HomeMy Public PortalAbout4945 BALDWIN AVE_Plumbing__ D S S 17 25M SETS 12 44 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING
WM J FOX CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO GROUP �(ZZO E PERMIT NO
"
_ ROUGH FIXTURES COMPLETE " r
HEATER CESSPOOL }I SEPTIC TANK RECEI ED BY FIR8 E INSPECTION FOR DATE ISSUED
GAS MISCELLANEOUS ` A't/�
APPLICANT FILL IN HEAVILY OUTLINED PORTION_ ONLY
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NAME I ADDRESS ,
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ADDRESS D /`1vIJ2 LOCALITY ,
NEAREST t
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OCITY f / - , TEL No CROSS ST IV
COUNTY ®! far
CERT NO EXPIRES Cw NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS
NORTH O
CITY x TEL No
1 AM THE LEGAL POSEEEV�SOR OF THE ABOVE LOS
` ANGELES COUNTY CERTIFICAT 'QUALIFICATION
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
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ABOVE
OWNBR
- CORRECTIONS
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SOUTH d
DESCRIPTION OF WORK
PATH TUB FURNACE ~
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SHOWER DISHWASHER 1
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN ~
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR E NAME
WATER HEATER ENTALLAVATORY ROUGH PLUMBING
METER GAS SODA FOUNTAIN
OUTL GAS PIPING I I
GAS VENT
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CESSPOOL
TOTAL NUMBER OF FIXTURES ] SEPTIC TANK I
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CE86POOI- SEPTIC TANK SEWER
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UTILITY CO NOTIFIEDTOTAL FEE
i FINAL �'�
D B S 17 25M SETS 12 44 APPLICATION FOR PERART
DEPARTMENT OF BUILDING %AND SAFETY I
` _COUNTY,,-OF LOS ANGELES _a 1 y PLUMBING , 1
WM J FOX CHIEF ENGINEER
' NATURE OF INSTALLATION - DISTRICT NO GROUP ZONE PERMIT NO
.ROUGH FIXTURES COMPLETE A(
RECEIV BY READY FOR Q
NEATER CESSPOOL F I SEPTIC TANK ` FIIBM RST INSPECTION tD�ATE ISSUED
GAS 17-IMISCELLANEOUS
APPLICANT_FILL IN HEAVIL OUTLINED PORTIPE ONLY
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NAME -f// ADDRESS �✓
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2 ADDRESS u LOCALITY C
no '
NEAREST
.ILj CITY EL No } /a CROSSST
COUNTY
CERT No EXPIRES If NAME 1 {�
_ LOCATION OF SEPTIC TANK, OR CESSPOOL 3 MAIL
} NORTH i� + i O
CITY u a TEL No
1 AM THE LEGAL POSSESSOR OF THE ABOVELOS
ANGELEe CE FrIC TE OF QUALIFICATION
} i P NTY
v
t PLUMBER Q
+ 9 ' I AM THE LEGAL OWNER OF THEYPROPERTY DESCRIBED
' ABOVE r' e k -
�
OWNER
a
ti x CORRECTIONS r 1
1 +
j SOUTH
DESCRIPTION OF WORK
1 Y
c ATH TUBS FURNACE -
� ` A ►a
SHOWER � DISHWASHER
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LAVATORY REFRIGERATOR I »
/—KITCHEN SINK WATER SOFTENER
QLOOR SINK L - -SAND TRAP » {
l
r
fi LOP SINK y . ` ItFLOOR DRAIN
WASH TRAY y URINAL APPROVALS .4
_— WATER CLOSET` DRINKING FOUNTAIN DATE— = INSPECTOR 8 NAME
r f WATER HEA ER 4 , DENTAL LAVATORY ROUGH PLUMBING-
4,
' �+ETE G n' QODA FOUNTAIN 6A8 PIPING
GAS VENT
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CESSPOOL
TOTAL NUMBER OF FIXTURES
s SEPTIC TANK
CESSPOOL- SEPTIC TANK
t HEWER
8
TOTAL FEE TUTILITY CO NOTIFIED I
FINAL
WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A
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 BUILDING AND SAFETY
Policy No Company
Pol /
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
El ,4C 7
Certified copy is filed with the county building inspec ADDRESS d✓ 1
tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY /
Date Applicant WATER CLOSET r . NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST �i G
COMPENSATION INSURANCE OWNER �+
(This section need not be completed if the work Involved by SHOWER
the permit is for one hundred dollars ($100)or less ) LAVATORY MAIL
ADDRESS
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner SINK CITY TEL NO
so as to be e e ers Compensation Laws DISHWASHER
CONTRACTOR
Date scant CLOTHES WASHER
%NOTICE O APPLIC NT If after making this Certificate of ADDRESS
Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code you must forth CITY TEL NO
LAWN SPRINKLER SYSTEM 07
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO P CESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM LPUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION O
DATE V
License Number Lic Class f�C
FINAL O
Contractor Date BY
Eli W
I am exempt under Sec , H
B&P C for this reason z
Plan check fee
Date PLUMBING PERMIT ISSUING FEE$ �O
Signature
, TOTAL FEE
Plan check applicant
SINGLE FAMILY a 4 2 5 7 A
HOMEIOWNER BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor s License # o o 0 0 0 5
Law for the following reason (Section 7031 5 Business and Address r
Professions Code) City Tel No 2 0 0 1 6 5 0
❑ I as owner of the property will do the work and the o 165053
structure is not intended or offered for sale (Section ,
7044 Business and Professions Code) 0 x 0 4-8 3
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 comp with all County
ordinanc an State laws rilgulalin �tyu.ont,
and hereby
author repr septa Ives thi our upon the
abov m nt neder n pect s
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signat a of Permute Date
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0305160021
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
TR 9848 LT 23 BL 001 4945 BALDWIN AV
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917804009
ASSESSOR BER NEAREST CROSS STREET LOWER AZUSA
8589 026 034 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID B5 LOCALITY TEMPLE CITY
05 BACKFLOW DEVICE(S) 1 00 DEV 16 20
TENANT 07 BATHTUBS/SHOWERS 2 00 FIX 32 40 ISSUED ON PROCESSED0
11 CLOTHESWASHER(S) 1 00 FIX 16 20 05/16/03 JK 11/12/03
13 DISHWASHERS) 1 00 FIX 16 20
OWNER TEL NO 21 HOSE BIBB(S) 2 00 FIX 32 40 FINAL DATEY CODE
SIERRA JOHN (626) 448 0961 25 LAVATORIES/SINKS 3 00 FIX 48 60
4945 BALDWIN 27 PRESS REG DEVICE(S) 1 00 DEV 16 20 E X P I R EA
TEMPLE CITY 91780 45 WATER CLOSET/URINAL 2 00 FIX 32 40 DESCRIPTION
47 WATER HEATER(S) 1 00 WTH 16 20 REPLACE ALL PLUMBING
64 WATER PIPNG <= 1 1/2 1 00 LIN 16 20
APPLICANT TEL NO TOTAL FEES 270 75
SAME AS OWNER
SPECIAL CONDITIONS
CONTRACTOR TEL N - APPROVA ATE INSPECTO S E
SAME AS OWNER -
LIC NO � _ � UNDER
WATER SERV E
PLASTIC Y/N METAL Y/N
ARCHITECT _
ROUGH PLUMBING
LIC NO ' �� i GAS PIPING
_ 3
GAS VENT
HOT WATER HEATER
PLLR481NG FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY 0
cWV
GRAY WATER SYSTEM
REPORT ID DPR263 ROUTE TO BS0508