HomeMy Public PortalAbout9423 BROADWAY_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY p 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0709170003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 9423 BROADWAY
IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917802446
ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: CLOVERLY
18588-003-020 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
I 107 BATHTUBS/SHOWERS 1.00 FIX 16.20
(TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
145 WATER CLOSET/URINAL 1.00 FIX 16.20 109/17/07 SR 03/15/08
TOTAL FEES 76.35 1
OWNER: TEL. NO: FINAL DATE FI Y: CODE:
IJACOBSEN, MARY L - (626) 309-0005- 1
19423 BROADWAY
ITEMP 917802446
I
DESCRIPTION
O
PLUMBINGF WORK
FORBATHROOM REMODEL
APPL ICANT: TEL. N0:
IL & W KITCHENS & BATHS (626) 287-1131- 1
18812 LAS TUNAS ISPECIAL CONDITIONS:
ISAN GABRIEL CA 91776
I
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
IL AND W KITCHEN AND BATHS (626) 287-1131- 1
8812 LAS TUNAS DR. LIC. NO JUNDER SLAB WORK
ISAN GABRIEL, CA 91776 2053448
I I (WATER SERVICE j '-
PLASTIC YIN METAL YIN -^
ARCHITECT OR ENGINEER: TEL. NO:
LIC. NO: TROUGH PLUMBING
GAS PIPING /
GAS VENT r
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
I
GAS TEST
IUTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
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REPORT ID: DPR263 ROUTE TO: SS0508
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FD'DRE'.S
JOHN A. LAMBIE.COUNTY ENGINEER 9Q -a
- 'WILLIAM A. JENSEN. SUPT OF BUILDING
7AVATORY
ANT TO FILL IN JOCESSEDBY NUMBERR ITEM EACH FEE,$1.25 a..
1.25 ADDRESS., - H
. 1.25 CITY _ TEL. No.
L25 / q CONTRACTOR.
f5 • ` C -13IIlt] Ixl 1
1.25 ADDRESS _CITY n I, , TEL.NO :DISHWASHER '1.25 T:REGIS RASON NO. 2?+Q `3,rj1 QJE '•LAUNDRY TUB 1.25 CLOTHES WASHER 125 DISTRICT NO. GROUP /ZJpHE, PR
WATER HEATER 1.50 " Si Q 'I \ l (./L�
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL '
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM INSPECTION RECORD d
0
u
L W
a
N
Z
APPROVALS DATE INSPECTOR'S SSIGGRNTTURE
PERMIT S 2 OO UNDER SLAB WORK - lj J
ROUGH PLUMBING �yll��frl�' IQ Jy�j/y¢7I
TOTAL FEE GAS PIPING
HEREBY -ACKNOWLEDGE THAT 1• HAVE .READ THIS APPLICATION GAS VENT '
AND STATE THAT THE ABOVE IS CORRECT ANp AGREE TO.COMPLT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING. '
I-HEREBY CERTIFY TNAT 1 AM PROPERLY pEGI.T"ED ANOIOR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF /
CALIFORNIA OR-THAT AM THE LEGAL OWNER OF,AND INTEND TO GAS-TEST
RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO..NOTIFIED • v _
SIGNATURE F
FINAL
OF PERMITTEE
ALIDATION ROBERT A''WOOD
cK. M.u. CASH SUPERVISING MECHANICAL ENG'R
. �
..:.;.,._ 1 L, 5 3-8 0 OCT 29 5 D . 4.50—
Q
°AB
DSS:17 ( APPLICATION FOR PLUMBING PERMIT 1 °
DIVISION OF BUILDING AND SAFETY
9 Ham
'
Department of County Engineer
County of Las Angeles BUILDING /
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ��/ 1-'qa OLUA
Pd
• CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY -7P M,01& [/I r
FOR APPLICANT TO FILL IN I CROSS NEAREST. C H /r / f✓/� A
OWNER O/O Yl N DISTRICT NO. GROUP ZON READY FOR-105PECT ION
MAIL
ADDRESS _
INDUSTRIAL
CITY TEL. NO. WASTEAPPROVAL
PLUMBER .�. r a / - INSPECTION RECORD
ADDRESS -//n 6 1y/r p / L. MI �- X �
CITY /SSeel /c TENO.a 7
l 0 ..N;
LICENSE NO. /Q O S q /
NUMBER TYPE OF FIXTURE OR ITEM FEE
/ WATER CLOSET (TOILET) @ $1.00 S /JD
BATH TUB @ 51.00 i w -
SHOWER @ $t-00
/ LAVATORY (WASH BASIN) @ $1.00
/ KITCHEN SINK @ $1.00 D2)
DISHWASHER @ $1.00
/ LAUNDRY TUB OR TRAY @ 51.00 D v
CLOTHES WASHER @ 91.00
I WATER HEATER @ $1.00 d
GAS SYSTEM @ $1.00 D
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT - $ 1 00 ROUGH PLUMBING
!I A� GAS PIPING
TOTAL FEE n I/ GASVENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
ANO STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES _
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS AN LES COUNTY AND STATE OF /
CALIFORNIA OR THAT I A THE GA OWNER OF THE ABOVE UTILITY CO.NOTIFIED 11
DESCRIBED RESIDENTIAL PE
C
SIGNATURE
OF PERMITTEE 1// FINAL A
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR B
K. V. . CASH
L?A a 1 ; tui 2 8.0 0Ir. .
