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Home My Public Portal About5202 BARELA AVE_Plumbing__ 76A667-CE8817 10-67 �Y APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEA SST NUMBER FIXTURE OR ITEM EACH FEE OWNER ' WATER CLOSET 1.50 MAIL BATH TUB 1.50 ADDRESS Al SHOWER 1.50 CITY TEL. NO. LAVATORY 1.50 CONTRACT SINK 1.50 ADDRESS DISHWASHER 1.50 CITY CTEL. NO. Q .. . CLOTHES WASHER 1.50 STATE LIC Q� CLASS LICENSE NO. SWIMMING POOL RECEPTOR 1.50 DISTRICT O. GROUP ZONE PROCESSED BY r LAWN SPRINKLER SYSTEM 2.00 WATER HEATER 1.50 INDUSTRIAL U WASTE APPROVAL 01 GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD U OUTLETS OVER .30 5 PER SYSTEM - Z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 9 2 00 s TOTAL FEE t7' APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING LANDSTATE ss GAS PIPING GAS VENT Tel. No. HOT WATER HEATER EBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYPLUMBINGFIXTURES LL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST NG.REBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED ED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFRNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TOIN,THE ABOVE ESC ED RESIDENTIAL P Y• FINALTURE JACK R. ALLEN, SUPER ISIN CHANICAL ENG'R. ERMITTEE '� PERMIT VALIDATION CK. - M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH AP, 4 410 J1,"12 5 o X50 76A667-CE817 540 APPLICATION FOR PLUMBING PERMI DEPARTMENTT OF COUNT NGN ENGIIVEER Q -B oMnaRI ES TY ENG NEOER nD &5 Barela WILLIAM A.JENSEN.SUPT OF BUILDING LOCALITY Temple City, California FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER Ray Bent WATER CLOSET M 5202 Barela, Temple CityESS ` BATS TUB CITY TEL N0. SHOWER LAVATORY CONTRACTOR Bryant Heating Co. .ADDRESS 8730 Las Tunas Drive snas .. DISHWASHER CITY San Gabriel Tom,. NO.AT - CONTBACTOR'S STATE ❑ LAUNDRY TUB. REGISTRATION NO. COUNTY CLOTHES WASHER DISSTTRIcr GR ZONE PR BY WATER HEATER IAL GAS SYSTEM v. DYDIIST APPROVAL , WASTE APP MSPECTION RECORD V 0 $1.00 PER ITEM Rica $ APPROVALS DATE INSPECTOR'S S16RATURE PERMIT $ 2 00 UNDER SLAB WORK. TOTAL FEE ROUGH PLUMBING / J GAS PIPING I.e�. '7•i\.a I.HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION V AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO. COMPLY GAS VENT WITH .ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGI SY AND/OR PLUMBING FIXTURES LICENSED AS .REO BANGELES COUNTY N STATE OF Ag TEST CALIFORNIA OR HAT M HE LEGAL OWNS OF HE ABOV DESCRIBED REST ENTI UTILITY CO.NOTIFIED SI GNATU RE- OF PERMITT FINAL ®,. VALIDATION ROBERT A.WOOD, C[. M.D. CAM SUPERVISING MECHANICAL ENG'R - Leo 6 5 1 7` ; idOV 5 5 D 3.5oN WORKERS'COMPENSATION DECLARATION 20-0026 PW 4/87 APPLICATION FOR PLUMBING PERMIT I hereb (firm that 7t I ha «r -of consent to s-If i Y n- 6A667A sure, or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company i ❑ Certified copy is hereby furnished. Certified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK CITY TEL. NO. as to become subject to the Workers'Compensation Laws. DISHWASHER / , ✓ CONTRACTOR_ �/ Date- /— E t Applicant /.? �la�cL/'v�- CLOTHES WASHER I ADDRESS NOTICE TO APPLICANT: If, afier making this Certificate of Ex- emption,you should become subject to the Workers'Compen- CITY , l sation provisions of the Labor Code, you must forthwith comp- t/ TEL. NO. I with such rovisions or this permit shall be deemed revok- LAWN SPRINKLER SYSTEM y P P LICENSE NO. CLASS ed. WATER HEATER /� LICENSED CONTRACTORS DECLARATION ! , DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER C —X\ and Professions Code, and-.,my license is in full force and ef- 5 PER SYSTEM FINAL VALIDA ION } fect. DAT O License Number Lic. Class V FIN Contractor Date BY O ❑ I am exempt under Sec. /,Sv�i�v U f/ W B.&P.C. for this reason a Plan check fee z Date: PLUMBING PERMIT ISSUING FEE$ Signature Zd TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION ,,,�7 I hereby affirm that I am exempt from the Contractor's License Name G�/LL' ///!P l�z� Law for the following reason (Section 7031.5, Business and Professions Code): Address 20Z Ear e,`G ® I, as owner of the property, will do the work and theCity��,�y7 �� G'i/c 40V Tel. No. ,),S structure is not intended or offered for sale(Section 7044, Business and Professions Code). ..; CONSTRUCTION LENDING AGENCY N:vt ;q`g__- ' T I hereby affirm that there is a construction lending agency for Y. '- _• •Y the performance of the work for which this permit is issued T - P p �I�= (Sec. 3097, Civ. C.). CHAI GE 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-menroooperty for inspection purposes. 4./ A tione r-� y-e � SEE REVERSE FOR EXPLANATORY LANGUAGE Signacture of Permittee Date