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HomeMy Public PortalAbout4937 WILLMONTE AVE_Plumbing__ 76A667-CE81.7-8-57 APPLICATION FOR' 'PLUMBING PERMIT 1 , COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ? JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS cJ CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER :FIXTURE OR ITEM WATER CLOSET OWNER MAIL BATH TUB ADDRESS ' SHOWER CITY TEL.NO. LAVATORY CONTRACTOR �/IJ 4. ,[ /�! ./r✓d 44 SINS ADDRESS Q r DISHWASHERCITY TEL.NO. 7 S LAUNDRY TUB CONTRACTOR'S STATE REGISTRATION NO. AV1707 COUNTY CLOTHES WASHER DISTRICT 10. GROUP I ZONE I READY FOR INSPECTION WATER HEATER Z GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD I APPROVALS I SCD@ $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE , OR FIXTURE $ �� UNDER SLAB WORK ROUGH PLUMBING PERMIT $ 1 00 GAS PIPING TOTAL.FEE ,f GAS VENT 1 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. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST ol LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF T ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENT 0;�TOY�. SIGNATURE � OFPERMITTEE FINAL t ROBERT A. WOOD, VALIDATION SUPERVISING MECHANICAL ENG'R N.O'. CASH 1440M FB21 3 A 1100 91 WORKERS'COMPENSATION DECLARATION 6A667A ® I hereby affirm that I have a' certificate of consent to self ME 617(2-60) APPLICATION FOR PIL U M B I N G PERMIT insure,or a cyrtificate of Workers'Compensation Insurance,or ^ 'fl. a certified copy thereof(Sec.3860,Lab.C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company i Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING Gy g-7A/ /J ,v Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM ® FEE ADDRESS [,� C department. WATER CLOSET LOCALITY TewP Date Applicant NEAREST BATH TUB CROSS ST. W�� (�W�/`� . CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER �/#V/ QAf er' ' PA4*AJ f^ (This section need not be completed if the work involved LAV ATO R Y ADDRESS `/ 7 /V �v J Le 0 ` by the permit is for one hundred dollars ($100) or less.) SINK CITY % 1�- TEL.NO. - % CL I certify that in the performance o the work for whic is DISHWASHER U permit isFlc�cabject hall not emplo ny n i any ner CONTRACTOR so as to the r mp ati CLOTHES WASHER ADDRESS O Datpplicant i SWIMMING POOL RECEPTOR U NOTI ?TA'PFe PLICANT: If, r making this/ertificate of CITY TEL..NO. WExem tiou should become subject to the. Workers' LAWN SPRINKLER SYSTEM STATE LIC. N Compensation provisions of the Labor Code, you must forth- LICENSE NOCLASS Z with comply with such provisions or this permit shall be W(aTER HEATER . deemed revoked. `GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION ness and-Professions Code,,and my license is in.full force and DATE effect. [� FINAL License Number Lic.Class BY Contractor Date F1 1.am exempt from the licensing requirements as I am a Plan Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that 1.am exempt from the Contractor's Address License Law for. the following reason (Section.7031.5, Busi- City Tel.No. o nest and Professions Code): �4638A I, as owner of the property, am exclusively contracting0 0 o o o 5 with licensed contractors to construct the project (Section 7044,Business and Professions Code). 2.0 0 2 4,5 0 CONSTRUCTION LENDING AGENCY 0 0 0 2 U,5 0 6 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.). 0 628.-82 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 SEE•REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby silt ize presentatives of tpls County to enter , pon the aoned p ert ction purp • Signature of Per Atte Date A COUNTY OF LOS ANGELES TEMPLE CITY # 0508 (PL-UMBIKO'PERMIT- DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0009060008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL I EES PAID BUILD ADDRESS; TR: 9848 LT: 4 4937_WILLMONTE-AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804045 ASSESSOR INFORMATION R: NEAREST CROSS STREET: LOWER AZUSA 8589-023-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY 21 HOSE BIBB(S) 1.00 FIX 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED Y: PAN BY: EXPIRES N: 09/06/00 UT 03/06/01 OWNER: TEL. NO: FINAL DATE JEw B CODE: PHAN LAN T (818) 444-9397- 4937 WILLMONTE AV TEMP 917804045 DESCRIPTION OF WORK NEW HOSE BIBB PPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: ES CO CONTRACTOR: TEL. NO: SOS �/� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO UNDER SLAB WOR WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. N1111111 GAS PIP NG \U D Ur, W0� S OS VENT WATERHEATER IIJ—�/ PLUMBING FIXTURES eg 0 t nl� LAWN SPRINKLERS eg ,��i, GAS TEST i0 El ©.'-=®yUTILITY CO PAN NOT I I ED t 0 wV C 9ervic Thai GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508