HomeMy Public PortalAbout5312 ARDEN DR_Plumbing__ 76A667-CE817 12/59 - CITY
APPLICAT�QNTOR PLUMBING PERMIT
COUNTY OF LOS-ANGELES-
DEPARTMENT-OF COUNTY,ENGINEER ME MMMOWWom
BUILDING AND SAFETY DIVISIONs"unDING`
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO'FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM '
_ QWNER�
WATER-CLOSET MAIL
BATH TUB ADDRESS /
CITY TEL. NO;
SHOWER
LAVATORY CONTRACTORif
-
SINN ADDRESS
DISHWASHER CITY TEL. NO. -�
-
CONTRACTOWS STATE ❑
LAUNDRY TUB. REGISTRATION NO. COUNTY ❑
CLOTHESWASHER DISTRIICST NO. �GROJUR Z NE P BY
WATER HEATER•
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
a
O
U
O
E
W
P.
N
z
@ $1.00 PER-ITEM
OR FIXTURE $ V�/ h APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 -' UNDER SLAB WORK
TOTAL FEE I00
0 .ROUGH PLUMBING
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ.THIS APPLICATION
AND.STATE THAT THE ABOVE IS CORRECT"AND AGREE-.TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE,LAWS -REGULATING _ HOT WATER HEATER
PLUMBING.
I 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 THE ABOVE .
DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIEDSIGNATURE
OF
OF PERMITTEE, C -
FINAL
®F.
VALIDATION--)- ROBERT A. WOOD,
- - - - •CB. 61.O. CASH SUPERVISING MECHANICAL,ENG!R .
:. LU07707'" FEB 1 .5 D 3-00
WORKERS'COMPENSATIONDECLARATION CC81e»A ) APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a' certificate of consent to self (z-so
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. CompanEl y
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING�� 6 Z ^ .C)�jd, r'
O NUMBER FIXTURE OR ITEM • FEE ADDRESS 1�T1 v
Certified copy is filed with the county building inspection
LOCALITY �^
department. WATER CLOSET ��l
Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER CtX_`,4
MAI LA
(This section need not be completed if the work involved LAVATORY >_
r
ADDRESSJ�)`2-Aif De�J�/r
by the permit is for one hundred dollars ($100) or less.) / 9
SINK CITY TEL.NO."l
I certify that in the performance of the work for which this DISHWASHER
permit is issued, I shall not employ any person in any manner CONTRACTOR G �0
so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER
ADDRESS -ACT �'� ��� �� `
Date Applicant SWIMMING POOL RECEPTOR LU
6LU
NOTICE TO APPLICANT: If, after making this Certificate of CITY��h�� C-�^ TEL.NO.'Vq�Gj� to
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.
Compensation provisions of the Labor Code, you must forth- A LICENSE NO. CLASS
with comply with such provisions or this permit shall be a.
WATER HEATER
deemed revoked. A DISTRICT NO. PR CESS
GAS SYSTEM OUTLETS
LICENSED CONTRACTORS DECLARATION OUTLETS OVER S�
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect.
FINAL
License Number Lic.Class BY
Contractor Date
0 I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
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).
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 C 11 C ,J U C
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
authorize representatives of this ty to enter upon the
ab e-mentioned property for ins ctioA purposes.
��- ?®
Signature of Permittee Date
COUNTY OF LOS ANGELES .TEMPLE CITY #.0508,_, PLUMBING PERMIT '
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS _ •PL 050$-0702220016
BUILDING AND SAFETY/-LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT.:
LEGAL ID:
FEES -PAID I BUILDING ADDRESS-: I
( I - -
ITR: 11699 UN: .002 I. 1531'2 ARDEN DR I
IEEE DESCRIPTION: QUANTITY.: UOM: AMOUNT: ( , TEMP CA 917803319 _
(ASSESSOR INFORMATION NUMBER: I' - I I 'NEAREST;CROSS STREET: OLIVE 3,{ tx.
18585-020-005 101 -PERMIT ISSUANCE FEE • 27.7.5 'I_ 'THOMAS PAGE: 59.7 GRID: B4 -LOCALITY: *TEMPLE Cl
1'07 BATHTUBS/SHOWERS 1.00 FIX 16..20 I I
ITENANT - 125 LAVATORIES/SINKS 1.0.0 FIX 16..20 (ISSUED ON.: PROCESSED BY: PLAN BY: EXPIRES ON: I
145 WATER CLOSET/URINAL 1.00 FIX- 16.20 102/22/07 JK 08/21%07 I
--TOTAL FEES 76.35 1 I
I OWNER: _ TEL. N0: I -'` �` I FINAL D TE FI Y.: - . CODE.: I
1BRADSHAW, -DIANA '(626) 453=8901- 1 I -
15312.ARDEN DR I I 1
ITEMP917803319 - ID48CRIPTIO9 OF WORK
JPL!UMBINGFOR BATHROOM & LAUNDRY ROOM REMODEL- I
1
(APPLICANT: TEL. N0:
I:B &, L CONSTRUCTION (818) 434-6617-
11317 N. SAN FERANDO I'SPECIAL CONDITIONS:
IBURBANK, CA 91504
CONTRACTOR: - TEL. N0: '"t .� .:r` _ ?`;.� �'_. t (APPROVALS DATE 'INSPECTOR SIGNATURE-
i
IB & L CONSTRUCTION (818) 434-6617-
11317 N.
34-6617-11317 -N. SAN .FERNANDO BLVD_ LIC.. NO I - (UNDER SLAB WORK
1#132 840526 B
IBURBANK, CA 91504 ,1 IWATER SERVICE I I
PLASTIC YIN METAL YIN -I I
(ARCHITECT OR ENGINEER: - - 'TEL'. NO: - I - I
IROUGH PLUMBING I I
LIC. NO: �I - _ _ I
IGAS PIPING I I
IGAS VENT I
- I HOT WATER.HEATER' -
I PLUMBING FIXTURES•.
ILAWN.SPRINKLERS
1 1 IGAS TEST
- 1UTILITY' COMPANY NOTIFIEDI
CWV
GRAY .WATER SYSTEM _
I I-
BS0508
I.REPORT ID: DPR263 ROUTE TO: 1
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