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HomeMy Public PortalAbout5610 WELLAND AVE_Plumbing__ T7-CEMS17 9/53 CITY OF ,TEMPLE CITY C_0790_1, APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER. susLOlNc BUILDING AND SAFETY DIVISION JOHN A. LAMBIE.'COUNTY ENGINEER ADDRESS Welland WILLIAM A.JENSEN, SUPT OF BUILDING �100111LOCALITY Tempi@ city FOR APPLICANT TO11111111110111111 -FILL IN NEAREST Tublt��de F -_ NUMBER FIXTURE OR ITEM EACH FEE OWNER Catalina Properties WATER.CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS Some SHOWER 1.25 CITY TEL. NO. j� ,Jk, LAVATORY 1,25 CONTRACTOR General Installation Co. ig SINK 1.25. ADDRESS • 6558 West Blvd. u DISHWASHER 1.25 CITY Los Angeles TEL. NO..PL 3-2541 ATE 91 LAUNDRY TUB 1.25 REGISTRATION NO, C-36 1.51839 787 ATE gi COUNTY HI CLOTHES WASHER 1.25 DISTR©Nf�, GR ES D BY WATER HEATER 1.50 v:�7 UY GAS SYSTEM OUTLETS 1.50 INDUSTRIAL O WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM '.30 INSPECTION RECORD U WATER SOFTENER Ready for Inspection Now p sVJ r n n!U1 ► A1r4.. o a - i?fl te',S Z r5 . X11:.! 0 sr-, AIC-4-r- X11 aki c` a,& i 9 i�# APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE ROUGH 50 GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. 'HOT WATER HEATER _ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I•AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDE L P OPE UTILITY CO.NOTIFIED SIGNATURE • OF PERMITTEE `e FINAL � Q� S I QAU�t' ALIDATION ROBERT A.WOOD U CK. M.O. CASH SUPERVISING MECHANICAL ENG'R LA60 5 9 1 5:fl NOV 16 5 0 3.50- a 76A667-CENS17 2-66 P20184 CITY OF TEMPLE CITY APPLICATION FOR PLUMBING PERMIT , COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 5610 Tgel I and COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALMY Temi2le Cit FOR APPLICANTTO FILL IN NEST CROSS ST. b,g, NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS S ame SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR General Installation Co. SINK 125 ADDRESS 6558 west Blvd. DISHWASHER 1.25 c1TY Los Angeles TEL, N0. PL 3-2541 LAUNDRY TUB 1.25 STATE LIC LICENSE NO: 0-36 151839_ CLASS CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE OG/EBBED BY 1 WATER HEATER 1.50 1 0 ri o Q 1, R lGKe GAS SYSTEM OUTLETS I'� WASTE A APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD WATER SOFTENER Ready for Inspection Now CD W a y Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 3 50 GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. _ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDIOR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOB ANGELES COUNTY AND STATE OF GAS.TEST CALIFORNIA OR THAT 1 AM THE LEGAL'OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED REST-. Tlyyps� UTILITY CO.NOTIFIED SIGNATURE (f�� OF PERMITTEE FINAL VIMATION JACK R.ALLEN M.O. ' CASH SUPERVISING MECHANICAL ENG'R. 2 �. s APR 9 5- :D 76AG67-CE#817 '12"64 City of Templae City p 5522 APPLICATION FOR PLUMBING COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY' ENGINEER BUILDING AND SAFETY DIVISION BUILDING5610 Mland JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS,SUPT OF BUILDING, LOCALITY Twple City FOR APPLICANT TO FILL IN CRNEAREST OSS T. NUMBER FIXTURE OR ITEM EACH FEE OWNER Jack Barry WATER CLOSET 51.25 BATH TUB 1.25 ADDRESS Same SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25. CONTRACTOR General Installation Co. SINS1.25' ADDRESS 6558 West .Blvd. DISHWASHER 1.25 CITY Los Angeles TEL. NO. PL 3-2541 CONTRACTOR'SC-36 151839 7876OT Ej LAUNDRY TUB 1.25 REGISTRATIONIONNO. UNYTY CLOTHES WASHER 1.0 DISTRICT N GR Z E P O BY 1 WATER HEATER 1.50JUL s GAS SYSTEM OUTLETS -1.50 INDUSTRIAL WASTE APPROVAL _ d OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD v Ready for Inspection Now m v Ofle;W—XA1 Opp Ru AL z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION' GAS VENT AND STATE.THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL •COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF .GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF;AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESILAROPE r. UTILITY COI NOTIFIED SIGNATURE q OF PERMITTEE FINAL / C�LIDATION ROe .ERA.wOOnM.0. CASH SUPERVISING MECHANICAL ENG'R ?