HomeMy Public PortalAbout10727 ARROWOOD ST_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Department of County Engineer �
DIVISION OF BUILDING & SAFETY
WILLIAM j
WILLIAM J. FOX, County Engineer
LUMBING
FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE
PERMIT NO.
PLUMBER VALLEY BOULEVARD P111RAPHNIr-1 rn REC IVED BAFIRST INSPECTION
READY FOR DATE ISSUED
`�Y- ,— '
ADDRESS 8300 EAST V rY .I �/
BUILDINGn
CITY ROSEn�1_AD TEL No. T 9-9-710 ADDRESS d
COUNTYQ3q� LOCALITY
LICENSE NO. N EXPIRES6--':10,6:3 -
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER -_
MAIL
WATER CLOSET(TOILET) 0.50 S ADDRESS
BATH TUB 0.513
CITY TEL. No.
SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
Ji LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
_ I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER
OF THE RESIDENTIA P OPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS 'Q 0.50
SIGNATURE OF �'
WATER HEATER 0.50 PERMITTE
SLOP SINK @ 0.513 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER Qx` 0.50
DRINKING FOUNTAIN 0.50
URINAL @ 0.513 -�
Q
HOUSE SEWER @ 0.50 _Z
MISCELLANEOUS
(Y
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT . . . . 1.00 GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE ��
FINAL
761667 DBS#17 6-52
' V
WORKERS' COMPENSATION DECLARATION Alf"U"UCA HOS �]( FOR PLUMMIG MIG PERWr
I hereby affirm that I have a certificate of consent to self 76A667A u V uvu u�u
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES—F—C BUILDING AND SAFETY
Policy No. Company r
Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 77 7 � 5-17
Certified copy is filed with the county building inspec- ADDRESS 187Z7 J �
tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY --r . C
WATER CLOSET .64
Date Applicant NEAREST y 1 c
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. �✓� j�/
COMPENSATION INSURANCE SHOWER OWNER dA) AG �°6ivE
(This section need not be completed if the work involved by
the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS 6/ J.om,et��L�l
I certify that in the performance of the work for which this �
permit is issued, I shall not employ any person in any manner SINK CITY 7 f TEL. NO.�g 7
so as to become subject to the Work7,7
.CKMR Laws. v
> DISHWASHER
- CONTRACTOR
DateApplicant �CXA/' CLOTHES WASHER ol1 11
NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL. NO.
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be ISTATE UC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM °OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER % Q
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION._
PI" v eve L DATE � � "(J� U
License Number Lic. Class �! 09
FINAL �GO
Contractor Date BY U
V
I am exempt under Sec. �
B.&P.C. for this reason
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE L
6.7 4�q'A
Plan check applicant _P o o•0 0 o`v
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name 2 0 0 1 SrQ
1 hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and Address o 0 1 b.5 0"
Professions Code): City Tel. No: ) 1,:1 0;-8 3
INI, as owner of the property, will do the work"and the
structure is not intended or offered for sale (Section D
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 D
above information is correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes.
SEE REVERSE FOR.EXPLANATORY LANGUAGE
Signature of Permittee Date
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 - PLUMBING PERMIT
DEPARTMENT OF_PUBLIC WORKS 9701 LAS TUNAS PL 0508 0807220008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1
ITR: 17867 LT: 35 1 1 10727 ARROWOOD ST 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803404 1
(ASSESSOR INFORMATION NUMBER: I I .NEAREST CROSS STREET: PERSIMMON 1
18574-002-011 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl
1 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 1
(TENANT: 121 HOSE BIBB(S) 2.00 FIX 32.40 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I
I I TOTAL FEES 76.35 107/22/08 SR 01/18/09 1
I I I I
(OWNER: TEL. NO: 1 IFINAL DATE FINAL BY: CODE: I
1AYALA, ROSEMARY (626) 222-7021- 1 I
110727 ARROWOOD ST
ITEMP 917803404 1 I EE C� OF WORK I
IPLUMBING FOR REMODEL EXISTING BATHROOM 1
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1APPLICANT: TEL. NO: I 1
1AYAIA (626) 222-7021- I
110727 ARROWOOD ST 1 ISPECIAL CONDITIONS: I
ITEMPLE CITY CA 91780 I
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ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
IROSEMARY AYALA (626) 222-7021- 1 1 I
110727 ARROWOOD STREET LIC. NO (UNDER SLAB WORK I I I
ITEMPLE CITY, CA 91780 NONE I I
I IWATER SERVICE
I 1 IPLASTIC Y/N METAL Y/N
1ARCHITECT OR ENGINEER: TEL. NO: I I
IPETER LEE ENGINEERING (626) 280-9000- 1 IROUGH PLUMBING
18748 VALLEY BL., STE. L LIC. NO: I I /
ROSEMEAD, CA 91770 53948 I IGAS PIPING I
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IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I
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