HomeMy Public PortalAbout5329 BALDWIN AVE_Plumbing__ (2) 17
DEIS APPLICATION FOR PLUMBING PERMIT
B512ZIVISION OF BUILDING AND SAFETY 1,
Department of County Engmeer
a County of Los Angeles
WM J FOX COUNTY ENGINEER BUILDING �"3 �Q 7 /t 464.11)-)
7
CASSATT D GRIFFIN SUP T OF BUILDING77
ADDRESS �J
LOCALITY V
FOR APPLICANT TO FILL IN NEAREST ��
CROSS ST
OWNER ADGL y} DISTRICT NO I GR UP I ZONE I READY FOR INSPECTION
MAIL
ADDRESS I
INDUSTRIAL yh _ 4 14-Ss"
CI TY TEL NO WASTE APPROVAL At
PLUMBER 1 e-1/ r- 4 ` INSPECTION RECORD
ADDRESS /�/+ /�-.
CITY e 4
fI') SIC //tea 7 TEL NO -/ o
&
LICENSE NO L
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET)
BATH TUB
SHOWER
r LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
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TOTAL NO ® 080 __7_�- APPROVALS
DATE INSPECTOR S SIGNATU E
CAS SYSTEM OUTLETS @ 100 r.
UNDER SLAB WORK
WATER HEATER ® 1 00
ROUGH PLUMBING
PERMIT SI 1 00 GAS PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER �r
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED REIA PROPERTY
SOF PERRESOF PERRITT rl / FINAL/ � , FINAL
OF PERMITTEE
WILLIAM J Fps COUNTY ENGINEER V VALIDATION
1V/ A"0LO 4 4 7 6S ,1Wi 8 3 820
BY
r
DEPUTY
7-SA-601 77 9 ag 9 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN, DISTRICT GROUP ZONE PERMIT NO
®(S7/$
PLUMBER RECEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
ADDRESS �ai Jl L l/Jl
BUILDING
CITY TEL NO �Z' ADDRESS i
COUNTY LOCALITY
LICENSE NO EXPIRES
NEAREST
PERMIT FEES CROSS ST _
NUMBER 1 TYPE OF FIXTURE OR ITEM FEE OWNER / y
MAIL
WATER CLOSET (TOILET) @ O 50 $ IADDRESS
ADDRESS
BATH TUB Q O SO I CITY TEL NO/a;; r
SHOWER @ O 50I I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ O SO I� APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
STATE LAWS REGULATING PLUMBING
KITCHEN SINK Q O 50 I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ O Sol ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE
GAS SYSTEM OUTLETS @ O 501 ((/
SIGNATURE OF
1 WATER HEATER @ O 501 PERMITTE _
SLOP SINK @ 0 Sol I INSPECTION RE 616 �^
FLOOR SINK @ O 50 1
FLOOR DRAIN Q O 50
DISHWASHER @ O 501
DRINKING FOUNTAIN @ O 501
1 URINAL L7n O 501 I j
1 HOUSE SEWER @ O 501 1 Q
MISCELLANEOUS
I�
APPROVALS
DATE INSPECTOR S NAME
ROUGH PLUMBING
GAS PIPING
F- GAS VENT
1. CESSPOOL @ 1 00 I I CESSPOOL
SEPTIC TANK 1 I SEPTIC TANKI
I DRAIN ( ) PIT ( ) Q 1 001 SEWER
PERMIT 1 00 GAS TEST
TOTAL FEE 1 $
UTILITY CO NOTWIED
I FINAL I r� I FA, %�'�
DBS-17 7 APPLICATION FOR PLUMBING PERMIT 1
oBS. (DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles FL
DING
JOHN A. LAMBIE, COUNTY ENGINEER ESSCASSATT D. GRIFFIN,SUPT OF BUILDING .�dLITY J C�/2O C
FOR APPLICANT TO FILL INNEAREST
CROSS ST.
OWNER Ida D e A, 7 C I DISTRICT NO. GROUP ZONE � READY FOR INSPECTION
MAIL
ADDRESS
�r —
INDUSTRIAL
CITY TEL. NO. WASTE APPROVAL
PLUMBER ��s e v INSPECTION RECORD
ADDRESS -? j J G
CITY T )fj j(A L,/ /� TEL. NO.