� LAL;0 4 1 1 6:00 AUG 12 5 D 3.5 Q 7GAee7-CE*817 2-e5 SITY OF TEMPLE CITY APPLICATION FOR PLUMBING PERMITP. 265 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY- ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 5610 Welland COLEMAN W. JENKINS. SUPT,OF BUILDING LOCALITY Temple City FOR APPLICANT TO FILL IN CSO = Live Oak NUMBER FIXTURE OR ITEM EACH FEE OWNER Phillips WATER CLOSET alas MAIL Same BATH TUB 1.Z5 ADDRESS SHOWER L25 CITY TEL. NO. LAVATORY 1 CONTRACTOR General Installation Co. SINS 1,25 `:ADDRESS 6558 West Blvd. DISHWASHER 1.25 Crnr Los Angeles TEL. NO. PL 3-2541 STATELIC LAUNDRY TUB 1.25 LICENSE NO. C-36 151839 CLASS CLOTHES WASHER1.25: p�RICTT NO GROUP ZONE P O BY 1 WATER HEATER 1.50 1.50,5Q GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD WATER sOMNER Ready for Inspection Now W D. h Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 31.50 5Q GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST _ CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED REST TI/ +R UTILITY CO.NOTIFIED SIGNATUREG(�/ OF PERMITTEE 1711 FINAL ATION JA K ALLEN CK. M.0.. CASH SUPERVISING MECHANICAL ENG'R. r 76 A 667- CE 817 7-68 CITY OF TEMPLE CITY $42445 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION nnasEss 5610 Welland JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN-W. JENKIN•S. SUPT. OF.BUILDING LOCALITY Temple City FOR.APPLICANT TO FILL IN PR NT.'OR TYPE) NEAREST CROSS ST. ' NUMBER. FIXTURE.OR ITEM EACH FEE OWNER Romanesque Apt. WATER CLOSET 1.50 ` BATH TUB 1.50 ADDRESS 5610 Welland ' SHOWER 1.50 CITY Temple City TEL. No. 794-1195 LAVATORY 1.50 CONTRACTOR General .bdavatim C-06 SINK 1.50 'ADDRESS 6558 west Blvd. DISHWASHER 1.50 CITY LOS AlkkdeB - . TEL. NO. FL 3-2M CLOTHES WASHER 1.50 SrATE Gg6 15-y$gg. LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUP / 1 CEASED BY LAWN SPRINKLER SYSTEM 2.00U ,.Loc 1, WATER HEATER 1.50 1.50 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD g OUTLETS OVER 5 PER SYSTEM .30 Ready for b2speogm Now WATEB BDPTXMM ' Oe 1) z Plan check fee 25% of above. See reveise. PLUMBING PERMIT ISSUING FEE 8 2 00 ' TOTAL FEE 3.50 APPROVALS DATE INSPECTOR'S SIGNATURE Plan Check applicant .UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. 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. GAS HEREBY•CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES.COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGA OWNER OF,AND INTEND TO. RESIDE IN.THE ABOVE DESCRIBED RE -1 P Y. FINAL 144 Yk SIGNATURE -JACK R. ALLEN, SUP R'V•SING HANI'CAL EN-G'R. OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH :P AN CHECK VALIDATION CK. M.0. CASH ( Q -.'.-_6 4 2 39 X21 5 D 3.50 76 A 667_ CE 617 7-69 CITY OF TEMPLE CITY APPLICATION FOR PLUMBING PERMIT � .: COUNTY OF LOS ANGELES B662 DEPARTMENT OF COUNTY ENGINEER ..BUIMING AND SAFETY DMSION BUILDING DDRESS 5610 Welland JOHN-A. LAMBIE, COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCIU.ITY ';Temple C.'1t17 FOR APPLICANT TO FILL.IN.