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Home My Public Portal About9465 BLACKLEY ST_Plumbing__ 6A.Bu7-CE817-8-58 � y APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONBUILDING JOHN A. LAMBIE, County Engineer ADDRESS 94665 B1 ark1 ey Sty CASSATT D. GRIFFIN,Sup't of Building LOCALITY Temple City FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER Robert Vanderha _en WATER CLOSET MAIL BATH TUB ADDRESS 6 Blackley St . CITY Temple CitV TEL. NO. t'T 66757 SHOWER LAVATORY CONTRACTOR Owner SINK ADDRESS Same DISHWASHER CITY TEL. NO. CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. j,:jrPe Z PR,01qESSED BY WATER HEATER •S^ 2 GAS SYSTEM INDUSTRIAL WASTE APPROVAL 1 INSPECTION RECORD APPROVALS @ 1.00 OR FIXTURE M $ I 1.00 DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 2100 ROUGH PLUMBING TOTAL FEE 1 3 0 GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LO ANGELES COUNTY }IND STATE OF CALIFORNIA OR THAT M E LEGAL O NERIpF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESI '�1-� P ROPY. , / SIGNATURE P andeerrhhagp�en FINAL OF PERMITTEE G ROBERT A.WOOD. ®F VALIDATION .SUPERVISING MECHANICAL ENG'R CK. M.0. CASH 3 - 4.� r7cES17 12/59 TEMPLE C11TY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND .F gTY IVISION BUILDING [� JOHN A LAMBIE, CouNTY NGINEER ADDRESS WILLIAM A JENSEN SUIT OF BUILDING / LOCALITY FOR APPLICANT TO FILL IN NEAREST CAOSS ST NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER �� CITY77n TEL NO. LAVATORY CONTRACTOR SINS ADDRESS DISHWASHER CITY O. CONTRACTOR'S STATE ❑ LAUNDRY TUB REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO GROUP ZONPBQCESSED BY WATER HEATER �F� . GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD P.a 0 F U W P. m z 0 $1 00 PER ITEM I I OR FIXTURE $ APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ I 2100 UNDER SLAB WORK {II TOTAL FEE - ROUGH PLUMBING / GAS PIPING /QIze.kn,, I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 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 Q t"ie rT�FaJC p CALIFORNIA OR THAT 1 AM THE LEGA OWNER OF THE ABOVE DESCRIBED RESIDENTIAL P OPERi UTILITY CO NOTIFIED 1 i7 SIGNATURE OF PERMITTE FINAL ®rVykLIDATION ROBERT A WOOD, CK N 0. CASH SUPERVISING MECHANICAL ENG R r,10 7 OCT ' r- :5 G .C1 i 76,m67- 17 3-59 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING f TORN A. LAMBIE, County En neer ADDRESS J CASSATT D. GRIFFIN, Sup t of Bmldmg LOCALITY FOR APPLICANT TO FILL IN NEARS TT. NUMBER FIXTURE OR ITEM CROSOWNER LiG.t�t. WATER CLOSET MAIL / BATH TADDRESS UB SHOWER CITY r TEL. NO. LAVATORY CONTRACTOR SINS ADDRESS DISHWASHER , CITY TEL NO. CONTRACTOR'S STATE El El LAUNDRY TUB REGISTRATION NO. COUNTY CLOTHES WASHER h// DISTRICTNO GROUP I ZONE CESSEDBY WATER HEATER GAS SYSTEM INDUSTRIAL ' WASTE APPROVAL INSPECTION RECO �9•'^r7�rT'J--ttL � 7 � ��f' 0 $1 00 PER ITEM I �/ OR FIXTURE $ APPROVALS DATE INSPECTOR S SIGNATURE PERMIT $ 2100 UNDER SLAB WORK / TOTAL FEE ROUGH PLUMBING 14114116r. GAS PIPING � V 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS A LIGATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF HE ABOVE /- DESCRIBED RESIDENTIAL PPPPERT UTILITY CO NOTIFIED 1A SIGNATURE Q` 'n6 OF PERMITTEE- FINALI OF VALIDATION ROBERT A/W&OD, c�c to o CASH SUPERVISING MECHANICAL ENG'It UlCo 0 1 2 9 VAY 2 5 A 7.0 0 `� ,78A 887-L'E4817 10-62` APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE. COUNTY ENGINEER ADDRESS 9 s WILLIAM A JENSEN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST ��O CROSS ST NUMBER FIXTURE OR ITEM EACH FEE OWNER„�6bert CI.LIC'tte / WATER CLOSET $l 25 -LS MAIL BATH TUB 125 ADDRESS (O� SHOWER 1 25 I Z-5 CITY�(� TEL NO ?S 7 z LAVATORY 1 25 Z �v CONTRACTOR SINS 125 ADDRESS DISHWASHER 125 CITY TEL NO LAUNDRY fUB 125 CONTRACTOR'S STATE [:1 REGISTRATION NO COUNTY ❑ CLOTHES WASHER 1 25 DISTRICT NO GROUP I ZONE PROCESSED BY WATER HEATER 1 50 �. 