HomeMy Public PortalAbout5120 BALDWIN AVE_Plumbing__ D.B.S.-17 25M SETS 12-45 APPLICATION FOR PERMIT
.DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBINGWM. J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO.
ROUGH _ FIXTURES COMPLETE •-,
TIA
READ FOR
EIVED DATE ISSUED
HEATER CESSPOOL SEPTIC TANK � FIRST INSPECTION
GAS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
.JOE
NAME ADDRESS
tIl ADDRESS LOCALITY
DNEAREST -
IL CITY _ TEL.No. CROSS ST.
COUNTY .. >.,
CERT.No. EXPIRESNAME
LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL
3 ADDRESS
NORTH O -
CITY _ TEL.N0.
1AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
PLUMBER
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
t4
D
OWNER
CORRECTIONS
w
SOUTH
DESCRIPTION OF WORK
a
BATH TUB FURNACE
SHOWER DISHWASHER A
LAVATORY REFRIGERATOR 0
KITCHEN SINK ---__WATER SOFTENER
FLOOR SINK --_—SAND TRAP
_.-SLOP SINK _ FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME
__ WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I
—METER GAS -SODA FOUNTAIN
OUTL GAS PIPING
GAS VENT I I
CESSPOOL
—TOTAL NUMBER OF FIXTURES " _ SEPTIC TANK
CESSPOOL SEPTIC TANK SEWER
I
TOTAL FEE UTILITY CO.NOTIFIED I
FINAL I
i i'
D B S 17 25M SETS 6 46 / APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
COUNTY OF LOS ANGELES
WM J FOX CHIEF ENGINEER
NATURE OF INSTALLATION DI 1 GROUP O PERMIT
NO-
ROUGH FIXTURES COMPL.E7E / YJ
HEATER CESSPOOL SEPTIC TANK CEIVED BY READY FOR DATE ISSUED
FIRST INSPECTION
A& MISCELLANEOUS �—
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
JOB
d, NAME ' ADDRESSld�/
W /meq NI<
m ADDRESS e� LOCAL
�
d CITY
NEARF�T
J .O!',�+ � TELrNo C4089 BT /7
COUNTY
CERT No r PIRES m NAME (J
LOCATION OF SEPTIC TANK, OR CESSPOOL' z MAIL ' n
NORTH O ADDRESS
CITY TEL No
IAM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OFFQUALIFICATION
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE
® _ >
OWNER
CORRECTIONS
SOUTH
J
t DESCRIPTION OF WORK i
BATH TUB FURNACE p
ir
SHOWER DISHWASHER Q
LAVATORY REFRIGERATOR
KITCHEN BINK WATER SOFTENER
FLOOR BINK BAND TRAP
GLOP SINK FLOOR DRAIN
WASH TRAY ' URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR S NAME
WATER HEATER DENTAL LAVATORY - ROUGH PLUMBING
METER GAS SODA FOUNTAIN
OUn CiAB PIPING
GAS VENT
CESSPOOL
TOTAL NUMBERL�EPTIC
FIXTURES SEPTIC TANK
CE8SPOO, TANK / t/ U SEWER
B'
TOTAL FEE UTILITY CO NOTIFIED
FINAL
DEPARTMENT OF COUNTY ENGINEER V PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J FOX COUNTY ENC3INEER ADDRESS
4
FOR APPLICANT O FILL IN LOCALITY
1B
BUILDINGp� „J� I CROSS ST
ADDRESS L .GT
LOCALITY DISTRICTGR ZON1% ERM���
NEAREST � ` spec AyT
CROSS ST J RECE�B Ready for Inspection �D��SU��
OWNER G�/�`f
``fit. QQQ INDUSTRIA
MAIL
ADDRESS WASTE APPROVAL �S
/�
INSPECTION RECORD
CITY p��, a k 0-0 .,TE NO
t � I
PLUMBER 1�I �j ,
ADDRESS 1
CITY S&*Z_ TEL NO (9>1'-6 44rSl
El STATE
LICENSE NO �1 �� U 4,t? ❑COUNTN
J
PERMIT FEES Q
_z
NUMBER TYPE OF FIXTURE OR ITEM FEE d
WATER CLOSET(TOILET) @ 080 $
O
BATH TUB @ 080
SHOWER @ 080
LAVATORY(WASH BASIN) @ 0 80
K TCHEN SINK @ 0 80 (/
LAUNDRY TUB OR TRAY (P 0 80
SLOP SINK @ 080
