Loading...
HomeMy Public PortalAbout5322-5326-5328-5330 VILLAGE CIRCLE DR_Plumbing__ 76AG67 (CE-817)- 5/73 APPLICATION FO PLU ING PPM1 .T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER �— BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: ao)oRESs 53 _ 5330 Village Circle HARVEY T. BRANDT, COUNTY ENGINEER LocALITY' Temple City FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST = vee CROSS ST. NUMBER FIXTURE OR ITEM @ FEE OWNER AIL Noel Baldwin WATER CLOSET 1-7 6 tic Ll BATH TUB 1'. 5 © ADDRESS . 5302 Baldwin Avee 4 SHOWER 1, 00 CITY Temple 1 y TEL. NO. 448-3907 LAVATORY 1, 06 CONTRACTOR Owen Bros. Plumbing Inc. SINK 1, 5 12 06 ADDRESS 4265 i. Ra-IdNin A-%re- DISHWASHER 1, 5 r 6 CITY TEL. NO. El Monte 4.43-0078 CLOTHES WASHER 1. 5 STATE LIC SWIMMING POOL RECEPTOR 1, 5 LICENSE NO. 231 1 CLASS. C36-20 DISTRICT NO. GROUP ONE a:4SEBY,LAWN SPRINKLER SYSTEM 1, 5 WATER HEATER 1. 5 / pO INDUSTRIAL fJ WASTE APPROVAL cr GAS SYSTEM OUTLETS 1.t5 INSPECTION RECORD OUTLETS OVER V 5 PER SYSTEM 30 CD F- _ c� W d y Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ TOTAL FEE Plan check applicant APPROVALS DATE INSPEC_TOR's SIGNATURE UNDER SLAB WORK -9W' s Name ROUGH PLUMBING _7i Address GAS PIPING City Tel. No. GAS VENT 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST 72d .�.�...-�L IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICEN SEDAS RECIUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVEED RESIDENTIA OPERTY. FINAL 7-1-26 ,1-,- t SIGNATU RE ,!, OF PERMITTEE � ! PERMIT VALIDATION cK M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 694it!NgV 10 5 0 6U.50 �J3 Y )WORKERS'COMPENSATION DECLARATION, APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers'Compensation Insurance, 76A667A ora certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS ' Policy No. Company ❑ Certified copy is hereby furnished. BUILDING r-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) . ADDRESS t�33 O l/ Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET Date Appli4ant NEAREST CROSS ST. e� \ 4V CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB COMPENSATION INSURANCE OWNER C (This section need not be completed If the work involved by SHOWER t the permit Is for one hundred dollars(;100)or less.) LAVATORY ADDRESS © 6 I 10A 12— Q t �! 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 CIT?--TV�i1 / TEL.NO. _ so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL 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. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm•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 ` VALIDATION C DATE License Number Lic. Class t� co C), ZX FIN _ Contractor Date BY �,r•r-T r_ O, I am exempt under Sec. a X1Ua B.BP.C. for this reason Plan.check fee Date: Z PLUMBING PERMIT ISSUING FEE$ . � Signature ' TO TAI_ TOTAL FEE r HI C'-'1. Plan check applicant -�i.nii_ SINGLE FAMILY =�t ANESE HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Address II;;-I_�j�t(I 51 1/92- E54ons Code): City Tel. No. LTJ 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 is a construction lending agency for the performance of the work for 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 above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter u on the above-mentioned'pro t for i pect' purposes. l SEE REVERSE FOR EXPLANATORY LANGUAGE S naW o ermittee um