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NUMBER STR ET
f . 3 APPLICATION FOR A
1 PLUMBING PERMIT
yS1 : BUILDING 8 SAFETY DIVISION
C7. fU j CITY OF ARCADIA,CALIFORNIA
1
`,� OWN6i2 �EL. NO.
'MA �2`-222/.„ , SL, NO ?
OD MAILING ADDRESS
- PANIC INSTALLERS ST f
r7 1O92€b��SGRAND AVE. CITY LIC. NO
ThMPLE CITY, CALIF. TEL,NO.
FEE COMPUTATION
BATHTUBS FLOOR DRAINS
SHOWERS REPLACEMENT SHOWER PANS
WATER CLOSETS URINALS
LAVATORIES CLOTHES WASHER
SINKS DRINKING FOUNTAINS
-1.\• GARBAGE DISPOSALS DENTAL UNITS
0 DISHWASHERS LAUNDRY TUBS
0 TOTAL NO.'OF ABOVE FIXTURES @ 1.75
7›. WATER HEATERS AND/OR VENTS @ 2.00 ,.,- '
IV
WATER SYSTEMS @ 2.00
GAS SYSTEMS 5 OUTLET ADD. OUTLET
@ 1.75 @ .50 EACH
LAWN SPRINKLER SYSTEMS @ 2.00
SAND TRAPS @ 10.00
CLARIFIERS @ 10.00
GREASE TRAPS @ 10.00
WATER SOFTENERS @ 2.25
SWIMMING POOL "P"TRAP @ 2,00
SEWER CAP @ 3.00
CESSPOOL FILL @ 3.00
SEWER CONNECTION ON PROPERTY @ 10.00
f
I have carefully read and examined the above PERMIT FEE 2 00
application and know the same to be true and
correct. All provisions of Laws and Ordinances INVESTIGATION
covering this type of construction will be com- FEE
plied with whether specified herein or not. No
person shall be employed in violation of the
Labor Cods of the TOTAL FEE e of California. 1/',3
41114' aair
GNATURE CONTO'C' AUTHORIZED AGENT OL
CONSTRUCTION PROHIBITED BETWEEN 7:00 P.M. AND 7:00 A.M.
AND ON SUNDAYS AND HOLIDAYS AS PER ORD. #1321.
/:/
PART AL CR MISC. `.NSPECliONS
UNSUCCESSFUL TRIPS
City of Arcadia
Building and Safety Division
CERTIFICATION RE: WORKMAN'S COMPENSAT ON
COVERAGE
Job Add.-ss� / .i I , AP AllOgf -.5
Own` _ ,11// 1/1 •
Contractor , °/lA Allto.� —/ 1
Permit #(s : ob Valuation
Building Elec.
Sw. Pool Plmbg. J(
Htg/A.C. Other
I certify that in the performance of
the work for which this permit is issued
I shall not employ any person in any
manner so as to become subject to the
Workman's Compensation laws of California.
L4I certify that as the applicant I am
censed under the provisions of the Con-
tractors L'cen d further that my
License 1 7 7 in Classification
is in full force and effect.
I certify that I am exempt from the
"License Required" provisions of the
Contractors License Law. (State basis of
exemption) :
I hereby acknowledge that I have read
this certification and state that the
above is correct and agree to comply with
all City Ordinances and State Laws regu-
lating building.
I (We) agree to save, indemnify, defend
and keep harmless the City of Arcadia,
its City Council, Redevelopment Agency,
and their employees and agents against
liabilities, judgments, costs and expenses
which may in any way accrue against said
City in consequence of the granting of
this permit. Ad
SIGNATURE � _
4 _/i
Date . %j��j