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HomeMy Public PortalAbout9502 BLACKLEY ST_Plumbing__ 76A667A)CE 8178)- 1 1/76 , r� i APPLICATION FOR PLUMBING PERMIT 1 A 2 BUILDIN D SAFETY DIVISI FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING `?saw.. NUMBER FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST SHOWER OWNER LAVATORY MAIL ADDRESS GG i /tt'0 H� SINK CITY TEL NO��3 DISHWASHER CONTRACTOR CLOTHES WASHER "� ADDRESS ©WAtCK— SWIMMING POOL RECEPTOR CITY TEL NO LAWN SPRINKLER SYSTEM STATE LIC • WATER HEATER LICENSE NO CLASS ` GAS SYSTEM OUTLETS ' �. DISTRICT NO GROUP OESSE BY J(PEJ OUTLETS OVER 5 PER SYSTEM INDUSTRIAL WASTE APPROVAL 0 INSPECTION RECORD 0 9. Plan check fee PLUMBING PERMIT ISSUING FEE'$ TOTAL FEE �O Plan check applicant APPROVALS DATE INSPECTOR S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING City Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT - THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER 1 HEREBY CE IF AT AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS A GELE OIUNTY AND STATE OF CALIFORNIA OR THAT'(AM THE GAS TEST LEGAL OWNER OF A D INTEN TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL , PROPERTY UTILITYCO NOTIFIED SIGNATURE , •�` J, OF PERMITTEE FINAL Z' X77 PLAN CHECK VALIDATION CK M O CASH PERMIT VALIDATION 1CK, M o ASH 30 4 i--fj0V 23 •3 ® 7.5 0 ®!= \ WORKER'S.POMPENSAI)ON DECLARATION 20-0026 PW 9/89 ) I hereby affirA'that"t have a certificate of consent to self insure, APPLICATION FOR PLUMBING PERMIT �J or a certificate of Worker's Compensation Insurance, or a certified 1 cop thereof(Sec 3800 Lab C) � - •, - � 1cliV ,� ���� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. . o icy o ompan; _ ❑• Certified copy is hereby furnished ❑^ � � FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ADDRESS � Certrfied copy is fled with the county budding i ecti � depa ent NUMBER FIXTURE OR ITEM ® FEE _ LOCALITY _ Date Applicant WATER CLOSET NEAREST 0-1 CROSS ST CER IFICATE OF EXEMPTION F OM WORKERS" BATH TUB COMPENSATION INSURANCE,- ASSESSOR MAP (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE ' PARCEL permit is for one hundred dollars($100)or less) I LAVATORY -OWNER I certify that in the performance of the work for which this permit - is issued, I shall not employ any person in any manner so as toMAIL SINK ADDRESS become subject to the Workers-' Compensation Laws DISWASHER - CITY- G TEL NO Date Applicant CLOTHES WASHER n ONTRACTORL NOTICE•TO APPLICANT If, after making ,this Certificate of • - �L" Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR N 6 provisions of the Labor Code, you must forthwith comply with such ADDRESS C provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CI D�� TEL NO (Y p a I hereby affirm that I am licensed under prov`sions of Chapter 9 WATER HEATER y J (commencing with Section 7000)of Division 3 of the Business and ICENATESE NOW64 L CLASS —' 3�p O GAS SYSTEM OUTLETS U Professions Code,and my license is in full force and effect / O OUTLETS OVER DISTRICT NO PROCESSED BY [t 311'(010 7g � 3� 5 PER SYSTEM ��/ ✓ ^ Q License Number, Lic Class / �< �j>� v �tiG�i U FINAL ,q ALIDAT10N_ W G1y/4(/G/C� 7 DATE a Contractor Date /0 El FINAL Z Z I am exempt under Sec BY � B&P C for this reason - Date Plan check-fee - Signature PLUMBING PERMIT ISSUING FEE$ , 1 F-11 TOTAL FEE 9 c Plan check applicant r• a SINGLE FAMILY AC\..T.v i HOME OWNER-BUILDER DECLARATION Name -3707 1 4.55 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Professions [Aciclresst �1�E Code) 1 ❑ City Tel