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Home My Public Portal About5260-5262-5262-5264-5266 VILLAGE CIRCLE DR_Plumbing__ 76A667 (CE-817)- 5/73 APPLICATION FO PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER i BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: ADIDRESNS 52 — 5266 Village Circle HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Temple City FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST Baldwin Ave. NUMBER FIXTURE OR ITEM @ FEE CROSS ST. WATER CLOSET r = OWNER Noel Bl(wip�� MAIL TA7]n ve• Ll BATH TUB 1. �� ADDRESS SHOWER 1. 66 CITY Temple City TEL. NO. 4A.8-3907 LAVATORY 1. 0.d CONTRACTOR Owen Bros. Plumbing, Ino. t SINK 1. iO ADDRESS 4265 N- Baldwin Ave. DISHWASHER 1. d 00 CITY TEL. NO nn E1 Monte ,443-0078 C1. CLOTHES WASHER 1. G LICENSE NO. 2 CLASS 036-20 STATE LIC SWIMMING POOL RECEPTOR 1. LAWN SPRINKLER SYSTEM 1. DISTRICT O GROUP ZONE /-MOCESSED BY 7 S . P WATER HEATER 1.7 `a `1� INDUSTRIAL WASTE APPROVAL GAS SYSTEMi�OUTLETS 1. INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM OP i.. v Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ o TOTAL FEE ` �� APPROVALS GATE INS eE,C TO R'S SIGNATURE Plan check applicant UNDER SLAB WORK #-/7-2-f Name ROUGH PLUMBING ,n ��► ..b's fl� Address GAS PIPING City Tel. No. GAS VENT Y HOT.WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES !� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.-NOTIFIED v LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR'THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE CR D RESIDENTIAL' PROPERTY. FINAL 7 SIGNATU RE OF PERMITTEE •�'A—J'�e/ PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 6 9 0 10 5 0 1 6 0,.5 0 Aas 76A667(CE-817)- 5/73 APPLICATION FO PLU B1NG PERMIT COUNTY OF LOS ANGELES j3 DEPARTMENT OF COUNTY ENGINEER . BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING 52 — 5266 Village Circle HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Temple City FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST Baldwin Ave. NUMBER FIXTURE OR ITEM FEE CROSS ST. WATER CLOSET •��7 f OWNER Noel Baldwi7l �� MAIL w121Ave* 4 BATH TUB 1.15 Q C>0 ADDRESS SHOWER 1, D� CITY Temple City TEL. NO. 448-3907 LAVATORY 1, 36 U/i CONTRACTOR Owen Bros. Plumbing, Inc. vV SINK 1, a 06 ADDRESS 4265 N. Baldwin Ave. DISHWASHER 1. A 00 CITY El Monte TEL. N0443_0078 �. CLOTHES WASHER 1. USTATE LIC LICENSE NO. 231 741 CLASS C36-20 SWIMMING POOL RECEPTOR 1, DISTRICT O GROUP ZONE OCESSED BY LAWN SPRINKLER SYSTEM 1.7 WATER HEATER 1.7 `� 4.1� INDUSTRIAL WASTE APPROVAL GAS SYSTEM,6'jj OUTLETS 1. INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM O 1..�. e• - d•p• Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ o TOTAL FEE irLL APPROVALS DATE INS PE,C TO R'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING 9° B I L A'`=��•r• City Tel. N0. GAS VENT HOT WATER HEATER IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TESTS �j .••' PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED Y LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR'THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE CR D RESIDENTIAL' PROPERTY. FINAL. 7 SIGNATURE " OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 69 0 U`I?aou 10 5 0 1 .6 0.5 0 ,&9,j WORKERS'COMPENSATION DECLARATION I APPLICATION FOR PWMBIN ! PERMIT I hereby efirm that I have o certificate of consent to self 20-0026 DPW 6/B7 irlsuye, or a certificate of Workers'Compensation Insurance, 76AS67A or a`iertified copy thereof(Sec. 3800, Lab. C.) _/ COUNTY OF LOS ANGELES DEPT.OF. PUBLIC WORKS �� b &AQ � Policy No. Compony ' Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 15;;2/0 Certified copy is filed with the county building inspec- tion department. �//t L NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date 116-1-1-L9 Appligant / ! 6� - WATER CLOSET NEAREST ` CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed If the work Involved by SHOWER i OS . P/ a l�SSeQt. the permit Is for one hundred dollars $100 or less. MAIL P ( ) ) LAVATORY ADDRESS e. lrlg4i�l I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY . �,.�,/�� CONTRACTOR TEL.NOM��7.'! so as to become subject to the Workers'Compensation Laws. DISHWASHER ucs m DateApplicant CLOTHES WASHER ADDRESS ` NOTICE TO APPLICANT: If, after making this Certiftcat of SWIMMING POOL RECEPTOR O O Exemption, you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- CITY dtn/r TEL. NO. j p LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DIST )ALIDATION OCS ED BY I hereby afflrm•that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL IIS O ��►�1� DATE License Number Lic. Class// ,1 V (p gy'9y BY AL Contractor 7 Date O ❑ I am exempt under Sec. 10 U B.BP.C. for this reason a Plan check fee en Date: Z PLUMBING PERMIT ISSUING FEE$ Signature � •• TOTAL FEE d SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name ACf oA I hereby affirm that I am exempt from the Contractor's License Address Law for the followingreason Section 7031.5, Business and 3307 16.50 Professions Code): City Tel. No. ❑ ITEMS I, as owner of the property, will do.the work and the structure is not Intended or offered for sale (Section - ( TOTAL 16.50 7044, Business and Professions Code). j ICHECK 16o50 CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for CHANGE o110 the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). MSD-0001 - 10/17/89 Lender's Name It 62-55 1 AM 905�! Lenders Address 1 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 I authorize representatives of this County to enter upon the e- ention d'property for Inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE • Signature of Permittee. Date