HomeMy Public PortalAbout9575 BLACKLEY ST_Plumbing__ 76A667 -CE#817 2-62 &7n12_47
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES Lot
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING FNEAREST
S 9575 E. Blackley Ct.
JOHN A. LAMBIE. COUNTY ENGINEER
WILLIAM A. JENSEN. SUPT OF BUILDING
Y Tem l e City
FOR APPLICANT TO FILL IN ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER J. B. 6ieber Dev. Co.
3 WATER CLOSET $1.25 3 75
1 BATH TUB 1.25 1 25 ADDRESS 5926 P. Temple City Blvd.
2 SHOWER 1.25 2 Sn CITY Temple City TEL. NO.
3 LAVATORY 1.2S �. 75 CONTRACTOR Valley Phuabing Co.
1 SINK 1,25 1 25 ADDRESS 442 L. Fleetwood Place
]_ DISHWASHER 1.25 1 25 CITY Glendora TEL. NO. Ed 512c'7
CONTRACTOR'S 7 STATE ❑
LAUNDRY TUB 1.25 REGISTRATION NO.! COUNTY ❑
1. CLOTHES WASHER 1.25 1. 25 DISTRICT NO. GROUP ZONE PROCESSED BY
l WATER HEATER 1.50 1 50
1 GAS SYSTEM OUTLETS 1.50 1 50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 3o INSPECTION RECORD ?�
0
V
OC
0
H
U
W
CL
LA
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 2O -n
GAS PIPING
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 I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES I _
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST O
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE `
OF PERMITTEE :T`'L' J.
FINAL
y�KLIDATION ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
UALU4366•10 ;'EP ' 31 5 D 20.30
I _ -
r I .•
WORKERS'COMPENSATIOi1 DECLARATION 76A667A C '
I hereby affirm that I have a certificate of consent to self ce 817 (2-80) A P P L•I C A T I O N, FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec. 3800,Lab.C.) ' ��
COUNTY OF LOS ANGELS .BUILDING AND SAFETY
,Policy No. Company \ / .
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE), BUILDINGc�+
ADDRESS
ID Certified copy is filed with the county building inspection NUMBER,. FIXTURE OR ITEM • FEEP
department. WATER CLOSET LOCALITY T / G;
'Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COM PEN SATION•INSURANCE - SHOWER OWNER �r SlacO
LAVATORY
MAIL `
(This section need not be completed if the work involved ADDRESS .� r Q, }
by the permit is for one hundred dollars ($100) or less.)
SINK CITC� TEL. NO� O 0
I certify that in the performance of,the work for which this DISHWASHERV
CONTRACT R
permit is issued;I shall not employ' any person in any manner
so as to becojne subject,to the orkers' Co nsation,Laws. CLOTHES WASHER ADDRESS - C)
Date 10/50 Applicant s ,' A.�J��� — SWIMMING POOL RECEPTOR 1 (~j
CITY TEL. NO. "u
NOTICE TO APPLICANT:If;after making this Certificate of - V�r d
Exemption, you should become subject to the LAWN SPRINKLER SYSTEM
P J STATE p LIC. rn
Compensation provisions of the Labor Code, you•must forth- LICENSE NO. 3/&a/ O CLAS 31 Z
with comply with such provisions or this permit shall be WATER HEATER --
deemed ievoked. DT NO. E SED BY
GAS SYSTEM OUTLETS O/V/
LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL a VAL'IDATI
ness and Professions Code, and my-.license is in-full force and DATE ,/ p v
effect.
7 TO 9 J FINAL
r
License Number ! S Lic:Class C- / BY
Contracto U S k d ate !7/ �d/g o
I am exempt from the licensing requirements as I am a Plan check fee
licensed- architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iners and Professions Code). TOTAL FEE
Lic.or Reg.No. Date Plah check applicant CI&r $ �/� ,✓
HOME OWNER-BUILDER DECLARATION Name `, d,�1L1T
I hereby affirm that I am exempt from the Contractor's I Address/6 f/ �^� �t a� `•.
License Law for the following reason (Section 7031.5, Busi- City C � - Tel.No..g,6e— /T
ness and Professions Code):
I, as owner of the_property, am exclusively contracting
with licensedcontractors to construct the project 2 9.4 A,
(Section 7044, Business,and Professions Code).
0 0 00:0
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency ,2'0 0 1 0,0 0
for the performance of the work for which this permit is
issued(Sec. 3097,Civ.C.). !/ :0 0 0 00 0
Lender's Name $0
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State.laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes.
JQ �-
Eve _t0
Signature of Permittee Date "
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
• DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0607070010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 29492 LT: 2 9575 BLACKLEY ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803143
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CLOVERLY
8590-006-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C
25 LAVATORIES/SINKS 2.00 FIX 32.40
TENANT: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 76.35 07/07/06 JK 01/03/07
OWNER: TEL. NO: - FINAL DATE FINAL BY:, CODE:
BADARO OUBERTO J;JACQUELINE M (626) 653-2324- `
9575 BLACKLEY ST I `G
TEMP 917803143 DESCRIPTION OF WORK
PLUMBING REMODELING KITCHEN AND RELOCATING BATHROOM
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
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
REPORT ID: DPR263 ROUTE TO: BS0508