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HomeMy Public PortalAbout9206 BLACKLEY ST_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer DIVISION OF BUILDING gi SAFETY WILLIAM J FOX, County Engineer DISTRICT NO. GROUP I ZONE FOR APPLICANT TO FILL IN �/79 PLUMBER RECEIVED BY READY FOR DATE 197 FIRST INSPECTION t ADDRESSBUILDING J CITY TEL NO ADDRESS COUNTY LOCALITY LICENSE NO EXPIRES NEARESTU I PERMIT FEES CROSS ST.y// / NUMBER TYPE OF FIXTURE❑R ITEM FEE OWNER MAIL /± -494 te, WATER CLOSET(TOILET) � Oso SB ADDRESS (� /, /ak�!j 1. BATH TUB (� O 50 CITY !�HO11 �11 t'.+/.r vl TEL. No An SHOWER Q 050 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS LAVATORY (WASH BASIN) 0 O 513 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES / KITCHEN SINK Q O 50 AND STATE LAWS REGULATING PLUMBING • / I CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY ❑ 50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER GAS SYSTEM OUTLETS 050 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. WATER HEATER O 50 BIGNPERMRITTEFr/���L;V[�G[/7&aZ SLOP SINK O s0 INSPECTION RECORD FLOOR SINK O 50 FLOOR DRAIN 050 2 0 DISHWASHER 050 DRINKING FOUNTAIN 0 BO URINAL Q 0.50 -I HOUSE SEWER O 50 Z MISCELLANEOUS F3 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1,00 CESSPOOL SEPTIC TANK SEPTIC TANK / DRAIN ( ) PIT ( ) 1 00 SEWER PERMIT 1 DD GAS TEST UTILITY CO.NOTIFIED TOTAL FEE Si/ ^ FINAL 76AG67 DBS#17 6-52 �✓ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT Department of County Engineer EU ® ' ME ,DIVISION OF BUILDING & SAFETY WILLIAM J FOX, County Engineer DISTRICT O. GROUP ON . FOR APPLICANT TO FILL IN PLUMBER RECEIVED BY READY FOR DATE ISSUED � � FIRST INSPECTION ADDRESS BUILDING CITY TEL Na ADDRESS COUNTY LOCALITY�„�^Q�yyl 'pA LICENSE NO EXPIRES NEAREST PERMIT FEESCROSS S 1_ NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER ''a/yJ.�`� MAIL ' D / 7-.. �.• l irCX WATER CLOSET ITOIL6T) 0 O SO $ ADDRESS BATH TUB ® O SO CITYTEL. No SHOWER a 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ O SO APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK Cts O SO j AND STATE LAWS REGULATING PLUMBING I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY O SO AND ELES COUNTY LICENSE, OR I AM THE LEGAL OWNER GAS SYSTEM OUTLETS (9 050 OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. SIGNATURE Of WATER HEATER 050 PERMITTED /! C SLOP SINK @ 0.50 INSPECTION RECORD FLOOR BINK 050 FLOOR DRAIN O 50 DISHWASHER 050 DRINKING FOUNTAIN (it 0 50 URINAL @ 0.50 -J Q HOUSE SEWER O 50 Z MISCELLANEOUB sa O APPROVALS DA'ItE INSPECTOR'S NAME ROUGH PLUMBING /Z GAS PIPING GAS VENT CESSPOOL @ 1 00 CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ) PIT ) 100 SEWER PERMIT 1 00 GAS TEST UTILITY CO NOTIFIED TOTAL FEE �(j �� FINAL 76A667 DBS#17 6-52 76AG67 17 25M SETS 7-48 APPLICATION FOR PEpJm DEPARTMENT OF BUILDING AND SAFETY COU PLUMBING�� �'�� .� COUNTY OFF LOS LOS ANGELES WM. J. FOX.CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUPI ZONE PERMIT �AINU. A ( 117L ROUGH FIXTURES COMPLETE -5 1 G d HEATER CESSPOOL I—I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED t-- l- FIRST INSPECTION ,�o L / q GAS MISCELLANEOUS mcmm APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB 4� d' NAME ADDRESS dl� W ® ADDRESS LOCALITY g j NEAREST �] c !L CITY TEL.NO: CROSS ST. COUNTY LICENSE NO. EXPIRESMC NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL — 3 ADDRES NORTH O /� `pn CITY T . o. `�, I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE-PROPERTY DESCRIBED ABOVE. XI 7 / Hhx.;•✓,NSA 3 OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK i BATH TUB FURNACE E9 Ir SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN 1I DATE t INSPECTOR'S NAME WATER HEATER DBNTALLAVATORY ROUGH PLUMBING l 1 METER..LLIAS SODA FOUNTAIN GAS PIPING I i OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOI SEPTIC TANK SEWER UTILITY CO.NOTIFIED I I TOTAL FEB LlINAL 76A667A a C6817(REV.iI/7d) L!