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Home My Public Portal About5843 AGNES AVE_Plumbing_1/26/1962_ 76A667 CE817 12/59 TEMPLE CITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING km �,SF�FETY RIVISION BUILDING g JOHN A L MBI ouNTY NGINEER ADDRESS �7 WILLIAM A JENSEN SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST ossssT NUMBER FIXTURE OR ITEM OWNER s WATER CLOSET N r f Ir BATH TUB ADDRESS r CITY TEL NO SHOWER LAVATORY CO TOA SINK ADDRESS��4� DISHWASHER CITYTEL NOM-1:56/3 CONT R S /� STATE LAUNDRY TUB REGISTRATION NO COUNTY ❑ CLOTHES WASHER DISTRICT NO GROUP I ZONE P ED BY WATER HEATER 1 lr& v GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD P. O U a O H U W a y a 00 OR FIXTURE $ I ER ITEM I APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK TOTAL FEE I d p ROUGH PLUMBING GAS PIPING � e AND HSTATE THAT THE EREBY EABOVE DGE HIS AT I CORRECT AND AGREE HAVE READ THIS ATOLCOMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AHD/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN=IALRORTY UTILITY CO NOTIFIEDSIGNATURE OF PERMTTEV d LV/ i' _ FINAL I OF VALIDATION--,ROBERT At WOOD r Cs m 0 (,,-�-�HsuPERVISING MECHANICAL ENG R UiCO74621 JAN 26 5 D 300ko 76A667 CE#817 6 65 �j2�� APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDAES COLEMAN W JENKINS SUPT OF BUILDING LOCAL FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET it 25 MAIL BATH TUB 1 25 ADDRE SHOWER 125 Cl , TEL NO LAVATORY 125 CONTRACTOR SINS 125 ADDRESS 9 DISHWASHER 125 C TEL NO STATE LIC LAUNDRY fUB 125 LICENSE NO CLASS � '� CLOTHES WASHER 1 25 DISTRICT NO r,, GR Z E P L�!' 1,-'vY WATER HEATER 1 50 , UPJ�J�/ GAS SYSTEM OUTLETS 150 INDUSTRIAL a WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V O H V Lu a N 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 1 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 RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL Z, VALIDATION CK MO CASH LALC) 8 7 5 b l hAY 2 6 5 D 325 s _ WORKERS COMPENSAt10N DECLARATION I hereb,-affirm that I hrave a certificaW'of consent to self in 76A6667A PW 4/87 APPLICATION FOR PLUMBING PERMIT , h sure or a Certificate of Workers Compensation Insurance or a CE 817(REV 8/86) certified copy thereof (Sec 3800 Lab AC ) ' COUNTY OF LOS ANGELES _ _ DEPT OF PUBLIC WORKS- Policy - \ }Noo Company4 n ^ a +Certified copy is hereby furnished 4 pY t r ❑ FOR APPLICANT TO FILL IN (PRINT OR TYPE) ` BUILDING I _`�� Ave e Certified copy is filed with the county building inspection ,r ADDRESS (�N department,c r •a sp + b "NUMBER FIXTURE OR ITEM t Ca- FEE LOCALITY _ Date a \ Applicant' Jt s > i a [ WATER CLOSET(TOILET) yi s NEARESTt k CERTIFICATE OF EXEMPTION FROM-WORKERS * BATH TU,B " °� CROSS STi A , e COMPENSATION INSURANCE a a +� OWNER E w h} c� SHOWER (This section need not be completed if the work involved by MAIL Q' v �s4 1 4 �J v s z the Permit is for one hundred dollars ($100) or less ) LAVATORY r �y a } 4 ADDRESS YGy y +\ I certify that in the performance of the work fo v✓hich this per mit is issued I shall not employ any person ny manner so ° rV �SINK' CITY �' " 4 TEL NO asxto beco a su ect to the Workers o s ion Laws DISHWASHER y v — � a Y \ ` � r CONTRACTOR Ow a � Date