HomeMy Public PortalAbout5128 BARELA AVE_Plumbing__ ;'• WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I her`by affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers'Compensafton Insurance, CE 817(REV: 10/81)
or a certified copy thereof(Sec. 3800, Lob. COUNTY OF-LOS ANGELES BUILDING AND SAFETY.: '
Policy No. - Company
Certified copy is hereby furnished.
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed'with the county building inspec- ADDRESS /
tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
WATER CLOSET
Date " Appli4arlt. . :NEAREST •
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS st..
COMPENSATION INSURANCE OWNER
' SHOWER
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars($100)or less:) LAVATORY
I certifythat in the performance of the work ADDRESS k for which this
permit is.issued, I shall not employ any person in any manner SINK" CI TEL. Nc_�p L
so as to become subject to the Workers'Compensation.Laws. DISHWASHER ,
,CONT4.
RALTO
Datpp CLOTHES WASHER P
ADDRES
NOTICE TO APPLICANT: If; after making this.Certificate of &f
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
CITY TEL.N
Compensation provisions,of the Labor Code, you must forth-
LAWN SPRINKLER SYSTEM
with comply with such..provisions.or this permit shall be STATE LIC.
deemed revoked. WATER•HEATER. LICENSE N CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO" P ED BY
I hereby affirm that'l am Licensed under provisions.of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000.)of Division 3 of the Business OUTLETS OVER
and Professions Code,and my Incense is in full force and effect. 5 PER SYSTEM FINAL
VALIDATION
DATE V'
License Number . • Lic. Class Od
IF
FINAL O
Contractor Date BY 4 gvt�
❑ i am exempt under Sec.
24Q3 Z.
B.BP.C;for this reason Plan check fee # . • . . .
Date: PLUMBING PERMIT ISSUING FEE'$
,r � • 2z5o''
• Signature ,
TOTAL FEE �.
Plan.check applicant ''e'• e 2.2 5 0
SINGLE FAMILY
07,p8L85
HOME OWNER-BUILDER DECLARATION Name -
I hereby affirm that I am exempt from the Contractor's License' Address
Low for the following,reason (Section 7031.5, Business and
Professions Code):. City Tel. No.
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (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
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
ordinances and State laws regulating Plumbing', and hereby
authorize representatives of this County to enter'upon the
above-mentioned property for ins ection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
�`�y Signature.of Pe ittee- Uate
. + •i
PLUMBING 1
~. DEPARTMENT OF COUNTY ENGINEER
•,DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
,C �/r l
WILLIAM J. FOX, COUNTY ENGINEER .ADDRESS ✓ rQ�� �C�fLJ
FOR APPLICANT TO FILL IN LOCALITY
ADDRESNO S NEAREST
BUILDICROSS ST.
DISTRICT NO. GROUP ZONE PERMIT NO.
LOCALIT re Pefl + �
NEAREST f
CROSS ST. REC,EIyEjD-BYI_./ Ready for Inspection / DATE ISSUED[
OWNER '_ /
MAIL INDUSTRIAL
ADDRESS WASTE APPROVAL
CITY TEL.NO. INSPECTION RECORD
PLUMBERiT3�,.r,rJ � .rr1L
ADDRESSa. A ' tow
CITY fTEL.NO. 4/ '7 /
p-7 � [STATE
LICENSE N0. IG A 5 �..� M:COUNTY J
PERMIT FEES Q
_z
,LIMBER TYPE OF FIXTURE OR ITEM FEE L7
WATER CLOSET(TOILET) 0.80 S 0
O
BATH TUB 0.80
SHOWER @ 0.80 v7r
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY 0 0.80
SLOP SINK @ 0.80
FLOOR SINK @ 0.80
FLOOR DRAIN D) 0.80
DISHWASHER @ '0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM..............OUTLETS @ 1.00
WATER HEATER a 1.00
MISCELLANEOUS
APPROVALS
DATE I NSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING r�aysr.Ojk- ILEA
TOTAL FEE GAS PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• GAS VENT
.AT
AND STATE THAT THE ABOVE 18 CORRECT AND AGREEHOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
1 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 THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE .. - -��.-- -• FINAL Kt�rs
76A067 DRS 17 Ob 12+53
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1203260006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 15683 LT: 48 1 5128 BARELA AV 1
1 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803846 1
ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET:
18589-011-020 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
1 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 1 1
TENANT: 1 TOTAL FEES 44.00 (ISSUED ON: PROCESSED BY: PLAN BY: 1
103/26/12 SR
OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE: 1
1MEADEN DOLORES A I /,Y
15128 BARELA AV 1 2 �-
n
1TEMP 917803846 1 ID SCRIPTION OF WORK \ 1
IREPLACE BATHTUB
I I I I
1APPLICANT: TEL. NO: 1
IBLANKENSHIP ENTERPRISES (818) 481-5119- 1
110567 MARKLEIN AVE ISPECIAL CONDITIONS: 1
IMISSION HILLS 91345 1
1 I I I
1CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE
1
1BLANKENSHIP ENTERPRISES (818) 481-5119- 11
110567 MARKLEIN AVENUE LIC. NO 1 1UNDER SLAB WORK
1MISSION HILLS, CA 91345 924376-B 1 1 1 1
I 1 1WATER SERVICE
1 1PLASTIC Y/N METAL Y/N 1 1 1
(ARCHITECT OR ENGINEER: TEL. NO: 1 1 1 1 1
- I 1ROUGH PLUMBING
1 LIC. NO: I1 1 1
1 1GAS PIPING 1 1 1
1 1 1
I 1
1GAS VENT 1 1
1 1HOT WATER HEATER 1
I I I
1 1 1PLUMBING FIXTURES 1
I I I
1 1 LAWN SPRINKLERS 1 1
I I I
I 1 IGAS TEST 1 1 1
I I I
1 1 1UTILITY COMPANY NOTIFIED( 1
I ICWV I I
I 1 1GRAY WATER SYSTEM
I I I
1 I I I I I
1 I I I I I
1 I I I I I
1REPORT ID: DPR263 ROUTE TO: BS0508
1 I I I I I