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HomeMy Public PortalAbout9511 BLACKLEY ST_Plumbing__ 76A667 138917 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1 FOR APPLICANT TO FILL IN I TR:IrO. r3R.OUPIO NE PERMIT f4P. A 0,6'-4 PLUMBER g g . % - �a ,.. RECEIVED BY READY FOR pq IggU ,d j(JjJ ��� FIRST INSPECTION < a `C ADDRESS t � � } �A !�J.o�'✓t)`/ BUILDING _ CITY J. TEL. No. _ �j ��S ADDRESS ✓ COUNTY / .4 LOCALITY / C LICENSE NO. �+ i EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE of FIXTURE OR ITEM FEE OWNER /�f7 �>I.f�/`/f. % Tl MAIL WATER CLOSET(TOILET) @ 0.50 $ .50 ADDRESS �� J/^� L7 '�C7�liAly. h? ✓y/ BATH TUB @ 0.50 CITY ' , TEL No. SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 �/J APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ 0.501--- .50 ,� -- SIGNATURE OF .="O6� WATER HEATER @ 0.50 PERMITTEE SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL 0.50 J Q HOUSE SEWER @ 0.50 Z_ MISCELLANEOUS 0 (Y O APPROVALS DAIrE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ) PIT ) @ 1.00 SEWER PERMIT . I 1.0 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE s FINAL 76A667 DBS 17 Ii-SD APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING �� � �' COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN TT NO. GROUP I ZONE / PLUMBER F Mer E IVED BY READY FOR D TE ISSUED �} �+ I RST I 9P T N ADDRESS o25 E E . Broadway BUILDINGey „�lw CITY San Gabriel .EL- No.AT 1=0385 ADDRESS ^T -_,��„e_� Ave. n ry COUNTY �+ Tract 17190 LICENSE NO. 4686 EXPIRES 6/30/1952 LOCALITY Temple City PERMIT FEES EARS sT. Blackley.St, NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER Pat T J. MAIL 1 WATER CLOSET(TOILET) @ 0.50 $ ADDRESS 1 BATH TUB @ D.SO CITY TEL No. SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 1 LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY L NSE. OR I AM THE -LEGAL OWNER OF THE REBID L ROPERTY DES 1 ED ABOVE. GAS SYSTEM OUTLETS @ 0.50 SIGNATURE OF 1 WATER HEATER @ 0.50 PERMITTE SLOP BINK @ o.so INS CTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 '�� DISHWASHER @ 0.50 - 'L' ''..✓rrn'G -cJr1-.o. `! '"..1�� - DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 J Q HOUSE SEWER @ 0.50 Z_ MISCELLANEOUS 6 O APPROVALS DATE INSPECTORS NAME ROUGH PLUMBING ' GAS PIPING i O,l li I GAS VENT CESSPOOL @ 1:00 CESSPOOL (/• SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT I 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE � 4 50 FINAL I WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT C I hereby affirm that I have a certificate of consent to self 76A667A insure, 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. Cotnpany Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING F-1 Certified copy is filed with the county building inspec- ADDRESS NUMBER FIXTURE OR ITEM C FEE tion department. LOCALITY WATER CLOSET Date Applicant 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 ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. I deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ., (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER a and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION 0 DATE U j License Number Lic. Class FINAL J Contractor Date BY LL. ❑ I am exempt under Sec. > .. . B&PCfor this reason 1101I Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ ` Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel, No. ❑ 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). r 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 above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat(` WOtIKER'SCOMPENSATIONDECLARATION 20-0026 DPW 9/89 76A667A APPLICATION FOR PLUMBING PERMIT I hereby affirm thai I have a certificate of consent to self insure, nor a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec. 3800 Lab.C.) COUNTY OF LOS ANGELES DEPT-OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. sompany f ❑ Certified copy is hereby furnished. �./ ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY t l Date L Applicant �. WATER CLOSET J NEAREST CROSS ST. CERTIFICATE OF EXEMPTI FROM WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR MAP BOOK PAGE PARCEL (This section need not be completed if the work involved by the / SHOWER r/ - permit is for one hundred dollars($100)or less.) j s� OWNER I certify that in the performance of the work for which this permit LAVATORY MAIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS G —� become subject to the Workers'Compensation Laws. DISWASHER CITY �^? /'. I EL.N Date Applicant / CLOTHES WASHER / CONTRACTOR �/ ,v NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 7 G v — provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITYTEL.NO. �- i I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER [ (commencing with Section 7000 of Division 3 of the Business and STATE LIC. a ( 9 ) LICENSE NO. CLASS G Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS t OUTLETS OVER DISTRICT NO. P� D BY cc 5 PER SYSTEMS-1©fit License Number Lic.Class _ FINAL J / Q DATE (� Z VALIDATION Contractor�/ �l�Lr Date❑ L /nom / (n FINAL �} Z_ I am exempt under Sec. BY B.&P.C.for this reason 's "$ Plan check fee 010, i l Date: .q_( 11.:e!�` PLUMBING PERMIT ISSUING FEE$ M Signature 1 ITE ' ❑ TOTAL FEE TOTAL 112 05 SINGLE FAMILY Plan check applicant CHECK HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law CHANGE ,SII_( for the fallowing reason(Section 7031.5, Business and Professions Address Code): City Tel. No.❑ {� y 7_�.I, as owner of the property,will do the work and the structure WOO-00001 18 4 ;�`; is not intended or offered for sale (Section 7044, Business i t i h�I and Professions Code). , c162 1 A i 7W, � 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 above-mentioned property fo inspection pur, seas.,jSEE REVERSE FOR EXPLANATORY LANGUAGE ature of Permittee� D to COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0601300023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 17190 LT: 7 9511 BLACKLEY ST _ FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803143 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: _ 8590-005-009 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID:,J4 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 3.00 FIX 48.60 TENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 13 DISHWASHERS) 1.00 FIX 16.20 01/30/06 JK 07/29/06 _ 21 HOSE BIBB(S) 2.00 FIX 32.40 •-T�,, OWNER: TEL. NO: 25 LAVATORIES/SINKS 4.00 FIX 64.80 FIN L TEFINA Y: �...---'"'CODE: ZHANG, SAM (626) 203-9639- 26 MISCELLANEOUS FIXTUR 1.00 FIX • 16.20 9511 BLACKLEY ST 27 PRESS REG DEVICE(S) 1.00 DEV 16.20 , TEMP 917803143 45 WATER CLOSET/URINAL 3.00 FIX 48.60 RI IO OF WORK 47 WATER HEATER(S) .. - 1.00 WTH 16.20 P6JMBING FOR BATHROOMS AND KITCHEN _ 49 WATER TREATING EQUIP 1.00 SYS 16.20 APPLICANT: TEL. NO: 64 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 ZHU (626) 203-9639- TOTAL FEES 335.55 556 W. LAS TUNAS DR SPECIAL CONDITIONS: SAN GABRIEL CONTRACTOR: TEL. NO: APPROVALS D TE INSPECTOR SIGNATURE NOVEL DEVELOPMENT, INC. (626) 202-5448- 319 N. SAN GABRIEL BLVD. LIC. NO UNDER SLAB WORK J SAN GABRIEL, CA 91775 855491B `�. WATER SERVICE / _ PLASTIC YIN METAL YIN 1 ARCHITECT OR ENGINEER: TEL. NO: - ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM �=-� �►,(�` =� Com----- REPORT ID: DPR263 ROUTE TO: BS0508