HomeMy Public PortalAbout9519 BLACKLEY ST_Plumbing__ COUNTY OF LOS ANGELES - APPLICATION FOR PERMIT
Department of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
DIS R NO. GROUP ZON PERMIT N
FOR APPLICANT TO FILL IN r, i I ham/ IQO��y
PLUMBER RECEIVED BY L R`EJADYtF1OR �dDATE(,ISSUED�j
FIRST INSPECTION
ADDRESS �VI✓Ca".t,'RI 1C.b�'`-t
BUILDING �'�
CITY TEL No. ADDRESS 914
�J,�
COUNTY LOCALITY / e"Ot*/
LICENSE NO. EXPIRE
NEAREST f1
PERMIT FEES CR❑Ss 9T. /(r�/
_�,C ,/� �F'
NUMBER TYPE of FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET(TOILET) @ Q.!40 $ � � _ADDRESS �`
BATH TUB @ ❑1 O D CITY ' TEL. No./!
s�' �" SHOWER @ 40 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) Q 0• O / APPLICATION AND BTATE THAT THE ABOVE IS CORRECT
I� AND AGREE TO COMPLY WITH ALL COUNTY ❑RDINANCES
KITCHEN SINK Q O. O D AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
• LAUNDRY. TUB OR TRAY @ O. ❑ ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL PflOPERTY DESCRIBED ABOVE.
1 OO AS SYSTEM OUTLETS Q O. Q
SIGNATURE dF
e WATER HEATER W_ 0.50 / PERM ITTE:;T;j;5;�
�
SLOP SINK O.PO INSPECTION RECORD
FLOOR SINK @ 0.6
FLOOR DRAIN @ O 50 ✓ _
DISHWASHER @ 050
DRINKING FOUNTAIN 0. O
URINAL Q ❑.10
HOUSE SEWER @ 0.50 g'�^_r _Z
MISCE LANEOUS
O.'
D
APPROVAje
DATE INSPEOTOW8 NAM
ROUGH PLUMBING � •`�
GAS PIPING
GAS VENT
CESSPOOL @ 1,00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) Q 1.00 SEWER �.,.,�•�
PERMIT 1.00 GAS TEST ,
UTILITY CO.NOTIFIED ,�I l�[ •�"'-
TOTAL FEE $
�� FINAL
76A667 DBS#17 6-52
-7-
WORKER'S I have
a certificate
of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT
20-002 A
I
by affirm that I have a certificate of consent to•self insure,ertificate of Worker's Compensation Insurance, or a certified
I
(Sec 3800 Lab C) ti
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV.
,y No Company,
Certrfied copy is hereby furnished
t " T
FOR APPLICANT O FILL IN(PRINT OR TYPE) BUILDING
ADDRESS
Certified copy js filed wtth'the county building inspection
department NUMBER FIXTURE OR ITEM FEE LOCALITY
Applicant WATER CLOSET NEAREST
r CROSS ST V C ice(
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ASSESSOR
COMPENSATION INSURANCE
MAP BOOK PAGE PARCEL
s,section,need not be completed if the work involved by the SHOWER,
pit is for one hundred dollars($100)or less.) LAVATORY OWNER
itrfy that in the performance of the work r which this permit MAIL
sued, I shall not employ any person i any anner so s to SINK' ADDRESS
me subject to the W ens.) o L 1�
DISWASHER CITY ,_A TEL NOLO �l r
(r �
-= Applicant CLOTHES WASHER CONTRACTOR s
IIICE TO APPLI ANT If','after ma ing t1iis Certificate of
hptton,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR— _ ADDRESS'
�isions of the Labor Code, you must forthwith complyjwith-s'uch
Iisions or this permit shall be deemed revok4d LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY 'TEL NO ' }
WATER HEATER Q
Feby affirm that I am licensed under provisions of Chapter 9 f
amencin with Section 7000 of Division 3 of the Business and STATE LIC
g ) LICENSE NO CLASS V
jessions Code, and my license is in full force and effect GAS SYSTEM OUTLETS
OUTLETS OVER DISTRICTO� PROCESSED BY O
/ _ ) 5 PER SYSTEM
se Number -9 Ltc Class
1 + �
FINAL ,1 VALIDATION a`
i DATE �/y--- �
rector r4� N
FINAL Z
I am exempt under BY
B&P'C for this re o ; r
Plan check,fee
PLUMBING PERMIT ISSUIN61FEE$
Signat r 6
TOTAL FEE —
Plan check applicant ,
SINGLE FAMILY
HOMEOWNER-BUILDER DECLARATION Name
rreby affirm that I am exempt from the Contractor's License Law .+
ie) following reason (Section 7031 5, Business and Professions Address
3303
lye) 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` A TOTAL £�
and Professions Code)
CHECK
CONSTRUCTION LENDING AGENCY
HAM
ereby affirm that there is a construction lending agency for the fltll9i��
of the work for which this permit tslssuh (Sec 3097,
iformance
nder's Name ( tr _
Ler's Address'
lertify that I h e read this application,and state that the above -
(6matio s rrect I age lrecomply with all County ordinances 4�
�d St ws r trig umbmg, and hereby authorize
pres t s of s C to ter upon the above-mentioned
rop fo spe n es
SEE REVERSE FOR EXPLANATORY LANGUAGE
S P i Date -
_ 'COUNTY OF LOS ANGELES TEMPLE CITY # 0508 Ll9MBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS 508 992x50016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL FEES PAID ILOM43
ADDRESS:
TR: 17190 LT: 8 19T
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY
8590-005-010 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 1.00 FIX 16.20
TENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
25 LAVATORIES/SINKS 2.00 FIX 32.40 12/15/99 UT 06/12/00
45 WATER CLOSET/URINAL 2.00 FIX 32.40
OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 FINAL DATE FINAL BY: DE:
WILKINSON ROBERT K;LAURA A (818) 286-3756- TOTAL FEES 141.15
9519 BLACKLEY ST —0
TEMP 917803143 DESCRIPTION OF WORK
PLUMBING FOR TWO BATHROOMS AND LAU DRY ROOM
APPLICANT: . NO:
TOM O'LEARY
5823 AGNES AVE. SPECIAL CONDITIONS:
TEMPLE CITY, CA
ES C® q�
CONTRACTOR:LEARY CONSTRUCTION TEL. N287 0927 APPROVALS DATE INSPECTOR SIGNATURE
5823 AGNES AVENUE LIC. NO UNDER SLAB WORK _
TEMPLE CITY, CA 91780 489354 B-1 —1110
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. N0:
- -- ROUGH PLUMBING
LIC. N0: 1111111
GAS NG
G S VENT
�FUBDQUC VO� uS HOT WATER
HEATER
a
PLUMBING FIXTURES
U LAWN SPRINFLERS
O ❑ *{ GAS TEST
O ® ®5UTILITY COMPANY IED
CWV
VICC�Ql�'t
Vtl
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508