/� l APPLICATI® ®R LIJMBIN RM IT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE( BUILDING ADDRESS .GV� NUMBER FIXTURE OR ITEM @ FEE y OCALITY WATER CLOSETNEAREST BATHTUB CROSS ST. SHOWER OWNER , LAVATORY MAIL f t ADDRESS Sf l SINK CITY TEL.NO, DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS lll'666....111C ?/I- FV SWIMMING POOL RECEPTOR / � ��/'. CITY � TEL. O. Ci LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. -S CLASS " ` GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING C6 GAS PIPING GAS VENT HOT WATER HEATER Q0 PLUMBING FIXTURES GAS TEST Plan check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDA1 Name Address ;21 0 2 b 2 A City Tel.No. ° .o o o o o 5 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES 2 - - 2200 AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS - 22,0025 REQUIRED BY LOS ANGELES COU Y AND STAT OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEN RES, T E ABOVE DESCRIBED RESIDENTIAL 0508-80 PROPERTY, SIGNATURE OF PERM ITTEE- DIjjPjKNO.I PR ESSED BY INDUSTRIAL WASTE APPROVAL 76A667A�•. CE a I i(,REV.6/778) ©5 d, APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE( BUILDING ADDRESS 9206 E• MING NUMBER FIXTURE OR ITEM @ FEE LOCALITY CITY- WATER CLOSET NEAREST y BATHTUB CROSS ST. SHOWER OWNER SRUILJAN, RAFAn LAVATORY MAIL SAME ADDRESS SINK CITY TEL.NO. DISHWASHER CONTRACTOR ITMIMHE TRAM HCC CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY S. EL �' NUE TEL.NO. 5797982 LAWN SPRINKLER SYSTEM STATE 09 LIC. WATER HEATER LICENSE NO. CLASS C-2O GAS SYSTEM OUTLETS Z 3 OO APPROVALS DATE INSPECTOR'S SIGNATURE OUTLETS OVER UNDER SLAB WORK k 5 PER SYSTEM ROUGH PLUMBING ` r y} GAS PIPING0 t phi GAS VENT u 14.E HOT.WATER HEATER PLUMBING FIXTURES ra` GAS TESTUZI Plan Check fee UTILITY CO.NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL PLAN CHECK VALIDAn Plan check applicant Name Address 0 00 ne// City Tel.No. I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE g U 7 2 8 A THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION O O O O O I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS ' REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE O U 0 /1 O 0 LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DES RIBED RESIDENTIAL G lL PROPERTY. SIGNATURE C� ! ' C) OF PERMITTEE O 604-79 DISTRICT�NO. ROCESSED BY INDUSTRIAL WASTE APPROVAL "weer,w g•ag T I APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J FOX, CHIEF ENGINEER PLUMBING 1 S FOR APPLICANT TO FILL IN DISTRICTNO GROUP UP 11N[� P�MIT NO 5 - 11 161 PLUMBER Q 0aj& READY FOR DATE ISSUED [� f FIRST INSPECTION ADDRESS � .a /t" BUILDING CITY TEL g2lADDRESS COUNTY / + ' LOCALITY LICENSE NO EXPIRES ;21 LCZ NEAREST PERMIT FEES CROSS ST NUMBER I TYPE OF FIXTURE OR ITEM FEE y� OWNER I WATER CLOSET (TOILET) Q O 501 $ I �jy MAIL' ADDRESS kBATH TUB Q O Bol-I CITY TEL NO ISHOWER Q O 501 I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) Q O 50 I I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING KITCHEN SINK Q O 50 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q O 50 I ANGELES COUNTY LI S OR1'A' THE LEGAL