(PR NT.O TYPE) NEAREST CROSS ST. NUMBER :FIXTURE OR ITEM EACH. FEE WATER CLOSET OWNER Romanes ue Apts. .1.50 BATH TUB 1.50 DRESS Same SHOWER 1.50 CITY TEL.NO. LAVATORY 1..50 CONTRACTOR siNx 1.50 ADDRESS 8658 West:Blvd. DISHWASHER 1.50 CITYLo / p AlkideS TEL. NO. �j &25a CLOTHES WASHER 1..50 STATE:LICENSE LIC NO: C76 151=9,• CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO GRO ZO E LAWN SPRINKLER SYSTEM 2.00 Qi WATER HEATER 1.50 1150 INDUSTRIAL %VASTE.APPROVJ}L GAS SYSTEM OUTLETS' 1.50 INSPECTION RECORD OUTL5 ERE SYSTETS M .30O_ Ready fay Inspeetfwn'Now Plan check fee 25% of above. See reverse. PLUMBING_ PERMIT ISSUING FEE E 2 00' TOTAL FEE 3 50. APPROVALS DATE INSPECTOR'S SIGNATURE Plan check.applicant UNDER SLAB WORK Name ROUGH PLUMBING ' Address GAS PIPING, 'GAS VENT City Tel. NO. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ.-THIS APPLICATION AND-STATE THAT'THE ABOVE-18 CORRECT AND.AGREE TO COMPLY PLUMBINGFIXTURES - WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATIND OAS TEST PLUMBING. _ 1 HEREBY CERTIFY THAT 1 .AM PROPERLY REGISTERED AND/OR' UTILITY CO..NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ' CALIFORNIA OR THAT 1 AM THE LEGAL OWNER-OK-AND INTEND TO - q092 _ RESIDE IN,THE ABOVE DESCRIBED REST TI PROPERTY. FINAL ./ SIGNATURE • JACK R.:ALLEN, SUP ,RVISI.NG CHANICAL EN'G'R. OF PERMITTEE.. PERMIT'VALIDATION M.o. CASH PLAN CIIEC'K VALIDATION CK. M.0. CASH - CR . 0 5'9 79: 1 .5. -D 3.50- '1q t ► c . 76A667-,CE#ef7 9/63 APPLICATION FOR PLUMBING ERMIT �- COUNTY OF LOS ANGELES. DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNE JOHN A.LAM IE. COUNTY ENGINEER WILLIAM A.JENSEN,SUPT OF BUILDING FOR APPLICANT TO FILL IN S NUMBER FIXTURE OR ITEM EACH FEE -AOL 10 OWNER WATER CLOSET $1.25 MAIL '7 049 BATH TUB 1.25 ADDRESSYSW t SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR SINK 1.25 ADDRESS 3 DISHWASHER 1.25 CITY TEL. NOl0 LAUNDRY TUB 1.25 CONTRACTOR'S t ``r STATE REGISTRATION NO J COUNTY ❑ CLOTHES WASHER 1.25 DISTRICT GRO U ZONE PR CES BY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 U � INSPECTION RECORD a-a 1, �.� lob tI ro 4V jff / W / 4 H Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THA I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABO E DESC IBED SIDENTIA PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL VALIDATION.!/ ROBERT A.WOOD CK. M:O. C CASH SUPERVISING MECHANICAL ENG'R LAW5 9 2 7:a FES 2 5 5 D 4.0 0'" c•` 76A667 - 08817 5/70 City pf Temple city_ APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES A3 15%90 DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION SBIIMDRIINSG '5510 Welland JOHN`A. LAMBIE. COUNTY ENGINEER COLEMAN W.JENKINS. SUPT. OF BUILDING 'tOCALITY Temple C y FOR APPLICANT TO FILL IN R NT OR TYPE CROSS ST. NUMBER FIXTURE OR ITEM EACH, *FEE WATER CLOSET 1.50 OWNER Romanes ue APts MAIL BATH TUB 1.50 ADDRESS S ame SHOWER 1.50 CITY TEL.NO. LAVATORY 1.50 , CONTRACTOR GMERAL INSTALLATION 'CO. SINK 1.50 ADDRESS 6$58 WEST BLVD. DISHWASHER 1 so I CITY Los. Angeles TEL NO- PL 3-2541 CLOTHES WASHER 1.50 STATE LIC LICENSE NO. C 36 15IS34) CLASS SWIMMING POOL.RECEPTOR 1.50 DISTRICT NO. GROUP NE PRO ESSE BY LAWN SPRINKLER SYSTEM 2.00. 3, WATER HEATER 1.50 1 75 �� APPROVAL, GAS SYSTEM OUTLETS 1.50 -INSPECTION RECORD OUTLETS OVER 5 PER SYSTEM .30 Ready for Inspection N. /I).- WATER SOFTENER Ivs Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE.$ TOTAL FEE 4 7 ' APPROVALS DATE INSPEETOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel' NO. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION PLUMBING FIXTURES AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANP STATE OF 717 - CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RES NTI L PROPERTY. FINAL SIGNATURE • JAC'K R, ALLEN, SUPERVISING H'AN{GAL EN'G'R. OF PERMITTEE r PERMIT VALIt1ATION CASH. PLAN CHECK VALIDATION Cl.. M.C. CASH 61 „ 3673 5 .