HomeMy Public PortalAbout4847 ARDSLEY DR_Plumbing__ '6A667-CE#817 6-66 F'
APPUCAT�ON
P BQ D G E R K-?
COUNTY OF LOS ANGELES �J
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, Courlry ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET 51.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER 1.25 Cl TEL. NO. �-��
LAVATORY 1.25 CONTRACTOR
SINK 1.25 ADDRESS
DISHWASHER 1.25 CI Y TEL. NO. Q 70
STATE LIC
LAUNDRY TUB 1.25 LICENSE NO. - CLASS -
CLOTHES WASHER 1.25 DISTRICT NO. GROUP Z E PROCESSED BY
WATER HEATER 1.50 O Q 1
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V
0
H
U
W
d
N
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
. ROUGH PLUMBING
3 �D
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
AI
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER �`6 j '- "
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,AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE r
FINAL
�VALIDATIOIV
CK. M.O. CASH
bAlLo 7 .0 3.a _.FEB . .8 5 D 3_5'0-
`-',WORKERS-'COMPENSATION DECLARATION
20.0026DP,W.4/87 " .G�lll /rV �0� lf��l�J �� �J Il :�IIUU�/U� II
1:hereby";affirm` th'aat`l'have a certificate,of`.consent to self in, 76A667A (�
P��C . 1OQ
sure,or a certificate of Workers'.Compensation Insurance,ora ;CE 617(REV:8/86)_
-certified copy thereof (Sec .3800, Lab C.
,. . COUNTY OF•LOS'ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company
Certified copy is hereby furnished •.`•
APPLICANT TO FILL TY BUILDING
FOR T. dN (PRINT OR PE).
Certified'copy is filbd-With the counfybuildirig inspection`, ADDRESS
department., @
NUMBER _.FIXTURE OR ITEM FEE
LOCALITY (..�`� �C n
`WATE'R CLOSET,(TOILET) /Y
t m.;, a' i.. .
.-Date � �•. Applicant. •" . NEAREST /
f
r -
r -+ • •'- - ., BATH.TUB - - CROSS ST •; E LE�'' .. .-
CERTIFICATE OF'EXEMPTION'FROM;WORKERS'
COMPENSATION INSURANCE OWNER Z/ a N
SHOWER l Al
��C7 /V�
(This section need not be completed if-the work involved by MAIL
the permit is for one hundred dollars($100)or less:) >: LAVATORY, ADDRESS 114 ^
I certify that in the performance of'the work for'which this per-'
67
mit is issued, I shall not employ any person'in any manner'so SINK ��� CITY TEL NO
.as to become subject to the`,Workers'Compensation Laws.
-� DISHWASHE CONTRACTOR:
SY C3ft?(/YLC� v
Date '^ Applicant � �� � _� '� CLOTHES.WASHER ,
NOTIGE(TO APPLICANTi'If, after making this,Certificate`of Ek= "'
ADDRESS
SWIMMING POOL RECEPTOR
emption.,you sliould,:liecome subject to the•Workers'.Compen- CITY TEL. NO.
sation provisions of the,iabor,Code;.you must forthwifh'comp- -LAWN,SPRINKLER-SYSTEM
ly"with-such provisions or'this.permit shall=be;deemed revok- "STATE UC
-HEATER_ LICENSE NO. CLASS'
ed: WATER
LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCESSED.BY
Lhereby,affirm'that I am ljcensed under provisions of„'Chapter GAS SYSTEM OUTLETS
9:(commencing with Section'7000)of Division 3:of-the Business OUTLETS OVER r '
ed Professionsn
..Code; and my licese is In'fu,ll force and ef. 5 PER SYSTEM FINAL' VALIDATI'O
f
DAT O .
License'Number Lic. Class` U
Contractor L-DateB O
I am exempt under Sec W
B.&P .C. for this reason 77 6 A
f/)
Plan check fee
Date:- :-PLUMBING PERMIT ISSUING FEE$r # o,o o'o o rj
D
Signature
°TOTAL FEE � � .,1 .e a 2.2 5 0
SINGLE FAMILY
HOME OWN ER=BUILDER-DECLARATION' Plan check applicant 9' 56. o"o e 2 2 5 Ox
I hereby affirm that]am exempt from the Contractor's License Name
Law for-the followi'ng'reason (Section 7031:5 -Bis i'ness,and F,t
Professions.Cocle): Address O:�':� 4 i 8 8
/ as'owne-r of ffie property, will doj.the work and'theCity Tel.'No.
structure isnot intended or offered for sale(Section 7044;
Business and Professions Code).
CONSTRUCTION LENDING AGENCY D.
Thereby affirm"that there is,a construction lending agency for
the performance of the work for.which this'permit is'iss"ued'
(Sec. 3097, Civ. C..):
-
.Lender's Name*.
Lender's Address, '
I certify that 1 have read this application•and sfcite that the
above information is correct. I agree to comply with all County
ordinances and.State laws regulating Plumbing, and hereby
authorize representatives of th"is County'to enter upon the
above,mentioned property for inspection.purposes.
„1L < _ SEE'REVERSE FOR EXPLANATORY LANGUAGE
`Signature of Permittee D to
P
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0701050001
BUILDING AND •SAFETY /. LAND DEVELOPMENT TEMPLE CITY CA 91780 -
PHONE: (626) 265-0488 EXT:
LEGAL ID: • FEES PAID BUILDING ADDRESS:
TR: 14647 LT: 30 - 4847 ARDSLEY DR "
"- FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917603802
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: TEMPLE CITY
8590-017-024 01 PERMIT ISSUANCE FEE - 27.75 THOMAS PAGE: 597 GRID: AS LOCALITY: TEMPLE CITY, C
07 BATHTUBS/SHOWERS 1.00 FIX 16.20
TENANT: 13 DISHWASHER(S) 1.00 FIX 16.20 -ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
25 LAVATORIES/SINKS 3.00 FIX. 48.60 01/05/07 JK 07/04/07
45 WATER CLOSET/URINAL 1.00 FIX 16.20
OWNER: TEL. NO: 47 WATER HEATER(S) 1.00 WTH 16.20 FI L DA F BY: CODE:
YOUNG ISAAC;ESTHER J (626) 285-8842- 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 ✓
4847 ARDSLEY DR TOTAL FEES 157.35
TEMP 917803802 DE CRIPTIOIN OF WORK
PLUMBING FOR KITCHEN, BAT OOM, RELOCATION OF WATER HEATER
APPLICANT: TEL. NO:
PERALTA (818) 523-3373- '
7318 VALIAN AVE SPECIAL CONDITIONS:
VAN NUYS CA 91406 -
CONTRACTOR: TEL. NO: - APPROVALS - DATE INSPECTOR SIGNATURE
A & WORKERS ASSOCIATES (818) 982-7904-
13141 HARTLAND ST. LIC. NO UNDER SLAB WORK
NO. HOLLYWOOD, CA 91605 697160 B
WATER SERVICE -
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLUMBING ( /
LIC. NO:
GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST - - -
UTILITY COMPANY NOTIFIED -
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 - ROUTE TO: BS0508