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Home My Public Portal About9445 BLACKLEY ST_Plumbing__ 76A667-CE81712/59 TEMPLE CITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY TY 71ENGINEER BBUILDING JOHNIAGLAAMB E COUNTY tN6 NEEER� ADDRESS y.1 , ,�/Q 6.��G CJG WILLIAM A JENSEN SUPT OF BUILDING Of LOCALITY `, /d FOR APPLICANT TO FILL IN NEAREST ROS Ssr p ve r/ NUMBER FIXTURE OR ITEM owNER �j �,,e j WATER CLOSET VAIL ADDRESS G-elle BATH TUB SHOWER CITY Gs�w /t2 C.� TEL NO LAVATORY CONTRACTOR SINS ADDRESS 02.2/iC yVi /d��rrsM C/E DISHWASHER CITY � 4A.M 8,o-A. TEL NO. LAUNDRY TUB R OSSTATE GISTRAT ONNO. /�G—4 ® COUNTY ❑ CLOTHES WASHER DISTRICT NO GROUP ZONE PROCESSED BY WATER HEATER �O —h '�r GAS SYSTEM INDUSTRIAL WASTE APPROVAL 6Q o,bei„Q 6 INSPECTION RECORD P. O - U aG O F U W a rn z 51 00 PER ITEM OR FIXTURE $ �'� p APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2 oo UNDER SLAB WORK TOTAL FEEOROUGH PLUMBING D GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY L COUNTY ORDINANCES AND STATE LAWS REGULATINGHOT WATER HEATER Y CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFGAS TEST A OR THAT I AM THE LEGAL OWNER OF THE ABOVE RESIDENTI PROPERTY UTILITY CO NOTIFIED, RE / AITTE FINAL �6j 1 Zy OF /VALIDATION ROBERT A WOOD, CK. M 0 �GeaH SUPERVISING MECHANICAL ENG'R 11 22 8 7 FEB 3 .0 r:' . ® meq/ (/�_® pg��p ��/�p� ,qp�y p/�►� 76A667 l 'APPLICATION FOR PLUMBING PERMIT DBS 171DIVISIONcOF BUILDING AND SAFETY 10epostment of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN,SUP T OF BUILDING /7LOCALITY FOR APPLICANT TO FILL IN OWNER NEARESTCROSSST 7 / U v�. Ck.L OWNER CS MAILDISTRICCTT NO GROUP ZONE READY FOR INSPECTION ADDRESS -J r INDUSTRIAL CITY TEL NO WASTE APPROVAL PLUMBER S/,� 4-: CA&pl jq?!, -' INSPECTION RECORD ADDRESS .3 CITY /tyQ.(,i ii TEL NO LICENSE NOZ,3,3 T.� 3 A NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1 00 $ BATH TUB @ $1 00 SHOWER @ $1 00 LAVATORY (WASH BASIN) @ $1 00 KITCHEN SINK @ $1 00 DISHWASHER @ S100 LAUNDRY TUB OR TRAY @ $100 CLOTHES WASHER @ $100 WATER HEATER @ $1 00 GAS SYSTEM @ $1 00 APPROVALS DATE INSPECTOR S SIGNATURE I UNDER SLAB WORK ROUGH PLUMBING PERMIT $ 1 00 .- GAS PIPING TOTAL FEE ) GAS VENT I HEREBY ACKNOWLEDGE THAT 1HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST 11 tl LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER THE ABOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIA P PERTY SIGNATURE - OF PERMITTEE FINAL kdi JOHN A LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A WOOD. CHIEF PLBG INSPECTOR CK m O CASH ��i{�o 8 3 2 6 C41,Y 2 0 3 7.0 0 �' J WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent•to self 20 0026 DPW 6/87 insure or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec 3800, Lab C )�A COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy N�-c::.' Ib'c ' an N H e1bf rn 7,Zd j02 ❑ 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 g'-lj---2f WATER CLOSET Date -Appligant NEAREST CERTIFICATE OF EXEMPTION FRO WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER / OWNER (This section need not be completed If the work Involved by MAIL 9�(i the permit is for one hundred dollars ($100)or less) LAVATORYADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER _ CONTRACTOR Date' Applicant CLOTHES WASHER ADDRESS 7 7 NOTICE TO APPLICANT If, after making this Certificate of 4 f� �� ✓ Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITYTEL NO /)� a Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM GoS �~ �t with comply with such provisions or this permit shall be STATE e��i G LIC deemed revoked I WATER HEATER LICENSE NO O O p CLASS G' 6 LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS t Q G (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER O and Professions Code,,nand my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION O License Number ST11i Lic Class G'7� DATE _ 0 FINAL X Contractor-"&/��Ur.d.,.