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Home My Public Portal About4927 WILLMONTE AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I �ereby,.Jrrp,thpt 11-haveDPW 4/90 he a certificate of consent to self in- 76A667A A.,dr a'dbrtificate'of Workers'Compensation Insurance,ora certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company a Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ADDRESS C 7 ) j eN-i 7-7- 0 department. @ FEE LCALITY Dtlte Applicant WATER CLOSET(TOILET), �p,�_ NEAREST r ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. j p Lr7 COMPENSATION INSURANCE SHOWER OWNER LTV (This section need not be completed If the work Involved by MAIL the permit is for one hundred dollars($100)or less.) Z LAVATORY ADDRESS T st�J L I certify that in the performance of the work for which this per- SINK " mit is issued, I shall not employ any person in any manner so CITY j l9� N L c�.TEL:NO. as to become subject to the Workers'Com �M1Laws: DISHWASHER 7y /-n�, CONTRACTOR•ifC1-Date. / Applicant .� CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this CertiOcate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL.NO sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS � I'�J��j , •?�A_C ly with such provisions or this permit shall be deemed revok- STATE LIC. 3� ed. WATER HEATER LICENSE NO. CJO CLASS LICENSED CONTRACTORS.DECLARATION DISTRICT NO. PROCESSEb BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS' 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER •�� and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. Q� HOSE BIB DATE �-� (� �� >.License Number S� Lic. Class — a FINAL G Contractor IJ l LLL AIIQZ•r 0 k�( Date BY I am exempt under Sec. V B.BP.C. for this reason W • � Plan check fee � , CL Date: PLUMBING PERMIT ISSUING FEE$ �� 0 Z Signature TOTAL FEE 0000-000" 7111/95 SINGLE FAMILY Plan check applicant 1 54 1 AN 8:06 HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031'.5, Business and Professions Code): Address ' ❑ I, as owner of the property, will do the work and the City Tel. No. 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 poll, information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize represent Wes pt this County to enter.upon the above-me e o may' r inspection.purposes. -��•- � SEE REVERSE FOR EXPLANATORY LANGUAGE --1� Signature of Permittee Date 76AG67-CEOG17 12-64 City of 'Temple City 1407\ APPLICATION FOR PLUMBING PERMIT \\; COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS — 4927 Willmont Ave. COLEMAN W. JENKINS,SUPT OF BUILDING LOCALITY Temple Ct$ FOR APPLICANT TO FILL IN NEAREST EARS ST . Rosemead NUMBER FIXTURE OR ITEM EACH FEE J OWNER R E Gustayson WATER CLOSET $1.25 MAIL BATH TUB 1.25ADDRESS Same CITY TEL.NO. SHOWER 1.25 LAVATORY 1;25 CONTRACTOR General Installation Co. SINK 1.25 ADDRESS 6558 West Blvd. DISHWASHER 1.25 CITY Los Angeles TEL.No. PL 3-2541 TE LAUNDRY TUB 1.25 REOGNISSTTRATION NO. C-36 151839 787couNTyy CLOTHES WASHER 1'25 DISTRI NO. GROUP Z NE PR SEED BY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 INDUSTRIA WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD 0 V 1 Softener 1 50 Ready for Inspection Now IM 0 C3 W IL ti Z APPROVALS DATE/ INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK , 3 ROUGH PLUMBING J ' TOTAL FEE GAS PIPING E I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT _I AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. f 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 I AM THE LEGAL OWNER:OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIO AL ROP UTILITY CO.NOTIFIED SIGNATURE �5�% ., OF PERMITTEE FINAL d /,-VALIDATION ROBERT A WOOD CK. M.o. CASH- SUPERVISING.MECHANICAL ENG'R iU� 6 1 1 6`n 0CT 4 5 D 3.50- 7GA fZ (CE-817)-4/72 , "APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS M0,10-144 HARVEY T. BRANDT,COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST , Q 8. NUMBER FIXTURE OR ITEM @ FEE CROSS ST. y WATER CLOSET --- OWNER ` MAIL � BATH TUB L75ADDRESS -ve Av-t — NF SHOWER 1,75 CITY—to AN4 e_%-n%A TEL. NO.444-64qk LAVATORY 1.75 CONTRACTOR' SINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER 1.75. STATE LIC LICENSE NO'. " CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP ZONE PROCESSED BY LAWN SPRINKLER SYSTEM 1:.75 C r . WATER HEATER 1.75INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 CD INSPECTION RECORD Cj OUTLETS OVER 5 PER SYSTEM .30 0F C.7 W CL. H Plan check fee Sae Reverse PLUMBING PERMIT ISSUING FEE $ 31. 