FLOOR SINK @ 080
FLOOR DRAIN @ 080
DISHWASHER @ 0 80
DRINKING FOUNTAIN @ 080
URINAL @ 080
GAS SYSTEM OUTLETS @ 1 00
WATER HEATER @ 1 00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING
1HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING PLUMBING FIXTURES w�
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF TH ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED
SIGNATURE �� ,
OF PERMITTEE _ - �_ ��.A - FINAL �`� ^,
76A667 DBS 17 1/53 Q r
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1401080016
BUILDING AND SAUTY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
LEGAL ID FEES PAID BUILDING ADDRESS
ITR 10821 LT 1 BL 001 1 1 5120 BALDWIN AV
I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803901 1
ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET
18585 007 001 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY CAI
107 BATHTUBS/SHOWERS 1 00 FIX 16 20 1
TENANT 121 HOSE BIBB(S) 1 00 FIX 16 20 JISSUED ON PROCESSED BY PLAN BY I
125 LAVATORIES/SINKS 1 00 FIX 16 20 101/08/14 SR
145 WATER CLOSET/URINAL 1 00 FIX 16 20 I
OWNER TEL NO 147 WATER HEATER(S) 1 00 WTH 16 20 1FL�A" `TF N BY CODE 1
IFLORENCIA PILPA TOTAL FEES 108 80K(^J
15120 BALDWIN AVE I 1
TEMPLE CITY CA 91780 IDESCRIPTION OF WORK
(BATHTUB/SHOWER HOSE BIBB LAVATORIE WATER CLOSET AND
IWATER CLOSET 1
(APPLICANT TEL NO 1
IKATIGBAK MAGNO (909) 267 8749 I
1
1961 CALLE HERMOSA 1 ISPECIAL CONDITIONS 1
ISAN DIMAS CA 91773 1 1
ICONTRACTOR TEL NO 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
IM S K BUILDERS (909) 267 8749 1 I 1
1961 CALLS HERMOSA LIC NO 1 1UNDER SLAB WORK I I
ISAN DIMAS CA 91773 720840 I I
IWATER SERVICE
I I IPLASTIC YIN METAL YIN I
1ARCHITECT OR ENGINEER TEL NO 1
IMENOR PETER (323) 255 3934 I IROUGH PLUMBING 1 I 1
11511 OAK GROVE DRIVE LIC NO 1 I I
ILOS ANGELES CA 90041C28539 1 IGAS DIPING
I I I I
1 1 IGAS VENT 1 I
I I I
I IHOT WATER HEATER 1
I I I
I IPLUMBING FIXTURES 1 I
I 1 I I I
1 (LAWN SPRINKLERS I
I I I
IGAS TEST I 1
I 1UTILITY COMPANY NOTIFIEDI I I
ICKV I I
IGRAY WATER SYSTEM I 1
1 1 I I I I
I I I I I I
I I I I I I
I 1 I I I I
1 1* ADDITIONAL DATA ON FILE 1 1
IREPORT ID DPR263 ROUTE TO BS0508 1 1
I I I I
'WORKERS COMPENSATION DECLARATION 76AG67A
I✓hereby affirm that I have a certificate of consent to self CE e17 (z 60) APPLICATION FOR PLUMBING PERMIT {�
insure or a certificate of Workers Compensation Insurance or I i J
a certified copy thereof(Sec 3800 Lab C)
�, �� � COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No Company f
0 Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING 51,04V
i yO �
ADDRESS L
Certified copy is filed with t county building inspection NUMBER FIXTURE OR ITEM • FEE
WATER CLOSET ��- LOCALITY
Dated
TEL NEAREST / ,{
BATH TUB CROSS ST Ld��+� fYZCJiZ�
CERTIFICATE OF EXEMPTION FROM WORKERS
COMPENSATION INSURANCE SHOWER OWNERf�L��'/(�
esd MAIL c CL
(This section on need not be completed if the work involved j -� ADDRESS /'�/As. d�Oy
` �
by the permit is for one hundred dollars ($100) or less) CITY TEL CONTRACTOR No7-7 t— U
I certify that in the performance of the work for which this DISHWASHER /� O