� Date IT- 11 - 1/ BY ❑ I am exempt under Sec y� U B 8P C for this reason 400 6-0 W a., �`/fr �� Plan check fee U) vDate � PLUMBING PERMIT ISSUING FEE$ / 6'O Signature a / TOTAL FEE Z7 2 Plan check applicant _ SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License d=) n'e Low for the following reason (Section 7031 5, Business and Address Professions Code) City Tel No ❑ 1, as owner of the property, will do the work and the _ I CEM: structure is not intended or offered for sale (Section 7044, Business and Professions Code) 01 AL 73 = 00 CONSTRUCTION LENDING AGENCY _ / { '��.� f J n!.0 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued + HONE (Sec 3097, Civ C ) Lender's NameI_ICIf 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 Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT �, ' DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0202190015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID:- FEES PAID BUILDING : ON FILE 9445 BLACKLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803141 _ SS NEAREST CROSS STREET: ALESSANDRO 8590-003-001 X01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE 596 GRID: J4 LOCALITY: TEMPLE CITY, C 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43.95 ISSUED 0 LAEXPIRES ON- 02/19/02 VG 08/18/02 OWNER- TEL. 0: I NAL DATE FINAL BY: CODE WANG, YOLIMEEI (626) 286-6375- 9445 BLACKLEY ST !I TEMP 917803141 SWORK WATER HEATER CHANGE OUT APPLICANT: i ACTION CONTRACTORS (310) 515-1311- SP C AL CONDITIONS: CONTRACTOR: TEL. NO. i APPROVALS DATE INSPECTOR SIGNATURE ACTION CONTRACTORS (310) 515-1311- 17111 S BROADWAY ', LIC. NO I F '. - UNDER SL GARDENA CA 90248 B/L 27953 * j - � � WATER SERVICE PLASTIC Y/N METAL Y/N TwEffrT-nTR: TEL. NO: r_ - � � -i ROUGH PLUMBING LIC. NO I --- - - GAS PIPING " GAS VENT W07WATER HEATER PLUMBING FIXTUWEF- LAWN SPRINKLERS UW TEST _ UTILITY COMPANYNOT FI CWV - GRAY WATER SYSTEM * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: SS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1108160006 BUILDING AND SAFETY j LANE• DZVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID FEES PAID BUILDING ADDRESS I ON FILE 1 9445 BLACKLEY ST I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803141 I (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET CLOVERLY 1 18590-003-001 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl 1 107 BATHTUBS/SHOWERS 1 00 FIX 16 30 1 ITENANT 125 LAVATORIES/SINKS 1 00 FIX 16 30 11SSUED ON PROCESSED BY PLAN BY 1 145 WATER CLOSET/URINAL 1 00 FIX 16 30 108/16/11 SR 1 I TOTAL FEES 76 70 1 10WNER TEL NO I IFINAL DATE FINAL BY CODE 1 1QIN, ZI-RAN (626) 466-5695- 1 1 1 Z 19445 BLACKLEY ST -�/� Q��/ 1 (TEMP 917803141 IDESCRIPTION OF WORK 1 IPLUMBING FOR A NEW BATHROOM 1 (APPLICANT TEL NO I 1 I SAME AS OWNER SPECIAL CONDITIONS I I I I I ICONTRACTOR TEL NO 1APPROVALS DATE INSPECTOR SIGNATURE 1 SAME AS OWNER - I I LIC NO 1UNDER SLAB WORK I 1 I (WATER SERVICE I 1 I IPLPSTIC Y/N METAL Y/N I (ARCHITECT OR ENGINEER TEL NO 1 I I IARTECH BUILDING PLUS (626) 264-1638- 1 IROUGH PLUMBING 112121 EAST VALLEY BLVD LIC NO 1 I 1EL MONTE, CA 91732 NONE GAS PIPING IGAS VENT I IHOT WATER HEATER I (PLUMBING FIXTURES 1 1 (LAWN SPRINKLERS 1 1 IGAS TEST I 1 (UTILITY COMPANY NOTIFIED( I ICWV I GRAY WATER SYSTEM 1 I I I I I I I I I I I I I I I I I I I I I I I I 1 1REPORT ID DPR263 ROUTE TO BS0508 I 1 1 I I i I I I r