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HomeMy Public PortalAbout9342 BLACKLEY ST_Plumbing__ 76 A 667 - CE 617 7-69 CITY OF TEMPLE CITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDIIll Blackley JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple Cit FOR APPLICANT TO FILL IN (PRINT OR TYPE) INEAREST CROSS ST. Freer NUMBER FIXTURE OR ITEM EACH FEE . OWNER Edgar Cook WATER CLOSET � 1.50 ADDRES 11.2 BlackleyMAIL SHOWER 1.50 CITY Temple City TEL. NO. 787-4855 LAVATORY 1.50 CONTRACTOR Pacific Installers SINK 1.50 • ADDRESS 10920 E. Grand Ave. DISHWASHER 1.50 CITY Temple City TEL. NO. 2-7070 CLOTHES WASHER 1.50 SATELIC LICENSE NO. 211898 - CLASS C--20 SWIMMING POOL RECEPTOR 1.50 DI T ICT G$OI�P ZONE_ P O S D BY LAWN SPRINKLER SYSTEM 2.0004-� fir'�,7; "yJ _ /E l WATER HEATER 1.50 1.50 INDUSTRIAL 0 WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RE RD2, 7 •30 OUTLETS OVER rr�` O 5 PER SYSTEM Q /�y d A•�• NJ H Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE 3.50 APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City. Tel. No. HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN.THE ABOVE D CRII111FD RESIDENTIAL PROPERTY. FINAL SIGNATURE Z / JACK R. ALLEN, SU PERVI. IN HANICAL ENG'R. OF PERMITTEE PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH � 4 2 7 7s~ hi 76A667-CE817-11-57 R I B APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER W "= BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS is -'� CASSATT D. GRIFFIN, Supt of Building - /f 7APPLICANT LOCALITY ��FTO FILL IN NEAREST NUMBERIXTURE OR ITEM CROSS ST. SETOWNERMAIL ADDRESS SHOWER CITY TEL. NO. LAVATORY CONTRACTORO:dTA 1'-;A PLUMBING CON11T2ACT Sig ADDRESS 13329 E. Ec'or Street DISHWASHER CITY City Of Indl,sfr , LEyifo• LAUNDRY TUB CONTRACTOR'S u96496 STATE ❑ REGISTRATION NO.#96496 COUNTY ❑ a' CLOTHES WASHER GROUP ZONE READY FOR INSPECTION DISTRICT O: / WATER HEATER r- / GAS SYSTEM INDUSTRIAL _WASTE APPROVAL INSPECTION RECORD I stip(/ / ,''t!✓�' . a _ {' U � elf APPROVALS x @ $1.00 PER.ITEM DATE INSPECTOR'S SIGNATURE OR FIXTURE $ S� t UNDER SLAB WORK PERMIT $ 00 ROUGH PLUMBING s_. TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT t-- •--'' ~� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY n. HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES ,� ..- 6� I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF t CALIFORNIA ORTHk 1 AM THE LEGAL OWN OF THE ABOVE - UTILITY CO. NOTIFIED Fj� j w• �t DESCRIBED RESIDE gL PF(!��PERTY SIGNATURE OF PERMITTE FINAL �j 'r Gel`s✓ �.z:..�•,�_ .r.,, .. ROBERT A.WOOD. OF ALIDATION SUPERVISING MECHANICAL ENG'R VK M.0. CASH ��_ t j&.2 3 1 7 5q FEB 5 A 1 2.0 0 WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I hove 6 certificate of ^nsent to self 20-0026 DPW 6/87 ipsure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 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 © 1 WATER CLOSET 9 Date Applicant '� NEAREST l j CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. (�L COMPENSATION INSURANCE SHOWEROWNER (This section need not be completed if the work involved by MAIL ! the permit is for one hundred dollars ($100)or less.) LAVATORY -7 5Q ADDRESS5 AM[� I certify that in the performance of the work for which this �g permit is issued, I shall not employ any person in any manner SINK CIT TEL.TEL: NO.2 —J7Z J so as to become subject to the Workers'Compensation Laws. DISHWASHER C InQ / [J CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. MCLASS LICENSED CONTRACTORS DECLARATION DI RICT NO ROCESS Y I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALF V LIDAT1'0 N DATE �a Z License Number Lic. Class f J FiiVA� � Contractor Date BY ❑ I am exempt under Sec. B.BP.C. for this reason 4r— �1 Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant c ' HOME OWNER-BUILDER DECLARATION Name r i'T A I hereby affirm that I am exempt from the Contractor's License A , 1.7 Law for the following reason (Section 7031.5, Business and Address 3307 58.011 Professions Code): City Tel. No. 1 ITEMS3 ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section TOTAL 58 . 01D 7044, Business and Professions Code). ® 5-3.00 CONSTRUCTION LENDING AGENCY CHECK I hereby affirm that there is a construction lending agency for (,;HANGS ,[ti i the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). 13000-1013.1 6r 8/90 Lender's Name Lender's Address 1070 1 AM 7:14 1 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 re resentatives of t is County to enter upon the above- one pro rt inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ign ure of Permute �j Date