No C5 I, as owner of the property,will do the work and the structure iJTt�1- °O =d is not intended or offered for sale (Section 7044, BusinessLt j�tt 194.55 , and Professions Code) , CHECK, y -1 ` CONSTRUCTION LENDING AGENCY C�H05E 1 hereby affirm that there is a,construction lending agency for the performance oflthe work for which this permit is issued (Sec 3097, Civ c) Lender's Name r Lender's Address I certify that I have read this application and state that the above j information is correct I agr comply with ounty ordinances , y and State laws re Plumbing, nil h feby authorize representa1 of i County to r po th4f above-mentioned proper sp tion purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Si nature of Pe&nittee Me, -' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0807140009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT: - ILEGAL ID I FEES PAID I BUILDING ADDRESS. 1 ITR 14572 LT 58 1 1 9502 BLACKLEY ST I IFEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917803142 (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET 18590-007-023 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY, Cl 107 BATHTUBS/SHOWERS 1 00 FIX 16 20 I I ITENANT 125 LAVATORIES/SINKS 1 00 FIX 16 20 (ISSUED ON PROCESSED BY PLAN BY. EXPIRES ON 1 145 WATER CLOSET/URINAL 1 00 FIX 16 20 107/14/08 SR 01/10/09 1 I TOTAL FEES 76 35 I (OWNER TEL NO 1 IFINAL DATE �� BY CODE IJACKSON, KEITH (626) 309-1733- 1 1 19502 BLACKLEY ST I I ITEMP 917803142 1 IDESCRIPTION OF WORK 1 I 1 (BATH, LAVATORIE, WATER CLOSET FOR A MINOR BATHROOM REMODEL 1 (APPLICANT TEL NO 1 I IDIANE MAROCCHI (562) 631-3684- 1 18407 ENRAMDA AVE. I (SPECIAL CONDITIONS 1 IWHITTIER, CA 90605 I I 1 1 1 I I ICONTRACTOR TEL NO I 1APPROVALS DATE INSPECTOR SIGNATURE 1 ID & T GENERAL CONTRACTING (562) 945-2083- 1 II I 18407 ENRAMADA AVE LIC. NO (UNDER SLAB WORK IWHITTIER CA 90605 B C10 I I I I IWATER SERVICE I 1 1PLASTIC YIN METAL YIN I I I (ARCHITECT OR ENGINEER: TEL NO I I I 1 _ I IROUGH PLUMBING LIC NO 1 I - I IGAS PIPING IGAS VENT IHOT WATER HEATER - I_ I I I IPLUMBING FIXTURES I I ILAWN SPRINKLERS I I I IGAS TEST I I - (UTILITY COMPANY NOTIFIED( I I I ICWV I I 1 IGRAY WATER SYSTEM I 1 1 I I I I * ADDITIONAL DATA ON FILE I I I I I I I I I IREPORT ID DPR263 ROUTE TO BS0508 1 I I I I I i I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1112150019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 14572 LT: 58 1 1 9502 BLACKLEY ST I I IFEE DESCRIPTION: QUANTITY: UOM: AM0UNT: 1 TEMP CA 917803142 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I 18590-007-023 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl 1 147 WATER HEATER(S) 1.00 WTH 16.30 1 (TENANT: I TOTAL FEES 44.10 (ISSUED ON: PROCESSED BY: PLAN BY: 1 I 112/15/11 SR (OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE: 1 IJACKSON KEITH M;RAMONA 19502 BLACKLEY ST I (TEMP 917803142 1 IDESCRIPTION OF WORK I IREMOVE/REPLACE GAS WATER HEATER 1 (APPLICANT: TEL. NO: I (FAST WATER HEATER COMPANY (425) 636-7084- I 1 I (SPECIAL CONDITIONS: I I I I ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1 (FAST WATER HEATER CO. (800) 454-8955- I 1 112601 132 AVE NE LIC. NO (UNDER SLAB WORK I IKIRKLAND WA 98034 877489 C36 1 I I (WATER SERVICE I I (PLASTIC Y/N METAL Y/N I (ARCHITECT OR ENGINEER: TEL. NO: 1I I (ROUGH PLUMBING LIC. NO: 1 I I I I I IGAS PIPING I I I 1 IGAS VENT I I I 1 IHOT WATER HEATER I I I I I IPLUMBING FIXTURES 1 1 I lLAWN SPRINKLE" `CCMPPiBT1f„ t CW4i GRAY WATER SYSTEM I I I I 1 i I I 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 I i I I I I