OWNER OF THE RESIDENTIA P O E TY ES IBED ABOVE GAS SYSTEM OUTLETS Q O 50 SIGNATURE OF I WATER HEATER Q O 50 IPERMITTE . SLOP SINK Q o Sol INSPECTION RECORD FLOOR SINK Q O 50 J FLOOR DRAIN Q O SOI DISHWASHER Q O 50I DRINKING FOUNTAIN Q O Sol Y/d�lZ7 URINAL a O SOI D' clr T J I HOUSE SEWER Q O 501 I Q �,�,� Z MISCELLANEOUS I I� APPROVALS DATE INSPECTORS NAME ROUGH PLUMBING -- �v GAS PIPING GAS VENT CESSPOOL Q I DOICESSPOOL SEPTIC TANK I�- SEPTIC TANK DRAIN ( ) PIT ( Q I 00 I SEWER PERMIT I I 00 GAS TEST TOTAL FEF UTILITY CO NOTIFIED �'{•� FINAL '76A661' 17 1;150'-B APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY L e ,. COUNTY OF LOS ANGELES WILLIAM J FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO In I/p r /I� d et� e131 PLUMBER _ y' �g RECEIVED BY READY FOR DATE ISSUED_ f���-)� FIRST INSPECTION ADDRESS /0 f /B / ^ / BUILDING ADDRESS CITY �f s�U). ,/ TEL NO (d•,_ COUNTY �T LOCALITY,-I-.— LICENSE NO EXPIRES PERMIT FEES NEAREST �' QUI ���-t 'I-A NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER moi- i�✓!f ADDRESS ,� �vw O1 WATER CLOSET (TOILET) @ O 50 $ I _ e BATH TUB Q O 50 I I CITY D NY �/ 0 1 '( I TEL NO SHOWER @ O 501 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND LAVATORY (WASH BASIN) Q-OSO AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK Q O 50 STATE LAWS REGULATING PLUMBING LAUNDRY TUB OR TRAY Q O SO 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS ANGELES COUNTY LICENSE OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE GAS SYSTEM OUTLETS Cel 0 Sol p /� SIGNATURE OF WATER HEATER Q O 501 `T/ PERMITTE ��N SLOP SINK @ 0 501 INSPECTION RECORD FLOOR SINK Cud O Sol \ FLOOR DRAIN Q O Sol \ DISHWASHER Q O 501 DRINKING FOUNTAIN Q O Sol URINAL @ O 5011 J HOUSE SEWER Q O 50 1 I \` Z MISCELLANEOUS I� o 1� I� APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT O /U' �� 4 CESSPOOL @ 1 00I CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ( ) PIT ( Q 1 00 SEWER PERMIT I 1 00 GAS TEST UTILITY CO NOTIFIED TOTAL FEE Is 1�c FINAL 76A667 17+11.417- - APPLICATION FOR PERMIT .,DEPARTMENT OF BUILDING •AND SAFETY ��� ' COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER t FOR APPLICANT TO FILL IN DISTRIC GROUP I ZO E pERMIT 0 0- BURKE-HOWARD ADY FOR PLUMBER REC.Et ED BY DATE ISSUED 2436 N. ROSEMEAD BLV®: �w FIRST.INSPECTION, ADDRESS •/I'iF'�.'/'"�'„9 L7.4/ _ _ BUILDING �. .CITY TEL. No.�® �//p' ADDRESS COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) @ 0.5131$ ADDRESS BATH TUB @ 0.50 CITY TEL. No. SHOWER @ 0.50 1 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 13,513 I APPLICATION AND STATE THAT THE ABOYE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN'-SINK @ 13.50 I I AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT i POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, ❑R I A �TE OWNER OF THE RESIDENTIAL PROPERTY DE E. GAS SYSTEM OUTLETS @ 0.50 SIGNATURE OF '.� ' —WATER—HEATER @ 13.50l I PERMITTEE SLOP SINK @ 0.50 I I INSPECTION RECORD FLOOR SINK -@ 13.50 FLOOR .DRAIN @ 0.50.1. DISHWASHER @ 0.50 (DRINKING FOUNTAIN @ O.SO I) URINAL @ 0.50 Q HOUSE SEWER @ 0.501 I Z MISCELLANEOUS I 1,7 I� O I • APPROVALS DATE INSPECTOR'S NAME " I ROUGH PLUMBING GAS PIPING -• I I_ GAS VENT CESSPOOL @ 1.00 CESSPOOL ISEPTIC TANK: SEPTIC TANK DRAIN ) PIT ( ) @ 1.00 I I - SEWER PERMIT I 1.00 GAS TEST ' UTILITY CO.NOTIFIED TOTAL FEE $ 2 FINAL. �q WORKER,1:.;COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 1 hereby affirm that P have a Fertificate of consent to self 76A667A in;;ure, 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 Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS 9206 E. Blackley tion department. NUMBER FIXTURE OR ITEM n FEE LOCALITY Date Applicant 1 WATER CLOSET NEAREST Temple Cit CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Blackley and Encinita Ave COMPENSATION INSURANCE 1 SHOWER OWNERROya and Charles F. COLLETT (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($loo)or less.) ] LAVATORY ADDRESS Same as above I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. 