6-g IA GbLQV GAS SYSTEM \ OUTLETS 150 s p INDUSTRIAL per, WASTE APPROVAL 0 --l-fOUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD fJ OG 0 r v W d N z APPROVALS ATE INSPECTOR S 5 G T PERMIT $ 2 00 UNDER SLAB WORK 17 9 ROUGH PLUMBING - TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING 0 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED R SIDENTIAL PROPS Y UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE ` FINAL VVeN ALIDATION ROBERT A WOOD- ry iy cK M o CASH SUPERVISING MECHANICAL ENG R 01606 0 1 7 ti, .+U 1 1 1 5 D 8.5 0 r 76A6 DBS 17 10 55APPLICATION ®LI ATION F®R ®. LIMBING PERMIT IT 1 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING ! , JOHN A LAMBIE, COUNTY ENGINEER ADDRESS CASSATT D GRIFFIN,SUP T OF BUILDING C LOCALITY e. i FOR APPLICANT TO FILL IN NEAREST CROSS ST 4-4 OWNER �V{J r DISTRICT NO GROUP I ZONE INiaADY FOR INSPECTION MAIL9 / ADDRESS / '{a [� CITY INDUSTRIAL TEL NO WASTE APPROVAL PLUMBER ? ..y INSPECTION RECORD ADDRESS �j �LG " �.SCA�(wS, CITY hircl. TEL NO l i O LICENSE NO� NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ slog BATH TUB @ $100 t7 +�.�c� �- _ v SHOWER @ $100 LAVATORY (WASHBASIN) @ $100 KITCHEN SINK @ $1 00 DISHWASHER @ $100 Z�%�IsCc1C LAUNDRY TUB OR TRAY @ $100 9 A60 6NA I- 6L8 Fa R A&II)/r CLOTHES WASHER @ $100 J-m /r S� d- Q O !7 WATER HEATER @ $100 -A > C GAS SYSTEM @ $100 APPROVALS DATE INSPECT S- G'FIATURE UNDER SLAB WORK `ZI PERMIT $ 1 00 ROUGH PLUMBING /d f _ i GAS PIPING TOTAL FEE L GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE 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 PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST FI -4 '`LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE L OWNER OF THE BOVE UTILITY CO NOTIFIED DESCRIBED RESIDENTIAL PROP RTY / SIGNATURE OF PERM ITT e FINAL JOHN'A LAMBIE, COUNTY ENGINEER - VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR CASH LAZO 5 4 4 91 DEC31 3 8.0,0 r ',6'VORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I*hereby, affirm that I have a certificate of consent to self in 76A6667A PW 4/90 sure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No Company 11 Certified copy is hereby furnished BUILDING F-] Certified APPLICANT TO FILL IN(PRINT OR TYPE) 1f Certified copy is filed with the county building inspection ADDRESS / department NUMBER FIXTURE OR ITEM Q - 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 ($100)or less ) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK CITY fT�7f ff7�� T� TEL NO ¢� mit is issued, I shall not employ any person in any manner so �,GGll6��(lY� / j cy� as'to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS ` NOTICE TO APPLICANT If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL NO sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC ed WATER HEATERv LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION U/ DISTRICT NO PR SSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS �ry 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER a and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VA DATION fect HOSE BIB DATE —� a License Number Lic Class FINAL O U Contractor Date BY tZ O I am exempt under Sec V a B 8P C for this reason Plan check fee W rA Date PLUMBING PERMIT ISSUING FEE$ 2 30 Signature TOTAL FEE � y SINGLE FAMILY applicant HOME OWNER-BUILDER DECLARATION - Plan check ppicant _ I hereby affirm that I am exempt from the Contractor's License Name' Law for the following reason (Section 7031 5, Business and �T s Pr fes ns Code) Address °4 j, as owner of the property, will do the work and the City Tel No 3303 4 °40 structure is not intended or offered for sale(Section 7044, 1 iTEme Business and Professions Code) TOTAL 3 m 40 CONSTRUCTION LENDING AGENCY 4J°�� I hereby affirm that there is a construction lending agency for _ CHECK the performance of the work for which this permit is issued C'MHG .00 (Sec 3097, Civ C ) qq i Lender's Name M—�MJV M.lV 1 11/20/9} Lender's Address 3384 1 PM 6:26 j 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 I w uI ting Plumbing, and hereby outhoriz representat es f his County to enter upon the above ent o e pro ert fo inspection purposes If-2.,0.- SEE REVERSE FOR EXPLANATORY LANGUAGE I I Signature o Permittee Date