`75N }rl ' 76A667-C MOO f 5/69 � r - APPLICATION FOR PLUM PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING • =�,j JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS iu Q 'I WILLIAM A.JENSEN,SUP'T OF BUILDING LOC /e T_ FOR APPLICANT TO FILL IN CROSS ST. hOC 5o X4 1• b ki ca-s NUMBER FIXTURE OR ITEM EACH FEE' OWNE 32 WATER CLOSET $1.?S Q 0 D 3 ;Z BATHTUB 1.25 p p p ADDRESSSHOWER �f C7 , TEL. NO.0'1 re;L-160./ /�. LAVATORY 1.25 O Q'0 . CONTRACTORS {T/f.h/ 0 h Q SINS 1.25_ ADDRESSS/#06 f�6l�o �y f DISHWASHER 1.25 CITY Id/0� PS r 7;�L.NO.. 3/- z ATE LAUNDRY TUB 1.25 d REGISTRATION NO.13 l C-34COUNTY ❑ CLOTHES WASHER 1.25 JO� DIST ICT N G P E PRO E88 Y .Z WATER HEATER 1.50 } 2- GAS SYSTEM OUTLETS 1.50 Q INDUSTRIAL IL WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .90. 1ASPECTION.RECORD APPROVALS DA7E ,INSPECTOR'S_SIGNATURE PERMIT 2 00 UNDER SLAB WORK' 7 � ��© ROUGH PLUMBING TOTAL FEE GAS PIPING ? l � I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTYORDINANCES AND STATE LAWS IVEGULATING PLUMBING. HOT WATER HEATER rf ' _ 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES '.r' .G✓J LICENSED AS REQUIRED BY'LOS ANGELES CO TY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 Al- HE LEGAL OWNE OF,AND INTEND TO RESIDE IN,THE ABOVE DES IBED RESIDENTIA ROPERTY UTILITY CO.NOTIFIED SIGNATURE 'OF PERM FINAL � f V ATION ROBERT :'WOOD r/ cK. M.o. CASH SUPERVISING MECHANICAL ENG'R l 3 4 1G OCT 11 5 D 220.50- V WORKERS'COMPENSATION DECLARATION j /0 PP APPLICATION F®® PI1 PLUMBING PERMIT 20.0026 DPW 4/87 C11f" 6 �rf�A 9� 41� k+a fiY�® 1 PERMIT I hgre.�y,affirm that I have a certificate of consent to self in- I 76A667A sure,or a certificate of Workers'Compensation Insurance,or a I CE 817(REV.8/86) certified copy thereof(Sec,3 000, Lab. C. I • Policy No. olfipany ./ G i COUNTY OF LOS ANGELES i DEPT. OF PUBLIC WORKS Certified co— eby furnished. ��/ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / 0 ;X ` Certified copy is filed with the county building inspection . ADDRESS '4.� {iGL department NUMBER FIXTURE.OR ITEM @ FEE / 6` WATER CLOSET(TOILET) LOCALITY Date Applicant NEAREST CERTIFICATE O EXEMPTION OM WORKERS' BATH TUB CROSS ST. COMPENSATION I RANCE I SHOWER OWNERid (This section need not be completed•if the work involved by I MAIL the permit Is for one hundred dollars($100)or less.) i LAVATORY ADDRESS 1 certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY lg at-ry TEL.. NO: as to become subject to the-Workers'Compensation Laws. DISHWASHER j� '�v� CONTRACT R /gyp Date ApplicantCLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- ' SWIMMING POOL RECEPTOR ,emption,you should become subject to the Workers'Compen- .� / ly with provisions of the Labor Code,you must forthwith comp- I LAWN SPRINKLER SYSTEM CITY � X&IG r `i TEL. NO. ly with such provisions or this permit shall be deemed revok- STA ELIC. ed. WATER HEATER LICENSE NO. �� CLASS C �� LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business I OUTLETS OVER and Professions Code, and my lice in full force a ef- 5 PER SYSTEM FINAL pI�j VALIDATION O fect. Sr�7p7 _ DATE `// License Number Lic. Class (1 FINAL ep; ContractorBY O I am exempt under Sec. W a B.&P.C. for this reason Plan Check fee y Date: PLUMBING PERMIT ISSUING FEE$ Signature 1 TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name W6-i o a. Law for the following reason (Section 7031.5, Business and —;- 21351-j Professions Code):. _ Address ='''u ' 7 Cit I, as owner of the property, will do the work and the Y Tel. No. structure is not intended or offered for sale(Section 7044, i 11 I HL Business and Professions Code).. _ CONSTRUCTION LENDING AGENCY [- `` 21-, I hereby affirm that there is a construction lending agency for :14PCt0E �f+l} the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). • LFwlil�l_)i;.l[I� ,•''f i�=��;'f Lender's Name -76 1 AM 9147 6110 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 upon the above- Toned property r ins ction pur ses. .16 r SEE REVERSE FOR EXPLANATORY LANGUAGE �ignref Permittee to