Applicant y CLOTHES WASHER NOTICj ,ADDRESS E TOA LICANT If after make g this Certificate`of Ex b SWIMMING POOL RECEPTOR emphon you should become subject to the Workers Compen N I satior ovisions of the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEM '� CITY TEL NO lydwith such"p?ov sions or this permit shall be deemed revok STATE r LIC ed WATER HEATER \ - LICENSE NO ' CLASS LICENSED CONTRACTORS DECLARATION ' DISTRICT NO PROCESSED BY " I hereby affirm that I am licensed under provisions offiChapter V ! GAS SYSTEM' g / OUTLETS ' moo-, /J p 91(commenang with Section 7000)of Drvis1 'n 3 of the Business -� OUTLETS OVER (/ and Profession"s Code and my license is m,full force and of „ 5 PER SYSTEM FINAL VALID AT r } fect f s , DATE d License Number' ' Lic Class + r I r O FINAL 6 Contractor Date " BY 1 1 9 71 +N p I am exempt under Sec r _ a" a # o o e • e 5 ,r_ t7-9 CL B&P C for this reason Plan check fee + ► L ` J ° ° 3 4,5 0 ca ca ti V " Date PLUMBING PERMIT ISSUING FEE$ �D • o • 3 4,5 0 v r Signature ` '� L M .-� JOTA,FEE SINGLE^FAMILY �_ Plhk licant ( 1 2 3 8 8 4 HOME OWNER BUILDER DECLARATION , an ceca PP , y x I hereby affirm that I am exempt from the Contractor s Licensee Name Law for the following reason (Section 7031 5 Business and i ` Professions Code) ` If' Address i 6 p I�(511 as owner of the property will do the work and'the City Tel No /7W structure is not intended or offered for sale(Section 7044 Business and Profession`s Code) + S1 _a 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 t (Sec 3097 Civ C ) Lender s Name t { x Lender s Address 1 certify that I have read this application and state that the above information is carr I agree to comply with all County ordinances and,St.te I s egulating Plumbing and hereby ;ab&ntioned, representati es of this County to enter upon he y r p y pro a r m ection purpos s r aA , k r SEE REVERSE FOR EXPLANATORY-LANGUAGE Sig ture of Permittee ate r r° r a v COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0310090013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285 0488 EXT LEGAL ID FEES P BUILD-114G ADDRESS TR 6561 LT 437 5843 AGNES AV FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802216 ASSESSOR INFORMATIONB NEAREST CROSS STREET LAS TUNAS 8587 027 010 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY 07 BATHTUBS/SHOWERS 1 00 FIX 16 20 TENANT 11 CLOTHESWASHER(S) 1 00 FIX 16 20 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 21 HOSE BIBB(S) 1 00 FIX 16 20 10/14/03 JK 04/11/04 25 LAVATORIES/SINKS 1 00 FIX 16 20 OWNER TEL NO 45 WATER CLOSET/URINAL 1 00 FIX 16 20FJW DISE FI BY CODE SHEHEE KEVIN,JOLYNN M 47 WATER HEATER(S) 1 00 WTH 16 20 �(/_(� 5843 AGNES AV 51 LOW PRS GAS 5 OUTLET 1 00 SYS 16 20 TEMP 917802216 TOTAL FEES 141 15 D€SCR R PLUMBING FOR ADDITION APPLICANT TEL N SAME AS OWNER SPECIAL CONDITIONS CONTRACTOR TEL NO QPM APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC NO WATER SERVIC ARCHITECT OR ENGINEER TEL NO PLASTIC Y/N METAL Y/N // ' LIC NO// 1111111 ROUGHBIN GAS PIPING 7 l_I �C Imo- GAS VENT Lg L�� [ ['117 HOT WATER HCAMF- PLUMBING FIXTURES i/ O 0 *` _ H�'f G AS TEST � __��nAA� Fy IT COMPANY NOTIFIED B Vv � CwV 0C�� GRAY WATER STSTEM REPORT ID DPR263 ROUTE TO BS0508