENSATION INSURANCE SHOWER ,� OWNER need(This section ed nos be rnmplesed H the stork Insrolred by / -- MAIL the permit Is for one hundred dollars($1W)or less ) LAVATORY 55 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 CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER _ CONTRACTOR Date Applicont CLOTHES WASHER NOTICE TO APPLICANT If after making this Certificate of ADDRESS SWIMMING FOOL RECEPTOR Exemption, you should become subject to the Workers CITY TEL NO Compensation provisions of the Labor Code, you must forth LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC deemed revoked r • WATER HEATER d�// LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO BY I hereby affirm that I am licensed under proviuorn of Chapter 9 • GAS SYSTEM 479L1. NWErS (}'t /) (commencing with Section 7000)of Drvniot,3 of the Business OUTLETS OVER V v COCA z and Professions Code,and my licenu a in full force and effect 5 PER SYSTEMY FINAL .i VALI TION 00 DATE V License Number Icc Class FIN Q Contractor Date BY F 1 am exempt under Sec d 9224.0A N B 8P C for this reason Plan check feeZ g . . . . . 5 Dote PLUMBING PERMIT ISSUING FEE E a Signature qI e - 4650 TOTAL FEE V Plan check applicant . • . 46505 SINGLE FAMILY HOME OWNER BUILDER DECLARATION Nome 0611 -85 1 hereby affirm that 1 am exempt from the Contractor's License Address Law for the following reason (Section 7031 5 Business and Professions Code) City Tel No I as owner of the property will do the work and the structure is not intended or offered for sale (Section , 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there so construction lending agency for the performance of the work far which this permit is issued (Sec 3097 Civ C ) Lender's Name Lender s Address I certify that I have read this application and state that the polo information is correct I agree to comply with all County ordinances and State jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above mentioned property for inspection purposes � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ybrvee tea e