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Home My Public Portal About9591 BLACKLEY ST_Plumbing__ 76A667 -CE#B17 2-62 � J APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 95�l E. Blackle .St. % `r WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY Te>~Inle Cit FOR APPLICANT TO FILL IN NEAREST 4 CROSS ST. 7� /� NUMBER FIXTURE OR ITEM EACH FEE OWNER J. 11. Weber Dev. CO. 3 WATER CLOSET $1.25 3 ?5 MAIL 2 BATH TUB 1.25 ? �-0 ADDRESS 5926 IT. Temple Uty Blvd. � 1 SHOWER 1.25 1 25 CITY Ternle City TEL. NO. 3 LAVATORY 1.25 3 75 CONTRACTOR Vallev Pllmb?ng Cc. 1 SINK 1.25 1 25 ADDRESS "2 1,1. Fleetwood Place �. DISHWASHER 1.25 1 25 CITY Glendora TEL. NO. Ed 51293 CONLAUNDRY TUB 1.25 R GIISTRATION NO. 209431 COUNTY CTOR'S STATE 0 1 CLOTHES WASHER 1.25 1 25 DISTRICT NO. GROUP ZONE PROCESSED BY ] WATER HEATER 1.50 1 50 �� L GAS SYSTEM OUTLETS 1.50 1 50 INDUSTRIAL WASTE APPROVAL � 1 OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD O F V w w APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE in r 'ft GAS PIPING - � I HEREBY ACKNOWLEDGE THAT 1 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 �,7+,;;;/�' PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANWOR 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 ESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE �( _ OF PERMITTEE '"-may f-� FINAL �LIDATION ROBERT A. WOOD CK. M J. CASH SUPERVISING MECHANICAL ENG'R Uu04390 %"P 5 D 2 03 0 ION DECLARATI WORKER'S I have a certificate of consent to 76A666DPW9,69 .APPLICATION FOR PLUMBING PERMIT -76A667A I hereby affirm that I have a certificate of consent to self insure, • or 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 Company »j`M� - Certified copy is hereby furnished. IJ Certified copy is filed with the county building inspection FOR APPLICANT 70 FILL IN(PRINT OR TYPE) BUILDING ADDRESS department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY C Date 1/9—.1— g Applicant WATER CLOSET NEAREST � CROSS ST O (Z - CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB ASSESSOR COMPENSATION INSURANCE MAP BOOK PAGE PARCEL (This section need not be completed if the work involved by the SHOWER permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit MAIL LAVATORY , G is issued, I shall not employ any person in any manner so as to , SINK ADDRESS e become subject to the Workers' Compensation Laws. DISWASHER CITY �" TEL NO _ Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If,/after making this Certificate of �e Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith'Comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM \ LICENSED CONTRACTORS DECLARATION / CITY �/�� TEL.NO. V(17rfiv� I hereby affirm that I am licensed under, provisions of Chapter 9 WATER HEATER /� _ /STATE LIC X47 d (commencing with Section 7000) of Division 3 of the Business and LICENSE NO (0 � j CLASS V Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS �jJI _ OUTLETS OVER DISTRICT N= �y CPROCESSED BY O 5 PER SYSTEM _� o License Number 4 /O Lic.Class� (¢ v U FINAL VALIDATION W r DATE (L i�2� &(21' -fes /D 31-9J� Contractor � Date co FIN❑ I am exempt under Sec. BY AL B&P.C.for this reason _ 7 Plan check fee S_ - . Date: PLUMBING PERMIT ISSUING FEE$ =''_ s Signat ❑ TOTAL FEE Plan check applicant 1 TTP-p's� SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name f s '� I hereby affirm that I am exempt from the Contractor's License Law f . 60 or the following reason (Section 7031.5, Business and Professions Address i` j_';� o. `i Code): ❑ City Tel No. -k'.r ' 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). CONSTRUCTION LENDING AGENCY 1 hereby affirm that there is a construction lending agency for the d , 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 r pect' p os s SEE REVERSE FOR EXPLANATORY LANGUAGE k SI nature f sqirffittee Date f _ , COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0402170027 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 29492 LT: 4 9591 BLACKLEY ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803143 ASSESSOR INFORMATION ,%f0fBER: _ NEAREST CROSS STREET: ENCINITA 8590-006-024 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 60.15 02/17/04 VG 08/15/04 OWNER: TEL. NO: FINAL DATE FIN BY: CODE: TOOHEY ROBERT J;MARY M (526) 286-8476- 9591 BLACKLEY ST '"5 TEMP 9178003143 DESCRIPTION OF WORK PLUMBING FOR BATH REMODEL APPLICANT: TEL. NO: GLASS (818) 994-1853- SPECIAL CONDITIONS: CONTRACTOR: 'TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ALL STAR REMODELING 0;800) 441-1758- 14039 SHERMAN WAY LIC. NO I UNDER. SLAB WORK SUITE# 102 740295 B VAN NUYS CA 91405 WATER SERVICE _ ARCHITECT JR ENGINEER: EL. N0: PLASTIC Y/N METAL Y/N LIC. N0: ROUGH PLUMBING G 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