HomeMy Public PortalAbout9069 WOOLLEY ST_Plumbing__ 76AS67A ICE 8178)-11/76 AI
"APPLICA�°'I F®R PLUMPING, PERMIT
BUILDING AND SAFETY DIVISION
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FORAPPLICANTTOFILL INIPRINTORTYPE) BUILDING
ADDRESS go67 woommy
NUMBER FIXTURE OR ITEM ® FEE LOCALITY TEMPIt CITY
WATER CLOSET
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER MARIANNE THIEBES
i LAVATORY ADDRESS go67 WQOLLEY
SINK CITY TEMPLE CITY TEL.N0.286-7120
DISHWASHER CONTRACTOR
AQUATIC POOLS
CLOTHES WASHER ADDRESS 101 E. HUNTINGTON DRIVE
SWIMMING POOL RECEPTOR
CITY ARCADIA. - TEL.NO.M6-46 1
LAWN SPRINKLER SYSTEM
STATE WATERHEATER LICENSE NO. 315620 CLASS C m53
GAS SYSTEM OUTLETS DISTRI�C,LNO.S j61(V i �CESSE Y
OUTLETS OVER ` 6 C
SPER SYSTEM 1 INDUSTRIAL
WASTE APPROVAL i
INSPECTION RD
ub
Plan check fee
PLUMBING PERMIT ISSUING FEE.$
TOTAL FEE
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE ? GAS'VENT
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER HEATER
AND STATE LAWS REGULATING PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES COUNTY ND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
Y• LEGAL OWNER OF,AND INTEND.T IDE IN TF . OVE HIED BESIDIINTIAL
+' PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL f F(] �/�/�' "'•+i.�
PLAN CHECK VAL ATION CK. M.O. CASH PERMIT VALIDATION cK. M.O. CASH
2.8 1-jUN 28 5 D 1. X705 {) &;d
1
WORKERS'COMPENSATION DECLARATION a' cr.887A /I, P I L I C A T I®N FOR , PLUMBING PERMIT
I hereby affirm that I have certificate of consent to self ce e» (z-ao) r'! FOR
, PLUMBING
or a certificate of Workers'Compensation Insurance,or
a certified copy thereof.(Sec.3800, b.C.
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company of ,t/ C!
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) TNEARESTILDING A IL
l j ,
Certifie cop t�county�builginspection NUMBER FIXTURE OR ITEM O FEE' DRESS
t WATER CLOSET CALITY
Date--,
ate plic BATH TUB OSS ST. h
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved LAVATORY MAIL
ADDRESS }
by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO.�X 7/ CL
I certify that in the performance of the work for which this DISHWASHER U
permit is issued, I shall not employ any person in any manner CONTRACTOR
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER 0
ADDRESS I� P-0 O
Date Applicant H
SWIMMING POOL RECEPTOR
NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO.qq2--)C)—X W
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM IL
STATECompensation provisions of the Labor Code, you must forth- L CENSE NO. 1 6 1 C ASS Z
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS D1 ICT NO. PR ESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 15 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL
ness and Professions Code, and my license is in full force and DATF?® VALIDATION
effect. Q
License Number Lic.Class I FINAL
FI
Contractor Date 14OA91�20 _T
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
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 I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
ness and Professions Code):
❑ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project
(Section 7044,Business and Professions Code).
L261.8A
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency RE,%� 00 0 0 0 0 ")
for the performance of the work for which this permit is ��� jp
issued(Sec.3097,Civ.C.). u u uZr il (J �+ �LSC� 2 0 o 1 G C (1
Lender's Name
Lender's Address a c o 1 � ^, ra
I certify that I have read this application and state that the 1 C. 1 5-8C
above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize sen a I this County to enter upon the
ned property for nspection u oses.
a �
Signature of Permittee Date