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Home My Public Portal About9677 BLACKLEY ST_Plumbing__ 17 70, %78A667 -CE#817 9i63 CITY- OF TEMPLE CITY 7 ' APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES u DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION ADDRESS S Blackly JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY , FOR APPLICANT TO FILL IN CROSS ST . Kauffman NUMBER FIXTURE OR ITEM EACH FEE OWNER A. Pnlimn7 WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS SOMe CITY TEL. NO. SHOWER 1.25 LAVATORY, 1.25 CONTRACTOR General Installation Co. SINK 1.25 ADDRESS 6558 West Blvd. DISHWASHER 1.25 CITY Los Angeles TEL. NO. PI. 3-2541 CON -TOR'SSTATE LAUNDRY TUB 1.25 EGISTRAT ON NO. C-36 151839 787 COUNTY E5 CLOTHES WASHER 1.25 DISTRICT NO. GROUP NE PR ESS BY' WASM HEATER 1.50 1 15C } GAS SYSTEM OUTLETS 1'� INDUSTRIAL 0 WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U WATER SOFTENER Ready for Inspection Now p h U W 0- APPROVALS APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT g 2 00 UNDER SLAB WORK f ROUGH PLUMBING -o,--N ! TOTAL FEE GAS PIPING - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENTJu WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER .yal��,�rG� f� PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES P f �^� 'V LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO GAS TEST 0, I RESIDE IN, THE ABOVE DESCRIBED RESIDEN, FPE UTILITY CO NOTIFIED SIGNATURE a /� OF PERMITTEE FINAL ALIDATION ROBERT A'WOOD cK M o CASH SUPERVISING MECHANICAL ENG'R L„to 5 9 1 6 6 5 0 3.5 0" ' '76ASS7 17 S-Bo XD APPLICATION FOR PERMIT �! DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1 FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER\ A y RECEIVED BY READY FOR DATE ISSUED ADDRESS 0d `x FIRST INSPECTION y �D e �o�� BUILDING / �' e, CITY Tg'"'Vle / TEL. NO. r / ADDRESS L CENSECOUNTY N �j— EXPIRES ��ZJ1 / LOCALITY NEAREST PERMIT FEES CROSS ST. n NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER f J _ ✓L MAIL WATER CLOSET (TOILET) @ 0.50 $ I ADDRESS BATH TUB @ 0.50 I I CITY TEL. NO. SHOWER @ O.So 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.501 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND �• KITCHEN SINK @ 0.501 STATE LAWS REGULATING PLUMBING. / I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY. @ O.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPE TRIB D ABOVE. GAS SYSTEMOUTLETS Q O.50 Y DESC SIGNATURE OF WATER HEATER Q 0.50 PERMITTE SLOP SINK Q o.so I INSPECTION REC D FLOOR SINK @ O.50 FLOOR DRAIN Q 0.50 DISHWASHER Q 0.501 /rrte� DRINKING FOUNTAIN @ 0.5011 URINAL @ 0.501 HOUSESEWER @ 0.501 ��, 1 MISCELLANEOUS �� =�✓ o I� I� APPROVALS 1 DA,.T�Ea INSPECTOR'S NAME 1 1 ROUGH PLUMBING GAS PIPING 1 1 1 GAS VENT CESSPOOL @ 1.00 I� CESSPOOL SEPTIC TANK: SEPTIC TANK / I DRAIN ( ) PIT ( ) @ 1.001 1 SEWER PERMIT . I 1.00 GAS TEST TOTAL FEE � UTILITY CO. NOTIFIED , I $/I � �-f FINAL 1 , WORKERS'COMPENSATION DECLARATION 76ae67A /� q I hereby affirm, that I have a certificate of consent to self CE 917 (i-ao) A P P L I C A TJ O#J., FOR PLUMBING PERMIT irifure, or a'certificSse of Workers'Compensation Insurance,or a certified copy 6ere'of(Sec. 3800,Lab. C.) k COUNTY OF LOS ANGELES i BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING e7 ❑ ADDRESS i Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM FEE LOCALITY department. WATER CLOSET Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER /� � �� 'Z (This section need not be completed if the work involved LAVATORY MAI L ADDRESS % f� °7 /a 4,4 by the permit is for one hundred dollars ($100) or less.) SINK CITY G TEL.NO. G O I certify that in the performance of the work for which this DISHWASHER ' permit is issued, I shall not employ any person in any ma ner CONTRALTOIWAI cc so as to ec me subject p orkers' Comnsa s. CLOTHES WASHER ADDRESS 0 O y Date Applica SWIMMING POOL RECEPTOR NOTI O APPLICANT: If, after making this Certificate of CITY TEL. NO. W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. a- Compensation provisions of the Labor Code, you must forth- LICENSE NO. CLASS � with comply with such provisions or this permit shall be WATER HEATER 3 _ deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. OPR CESSED BY LICENSED CONTRACTORS DECLARATIONOUTLETS OVER ) •i L/�J c`J I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL `�� ness and Professions Code, and my license is in full force and DATE ��: �>1r' VALIDATION effect. FINAL License Number Lie.Class BY Contractor Date F1I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section.7031.5, Busi- City Tel.No. ness and Professions Code): f� I, as owner of the property, am exclusively contracting 0 2 Jr 'J A with licensed contractors to construct the project (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 2 0 0 2 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.). 0 - 25,0050 Lender's Name 07,0.8-8 1 l 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 author' a representatives of this County to enter upon the a e- entioned property folp in pection purposes., ignature of Permitte Date