00 TOTAL FEE Plan check applicant APPROVALS DATE 1 PECTOR'S SIGNATURE UNDER SLAB WORK Name ROUGH PLUMBING lr Address GAS PIPING City Tel. No. GAS VENT HOT WATER HEATER I 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 PLUMBING. GAS TEST I HEREBY CERTIFY THAT 1. AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - - - OR THAT I AM THE LEGAL OWNER OF, AND INTEND T0. RESIDE IN CALIFORNIA.HE ABOVE DESCRIBED RESIDENTIAL PROPERTY. FINAL �.. r. SIGNATU RE OF PERMITTEE 'O\hS 4PE�RMIT (DATION CK. M..O. CASH PLAN CHECK VALIDATION CK. M.O. CASH (� {�f1 r15 5 D1. (3.00b V• 76A867-CE817.8-57 COUNTY OF LOSAPPLICATION FOR' PLUMBING PERMIT ANGELES 1 DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS 4927 tilillm me IOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY Tem le Celt FOR APPLICANT TO FILL IN CROSS EST. Lower Azusa NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY TEL.NO. LAVATORY CONTRACTOR SINS ADDRESS ' 7821 E.Garvey Ave DISHWASHER CITYS S Gabriel TEL.NO. AT05349 LAUNDRY TUB CONTRACTOR'S STATE REGISTRATION NO. 134935 COUNTY ❑ CLOTHES WASHER DISTRICT NO. GRO I ONE I READY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD t APPROVALS @ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE OR FIXTURE $ 4.00 UNDER SLAB WORK PERMIT 8 2100 ROUGH PLUMB.ING c._.•-. - GAS PIPING TOTAL FEE GAS VENT ` I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING. 1HEREBY CERTIFY THA AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED S ANGELES' COU A D STATE OF CALIFORNIA OR THAT A THE LEGAL 0 ROF THE ABOV UTILITY CO. NOTIFIED DESCRIBED RESIDENTI P OPERTY. SIGNATURE OF PERMITTEE / FINAL ROBERT A. WOOD, ®s VALIDATION SUPERVISING MECHANICAL ENG'R CK. N.0. CASH I:AC 7 1 6 0+ DEC 2 5 A .6,0 0 PLUMBING 1 DEPARTAEOff OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BUILDING WILLIAM J. FOX, COUNTY ENGINEER ;,ADDRESS • .+ � 17FOR APPLICANT TO FILL IN LOCALITY / ADDRESSWillmonte Stols cRoss ST. DISTRICT NO. GROUP ZON97- PERMIT NO. LOCALITY Te le City. Calif. l ry r-PJg NEAREST CROSS ST. ECEIVED BY Ready for Inspection DATE ISSUED OWNER . Celeste Const ction coo MAIL INDUSTRIAL ADDRESS 55 E.Foothill Blvd., WASTE APPROVAL CITY Arcadia p Cal. TEL.NO. INSPECTION RECORD PLUMBER , C 'D ADDRESS D -GL 7--4e—A �� G~� CITY b� TEL.NO. �/ 'T 9C7' C17/V GI _ d LICENSE NO. +J _J T ❑COUNTY PERMIT FEES 26 -.,e - �_On J Y 4UMBER TYPE OF FIXTURE OR ITEM FEE �Q ��' Z ' t7 yV9►TEW OSET(TOILET) 0.80 A I t. 1-,j Ar25P 2 til A D i s BATH TUB @ 0.80 SHOWER 010.80 . eLAVATORY(WASH BASIN) @ 0.80 1J KITCHEN SINK @ 0.80 4AUNORY TUB OR TRAY @ 0.80 l3 SLOP SINK @ 0.80 FLOORSINK 0 0.80S il FLOOR DRAIN @ 0.80 DISHWASHER @ 10.80 DRINKING FOUNTAIN @ 0.80 URINAL 49@ 0.80 GAS SYSTEM.... ___._OUTLETS @ 1.00 bd WATER HEATER @ 1.00 D 450 MISCELLANEOUS APPROVALS DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 1 00 ROUGH PLUM�BING — S ^E�711e- TOTAL FEE O GAS PIPINq iNti� I K 1 HEREBY ACKNOWLEDGE THAT'1 HAVE READ THI APPLI- GAS VENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREEHOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES /Q $ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED-%Y-EOS ANGELES COUJ�ITY GAS TEST •N AND STATE OF CALIFORNI OR'THAT 1 AM THE LEGAI,i N- ER OF THE ABOVE rDB SIDENTIAL PROPE UTILITY CO.NOTIFIEDSIGNATURE A 0 PERMITTE ..._._.._.._..... FINAL Lnis jh�tVG'((J�'y"G6t,J 76A007 DBS 17