permit is issued I shall not employ any person in any manner O �v
so as to become subject to the Workers Compensate ,n, Laws
CLOTHES WASHER ADDRESS U
LU
Dat J Applicant � '� SWIMMING POOL RECEPTOR d
NOTICE TO APPLICANT If after making this Certificate of CITY TEL NO Cl)
Exemption you should become subject to the Workers LAWN SPRINKLER SYSTEM STATE LIC Z
Compensation provisions of the Labor Code you must forth LICENSE NO CLASS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked GAS SYSTEM OUTLETS DISTRICT NO PROCESSED BY
LICENSED CONTRACTORS DECLARATION �O �✓
OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi FINAL l VALIDATION
ness and Professions Code and my license is in full force and DATE
effect /
FINAL lr(/1 ✓ —"t
License Number Lic Class BY
Contractor Date i
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051 Bus
iness and Professions Code) TOTAL FEE m
Lic or Reg No Date Plan check applicant
HOME OWNER BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractors Address 9 1 2 7 8 A
License Law for the following reason (Section 7031 5 Busi City Tel No
ness and Professions Code) # 0 0 0 0o 5
I as owner of the property am exclusively contracting " 2 o 0 1^9 0 0
with licensed contractors to construct the project
(Section 7044 Business and Professions Code)
01400x
CONSTRUCTION LENDING AGENCY 2 2-8 1
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 l
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 County to enter upon the `
abov mentioned property for inspection purposes
�1-22
Signa of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING+PERMIT
• DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ' L PL-0508-9907280006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 1
PHONE (626) 285 0488 EXT i
l
LEGAL ID FEES PATD BUILDING ADDRESS
TR 10821 LT 1 BL 001 } 5120 BALDWIN_AV1
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803901
ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET
8585 007 001 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY
03 BACKWATER VALVE(S) 1 00 VAL 46 95
TENANT 07 BATHTUBS/SHOWERS 1 00 FIX 16 20 ISSUED ON PROCESSED BY PLAN BY EXPIRES 0
11 CLOTHESWASHER(S) 1 00 FIX 16 20 07/28/99 UT O1/24/00
13 DISHWASHER(S) 1 00 FIX 16 20
OWNER TEL NO 47 WATER HEATER(S) 1 00 WTH 16 20 FINAL DATE FINAL BY CODE
PILPA,FLORENCIA I 51 LOW PRS GAS 5 OUTLET 1 00 SYS 16 20
5120 BALDWIN AVE 60 DWV REPAIR OR ALTER 1 00 SYS 16 20 S-
TEMPLE CITY, CA TOTAL FEES 171 90 DESCRIPTION-OF-WORK
GAS-L-INE-FOR-NEW-HVAC SYSTEM-AND-P UMBING F R REMODEL
APPLICANT TEL
M S K BUILDERS (909) 592 3465
129 W THIRD STPECIAL CONDITIONS
SAN DIMAS, CA
GI 11 �ES Co
MCONTRACTOR TEL S K BUILNAPPROVALS DATE INSPECTOR SIGNAT
BUILDERS (909) 592 3465 �.�� V�r�
129 WEST THIRD STREET LIC NO UNDER SLAB
SAN DIMAS, CA 91773 720840 B WATER
�, PLASTICEYINCEMETAL YIN
ARCHITECT 0 ENGINEER /
LIC NO / ROUGH
ttt///rrr, 1 11 111 �
� GAS
GAS VE NT
U ULBUC W®�KPLUMBING FIXTURES
� 0 R HEATER
at LAWN ERS
X GAS TEST
0 ® ®y -U=TY COMPANY
O
46,�c Service rba�� �' cwv
GRAY WATER
K
REPORT ID DPR263 ROUTE TO BS0508