HomeMy Public PortalAbout9639 BLACKLEY ST_Plumbing__ COUNTY OF LOS ANGELES APPLICATION FOR PERMIT
DSION OF F BUILDING & SAFETY of County Engineer B '
� DIVISION '
WILLIAM J. FOX, County Englneer
DISTR)-NO. I GR P � jl a/AK�
FOR A/P^P'LICAyN�Tp,TO FILL IN / 'f��yf
PLUMBER (� 'P/il/�y V' �� RECEIVED BY READY FOR D E 1 UED
FIRST INSPECTION �w
ADDRESS
CITY WlIft&if2TEL NO.D ?Ir77
7-6 ADDRESS
COUNTY
LICENSE NO. / EXPIRES LOCALITY
NEAREST �J965-44
PERMIT FEES CROSS ST. �i� -y�Lr.I��,
NUMBER TYPE OF FIXTURE OR ITEM FEE
OWNER
MAIL
WATER CLOSET(TOILET) (m O.5' $ ADDRESS �,I /� _
BATH TUB @ O.5 CITY TEL. N 'j'� 1eJ
SHOWER fL O. O I HEREBY A KNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) Q O 5❑ APPLICATION AND STATE THAT THE ABOVE IS CORRECT
A AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
r KITCHEN SINK (� .5❑ AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
<"LAUNDRY TUB OR TRAY @ D.SD ANGELES COUNTY LIC NSE. OR I AM T)fE LEGAL OWNER
®
OF THE RESIDENTIA PROPERT SSC 16 D ABOVE. _
GAS SYSTEM OUTLETS 50
SIGNATURE OF
WATER HEATER Q O.'s'. PERMITTEE
SLOP SINK 0.5b INSPECTI ON RECORD
FLOOR SINK @ O. -
FLOOR DRAIN @ .50
DISHWASHER Q d.50
DRINKING FOUNTAIN @ 50
URINAL (it O. O A=—r //l0 S'/4
.. Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS L7
0
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING !
GAS VENT
CESSPOOL 0 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT 1,013 GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE S Q L9 Z;
FINAL
76AG67 DBS#Z 17 10/52
4 W RKER-S'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
�reby,la.4ig% that I have a certificate of consent to self 76A667A
insure, or a'certificate of Workers' Compensation Insurance, CE 817 (REV. 8/86)
or a certified copy thereof (Sec. 3800, Lab-C.) _
Policy No]3�3?c� 'Company�`C�J �- •� N� COUNTY.OF LOS ANGELES, DEPT.. OF-,PUBLIC WORKS
Certified copy is,hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING(
Certified copy'is filed,with the county building•inspec.- ADDRESS v'
NUMBER FIXTURE OR ITEM @ FEE T
hon depaQQrtment. LOCALITY `
'Date �/� A'ppligant �L`I�L• WATER CLOSET
NEAREST• ,• a� ,�'
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 ' ' l K
the erinit is for one hundred dollars $100 or less.,),' t +"-''
P ( LAVATORY ADDRESS .
I certify that-in the performance•of the work for,which this
permit is issued, I shall not employ any person in any manner SINK CITY T s�� TEL N6
so as to become subject to the Workers 'Compensation laws• DISHWASHER
• - CONTRACTOR •--t
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT- If, after making this Certificate of
SWIMMINGPOOL RECEPTOR,
Exemption,.`you should •become subject'fo the Workers' f CITY TEL NO.
Compensation provisions of the Labor Code,.you must forth- LAWN SPRINKLER SYSTEM
with comply with .such provisions or this permit shall be STATE LIC
deemed revoked. WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION _ DISTRICT`NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter-9, GAS SYSTEM Z OUTLETS /vJ 11
-
(commencing-with Section 7000);of DiJision 3 of the Business• OUTLETS OVER
and Professions Code,and my license'is in full force and'effect. - 5 PER SYSTEM VALID ON
FINAL+
' r Q DAT O �•
;License Number `"17��^I n Lic Class
FIN A
Contractor 'r�� Date `w 7� 1� BY
�7 p.
❑ -I am exempt underSec W
•B.&P.C:for this reason'
Plan check fee z
Date PLUMBING PERMIT ISSUING.FEE.$ 4 ' 0$ 2 A
Signature
TOTAL FEE #'.9 o 0 o o 5
Plan check applicant I o`o 4 b 5 0
SINGLE FAMILY.
HOME OWNER-'BUILDER DECLARATION' Name o o•0 4,65 0�.
I hereby 6ffirm that I am exempt from the Contractor's License Address '
Law for the following reason (Section-7031.5,, Business and 6 -88
Professions Code): City, Tel. No. 1.,Q'0
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale,(Sectiori
7044, Business and Professions Code).
CONSTRUCTION LENDING•AGENCY
I hereby affirm that there is o'construction lending agency for
the performance of the work for which this permit is issued
(Sc. 3097, Civ. C.).•
Lender's Name
Lender's Address
rhfy that I have read.-this application and state'that the
abo a information is correct. I agree to comply with all County
ordi nces and State laws regulating Plumbing, and hereby
ut rize rr sentatives of this County to enter upon the
ve-men i property for inspection purposes.'
'SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature'of Permittee Date
• ` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING+PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 05072'50001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 '
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 9639 BLACKLEY ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803852
ASSESSOR INFORMATION NUMBER: _ NEAREST CROSS STREET: TEMPLE CITY
8589-002-012 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C
07 BATHTUBS/SHOWERS 1.00 FIX ' 16.20
TENANT: 21 HOSE BIBB(S) 2.00 FIX 32.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
25 LAVATORIES/SINKS 1.00 FIX 16.20 07/25/05 JK 01/21/06
26 MISCELLANEOUS FIXTUR 1.00 FIX 16.20
OWNER: TEL. NO: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 FINAL DATE FINAL BY: CODE:
RINCON ROBERT R;ANNA M (626) 285-1080- 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 /3-
9639 BLACKLEY ST 60 DWV REPAIR OR ALTER 1.00 SYS 16.20 f
TEMP 917803852 63 WATER PIPING BR/FIX 4.00 FIX 27.00 DESCRIPTION OF WORK
TOTAL FEES 184.35 PLUMBING FOR NEW GUEST HOUSE
APPLICANT: TEL. NO:
MELILLO (626) 237-0942-
9703 GARIBALDI AVE SPECIAL CONDITIONS:
TEMPLE CITY CA 91780
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
D T M CONSTRUCTION CO. (626) 237-0942-
9703 GARIBALDI AVE. LIC. NO UNDER SLAB WORK
TEMPLE CITY, CA 91780 266616B
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLUMBING
LIC. N0: --
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