2858425 sons to become subject to the Work rs Compensation Laws. DISHWASHER 7/12/83 CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after maki this Certificate of ADDRESS Exemption, you should become sub ct to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PRO SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL7 — e�7_ VALIDATION ,Z License Number Lic. Class P9 FIN Contractor Date BY I am exempt under Sec. � B.BP.C. for this reason Plan check fee 000 Date: PLUMBING PERMIT ISSUING FEE$ I Signature TOTAL FEE SQ Plan check applicant -7 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o c c c I hereby affirm that I am exempt from the Contractor's License Address ' Law for the following reason (Section 7031.5, Business and r Professions Code): City Tel. No. 2 i!, : 0 ❑ 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). ® (� ? 1 2-8 J 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 &-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Z, 7/12/83 Signatu Fof Fermi ee Date WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I�rtereb�r affirm that I have a certificate of consent to self insure, or a,4e�eific6be of Worker's Compensation Insurance, or a certified copy%preof(Sec.3800 Lab. C.) • �Z , � j��_ COUNTY OF LOS ANGELES DEPT.OF'PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company Certified copy is hereby furnished. BUILDING / FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building inspection///� @department. � ��e//y�AG�� NUMBER FIXTURE OR ITEM FEE LOCALITY Date LA/72Z Applicant ,V WATER CLOSET G' NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB / CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) / OWNER I certify that in the performance of the work for which this permit LAVATORY 1 76-V is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITY TEL.NO. Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR �I�'JtiCl�Gl�.S Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR pnbvisions of the Labor Code, you must forthwith comply with such ADDRESS (provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM _ �► LICENSED CONTRACTORS DECLARATION CITY �� ✓��// TEL.NO. WATER HEATER I hereby affirm that I am licensed under provisions of Chapter 9 � (commencing with Section 7000) of Division 3 of the Business and STATE LIC. Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. � CLASS /1 �^C�+�� OUTLETS OVER DISTRICT NO. PROCESSED BY Ig License Number 7�J Gid Lic.Class ,� 5 PER SYSTEM a /AAt�j �/� FINAL VALIDATION //%�[�JA � �J /✓�/ DATE /] Contractor � Date I am exempt under Sec. FINAL �Q O D BY B.&P.C.for this reason Plan check fee , J f, Signature Date: PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE �� p r SINGLE FAMILY Plan check applicant 4 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law _`_i foo the following reason (Section 7031.5, Business and Professions t - i _j ,_n_ ❑ City Tel. No. y_r_._r; I,as owner of the property,will do the work and the structure sI •s is not intended or offered for sale (Section 7044, Business and Professions Code). , T_. 