LICENSE NO. IV
YG ;� IF
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00 k
BATH TUB @ $1.00 j0
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
16
DISHWASHER @ $1.00
ie w
LAUNDRY TUB OR TRAY @ $1.00 qi,'t
CLOTHES WASHER @ $1.00
�ya
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
V m'
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING ter, -""
TOTAL FEE !r
GAS VENT _
I HEREBY ACKNOWLEDGE THAT I 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. PLUMBING FIXTURES
-.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF f
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIEDis;.-4r,-+-
DESCRIBED RESIDE IAL OPE TY.
SIGNATURE
OF PERMITTE FINAL 'i / ?4- R'
JOHN A. LA IE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. M. O. S
'. r
0 .5 6 SEP 2 5 3 2.0 D in
WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of c sent to self in 76A�667ADPW 4/90
sure or a certificate of Workers Compensa on Insurance or a
certified c t e ( c 3800 La
COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
Policy No pony '
Certified copy is hereby f hed
FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
Certified copy is filed wit the unty building inspection ADDRESS `tel
de rtmenj NUMBER FIXTURE OR ITEM @ FEE
t LOCALITY
pplicant WATER CLOSET(TOILET) NEAREST
Date
CERTIFICAT F EXN FROM WO ERS BATH TUB CROSS ST
EMPTIO
C PENSATION INSURANCE SHOWER OWNER
(This section nee not be completed if the work involved by MAIL
the permit is for one hundred dollars($100)or less) LAVATORY ADDRESS
I certify that in the performance of the work for which this per SINK
mit is issued I shall not employ an erson in a y manner so CITY TEL NO
as to bec e s jec the Work s ;m ens io ws DISHWASHER CONTRACTOR
Date Applicant CLOTHES WASHER
ADDRESS
NOTICE O APPLICANT If after making this Certificate of Ex SWIMMING POOL RECEPTOR
emption you should become subject to the Workers Compen CITY 'S TEL N QJ g`� O
sation provisions of the Labor Code you must forthwith comp LAWN SPRINKLER SYSTEMS _ `
ly with such provisions or this permit shall be deemed revok STATE / /� LIC
ed WATER HEATER �`�
LICENSED CONTRACTORS DECLARATION LICENSE NO CLASS DISTRICT NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER C '�
and Professions Code and my license is in full force and of 5 PER SYSTEM FINAL (j (� hIALIGATION
fect HOSE BIB DATE ` l V
License N �er, t �/'"� L c Class C�✓ CL
CL
FINAL `� 3343 43.40 0
Contractor Date � � BY v �
Q
F-1I am exempt under Sec T4TAITEMS43
® , 0 U
B 8P C for this reasonW
D Plan check fee P CHECK 43.40 CL
ti
PLUMBING PERMIT ISSUING FEE$ d tHAKE 00 z
Signature IZ
TOTAL FEE 3� 0
SINGLE FAMILY
HOME OWNER BUILDER DECLARATION Plan check applicant ,
I hereby affirm that I am exempt from the Contractor s License Name M-0001 u/ 7/9",
Law for the following reason (Section 7031 5 Business and i�g� 1 �;`)c
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
above information is correct I agree to comply with all County
rdinances and State jaws regulating Plumbing and hereby
a than a repr en�for
esty to enter upon the
ve enhon'd07a�—
oses
/ SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0102070004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 6755 LT 12 5329 BALDWIN AV
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803264
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET OLIVE
8589 005 008 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY
19 FLOOR SINK(S) 1 00 FIX 16 20
TENANT 25 LAVATORIES/SINKS 1 00 FIX 16 20 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
TEMPLE CITY ARCO TOTAL FEES 60 15 02/07/01 UT 08/06/01
OWNER TEL NO FINALIDATE FINAL B CODE
MFT CORP �7_
180 LINDA IS L "� 441
ESC PTION OF WORK 1 —1
NEW WPSH ROOM AND FLOOR SINK (NO ADDED SQUARE FOOTAGE)
APPLICANT TEL N
SAME AS OWNER
SPECIAL CONDITIONS
(y'iE L Q,®
CONTRACTOOR WNER TEL NO ®� �� APPROVALS DATE INSPECTOR SIGNATURE
SAMELIC NO UNDER AB WORK
WATE
PLASTICEY/NCEMETAL Y/N
ARCHITECT R TEL NO
UGH PLU
LIC Np
1111111 GAS PIPING
GAS VENT
FULS" U"C WD'u"IMS HOT WATER HEATER
PLUMB INT RES '
i
LAWN SPRINKLERS
GAS TFS
❑ �� UTILITY COMPANY NOTIFIED
V
cWV
�epVBC GRAY WATER SYSTEM
REPORT ID DPR263 ROUTE TO BS0508