HomeMy Public PortalAbout10776 BLACKLEY ST_Plumbing__ 70A667A (CE 8178) -4/77
( APPLICATION FOR PLUMBING PERMIT
J
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ^u!`_
NUMBER FIXTURE OR ITEM CSD FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNER
LAVATORY MAIL
ADDRESS
SINK CITY TEL NO
DISHWASHER CONTRACTO
CLOTHES WASHER
ADDRESS
SWIMMING POOL RECEPTOR 3
CITY EL NO
LAWN SPRINKLER SYSTEM
STATELIC
WATER HEATER LICENSE NO 0CLASS
GAS SY TLETS DISTRICT NO o G U Z NE OCES D BY
✓ , D a O
OU R TS EMR INDUSTRIAL V
WASTE APPROVAL
INSPECTION RECORD CD
w
r a
CID
G�� s
Plan check fee
PLUMBING PERMIT ISSUING FEE$ v
TOTAL FEE
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel No. GAS PIPING p1
I HEREBY ACKNOW GE TH I HAVE READ THIS APPLICATION AND STATE GAS VENT
THAT THE ABOVE IS Cop
O ECT AND AGR E TO MPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS RE EATING PLUMB G HOT WATER HEATER
I HEREBY ERT IFY
THAT I PR Y REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY S GEL NTY A ATE OF CALIFORNIA OR THAT I AM THE GAS TEST - _
LEGAL OWNE OF AND ND TO RE E THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY UTILITY CO NOTIFIED
n
SIGNAT
OF P • FINAL .1-4(-7q
PLAN CHECK VALIDA<TIONyiL d`I M oL� CASH PERMIT VALIDATION CK. M 0. CASH
4 9 AUG 5 u 1 6.0 0 ,616
LICY NUMBER
7GA867-C V817 9/03 �/r/ /�� r �'T'�•
APPLICATION . FOR ' PLUM TING - PERMIT
COUNTY OF LOS-ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FNEAREST
G �j�/ e[/f /�
JOHN A. LAMBIE, COUNTY ENGINEER / (P /[/`//�
WILLIAM A. JENSEN, SUPT OF BUILDING Y ^ er
71,
FOR APPLICANT TO FILL IN T. Ad
G U LL p C7V
NUMBER FIXTURE OR ITEM EACH FEE OWNER,.
WATER CLOSET $1.2S
BATH TUB 1.25 ADDRESS -j0 Ml
SHOWER 1.25 CITY TEL. NO. ,y &'
LAVATORY. 1.25 CONTRACTO
SINK 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
CONTRACTOR'S STATE
LAUNDRY TUB 1.25 J 2S 'REGISTRATION NO. COUNTY �❑
CLOTHES WASHER 1.25DISTRICT NO. GROUP ZONE ROCESSED Y
WATER HEATER 1.50 s, Q
1.50 INDUSTRIAL CL
GAS SYSTEM OUTLETS a
WASTE APPROVAL O
OUTLETS OVER 5 PER SYSTEM .30 V
INSPECTION RECORD
w
O
H
U
W
a
' h
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE LZ GAS PIPING
I HEREBY ACKNOWLCDGE THAT I HAVE READ THIS APPLICATION
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.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY-CO. NOTIFIED
SIGNATURE
OF PERMITTEE FINAL p,--
LIDATION ROBERT A. WOOD
CK M o CASH SUPERVISING MECHANICAL EiIG'R
L`Lo709224 5 D 3.25- 13
COUNTY OF LOS ANGELES TEMPLE CITY #, 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0908180012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: I FEES PAID 1 BUILDING ADDRESS:
ITR- 13613 LT: 56 I I 10776 BLACKLEY ST I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803501 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: PARMERTON 1
18573-006-010 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, CI
1 107 BATHTUBS/SHOWERS 3.00 FIX 48.60 I I
(TENANT: I11 CLOTHESWASHER(S) 1.00 FIX 16.20 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1
I 125 LAVATORIES/SINKS 2.00 FIX 32.40 108/18/09 SR 08/16/10 1
I 145 WATER CLOSET/URINAL 2.00 FIX 32.40 1 I
(OWNER: TEL. NO: 147 WATER HEATER(S) 1.00 WTH 16.20 (FINAL DATE FINAL BY: CODE: 1
IROSENBLUM MARK I;LUPE M (626) 453-8890- 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 I���__ f� �^e
110776 BLACKLEY ST I TOTAL FEES 189.75 1 l y
(TEMP 917803501 1 IDESCRIEfTION OF WORK I
I (PLUMBING FOR NEW BATHROOMS 1
I
1APPLICANT: TEL. NO: I I I
IROSEMBLUM (626) 453-8890- I I
110776 BLAKCLEY ST. I (SPECIAL CONDITIONS: 1
ITEMPLE CITY CA 91780 I
1 1 I I
1CONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE I
ICAMINO REAL BUILDERS (626) 447-0715- 1 I
12671 FAIRGREEN AVENUE LIC. NO I 1UNDER SLAB WORK I I
1ARCADIA, CA 91006 240278 B I I I
(WATER SERVICE I I I
(PLASTIC YIN METAL YIN 1 I I
(ARCHITECT OR ENGINEER: - TEL. NO: 1 I I I I
- I IROUGH PLUMBING I I I
I LIC. NO 1 I I I I
1 1 IGAS PIPING
I I I I
IGAS VENT I I
I I I I
IHOT WATER HEATERIot
I I
IPLUMBING FIXTURES 1 I
I I I I
I ILAWN SPRINKLERS I
1 IGAS TEST I I
I 1UTILITY COMPANY NOTIFIEDI I I
1 ICWV I I I
1GRAY,WATER SYSTEM I I I
11 0 1 A
I z-
j j I I II
I I I I I I
I I I I I I
I I I I I I
I (REPORT ID: DPR263 ROUTE TO: BS0508 1 1
I I I I I I