3 00jt CONSTRUCTION LENDING AGENCY .fC s`, fti=�•=� I hereby affirm that there is a construction lending agency for the r• performance of the work for which this permit is issued (Sec. 3097, CH 1IGE 100 Civ.C.) i Lender's Name �':' C}I'17 '� I-�t i —a ij :60 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 inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 20026 WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT` m d hereby, offir 'that I have a certificate of consent to self in- 76gPW 4/87 667A wire,or a�ertificofe of Workers'Compensation Insurance,or a CE 817(REV. 8/86) ce0ified copy th'e'reof (Sec. 3800, Lab.•C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy NoZy39'%f Company St0_1 e, Fc�nO Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS �a department. NUMBER FIXTURE OR ITEM @ FEE ^� y (( pny/�1 r n LOCALITY Date /'�u –�� Applicant M43I},,'�e-Yece /�S WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' �– BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER ChvG� C�//x-10 (This section need not be completed_if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY ern TEL. NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Lows. DISHWASHER /_ OJ CONTRACTOR 74* Date Applicant CLOTHES•WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'.Compen- CITYST sation provisions of the Labor Code, you must forthwith comp- . LAWN SPRINKLER SYSTEM ]Wwith such provisions or this permit shall be deemed revok- STATE G� LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL fect. VALIDATION ATE License Number /�✓ / Lic. Class D0 FINAL �- V Contractors// W ,1��SDate 7 F4;/ BY O El I am exempt under Sec. U LU B:BP.C. for this reason Plan check fee � Date: PLUMBING PERMIT ISSUING FEE$ t Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check appliccirit I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and 1'IN—' Professions Code): Address ' ;iy1•I °� 0 I, as owner of the property, will-do the work and the City Tel. No. structure is not intended or offered for sale Section 7044, f 4"'rl'_ ( X t fit•: Busiriess and Professions Code). ► ;i`•= - – 50 CONSTRUCTION LENDING AGENCY CHECK I hereby affirm that there is a construction lending agency for ::HECK - the performance of the work for which this permit is issued %) itt}vR' ° Ii (Sec. 3097, Civ. C.). L. Lender's NameI'ILfti'•{`+ Lender's Address f7I AM 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 aboy -mentioned property for inspection,purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perm' a Date / COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9811090002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 11492 9206 BLACKLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803136 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: ENCINITA 8590-009-002 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: A LOCALITY: TEMPLE CITY 13 DISHWASHER(S) 1.00 FIX 16.20 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES N: TOTAL FEES 60.15 11/09/98 UT 11/0 9 OWNER: TEL. NO: FINAL DATE FINAL BY CODE: URIBE;RICARDO;BERYL (626) 796-7337- _2� 9206 BLACKLEY ST TEMP 917803136 DESCRIPTION OF WOR PLUMBING FOR KITCHEN REMODEL APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE i SAME AS OWNER LIC. NO ��/� y' �' ���� A UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: I ROUGH PLUMBING LIC. N0: GAS PIPING I . GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED \� = CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508