WORKERS'COMPENSATION DECLARATION •20-0026 DPW 4x90 APPLICATION TION FOp pLUMB'NG PERMIT
I.hgreby, affirm that I have a certificate of consent to seif.in' 76g667A /1 - •\r M, R ,f R
sure,or a certificate of Workers'Compensation Insurance,or a _ .
.Pokycertited copy thereof (sec.Company,
Lab. r, - COUNTY OF LOS ANGELES " DEPT. OF PUBLIC WORKS
Policy No. /`7y Company' v 6G
❑ Certified copy is hereby furnished.. - -FOR APPLICANT TO FILL IN(PRIM-OR TYPE) - BUILDING -
IC'.l' Certified copy is filed with the county building inspection _ ADDRESS
1�
department. NUMBER FIXTURE OR ITEM .(d_ ;s FEE
I `p /� s .LOCALITY
DateyC16�Applimnt �l�� ' /C�' � G WATER CLOSET(TOILET) - NEAREST
-CERTIFICATE OF EXEMPTION FROM WORKERS;' BATH TUB - , CROSS 57. ry L�SS/�R/� �/�0�Q
COMPENSATION INSURANCE - SHOWER - OWNER h/Or�/l{O C3�T/C�IN
'(This section need not be completed if the work Involved by MAIL
the permit is for one hundred dollars ($100)or lass.) LAVATORY ' - '_ ADDRESS 2�5 06!494 A'R'1
I certify that in the performance of the work for which this per- SINK s
mit is issued, I shall not employ any personinany manner so - - CITY �m��_ [� 40
TEL. NO.`�G^
as to become subject to the Workers'Compensation Laws. t
DISHWASHER CONTRACTOR
Date - Applicant CLOTHES WASHER ADDRESS ��3a S 7/'rylr,T L�
NOTICE TO APPLICANT: If,after making this Certificate of Ex- SWIMMING POOL RECEPTOR Q
emption;you should become subject to the Workers'Compen- _ CITY, �O.v �l/-1- �p-- TEL. NO3.
sation provisions of the Labor Code,you must forthwith comp- 'LAWN SPRINKLER SVSTENS
iy with such provisions or this permit shall be deemed revok- - - STATE •�cLIC. n 2
ed. - WATER HEATER . . - _ LICENSE NO. �sysgsz� CdASS
LICENSED CONTRACTORS DECLARATION . ' DISTRICT NO. PROCESSED BY ,
GAS SYSTEM OUTLETS / 1
1 hereby ricin that am licensed under Division
3 of the Chapter 1. d •CT.T
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER - 'G
and Professions Code, and my.license is in full force.and ef- 5 PER SYSTEM FINAL VA &TION 3.40
fect. Y HOSE BIB DATE
license Number LJ7�22�. Lia Classic: i d
a - _ FFI`NAL TOTAL 43 _ 4C6
'Contractor r J x/�+ `� /�'G Date 1 2— T=!
❑ I am exempt' CKCK 43,400.ander sec. CHANGE ' .0(t- 8.8P.C. for this reason ' Plan check fee- ► h
Date: PLUMBING PERMIT ISSUING FEE$' 7 ' p 0000-0001 4/25/963
'Signature -
TOTAL'FEE "y�.��j DO c
SINGLE FAMILY. � � � - � E106u 1 FM 4�`rP
HOME OWNER-BUILDER DECLARATION Plan check applicant •
1 hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and - -
Professions Code): Address - -
❑ I, as owner of the property, will do the work and the City - Tel. No.
structure is not intended or offered for so le(Section 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 -
(Sec,3097, Civ. C.).
Y 1SM1�
Lender's Name -
Lender's Address '
I certify that I haveread this application and state that the ,
above information is correct. I agree to comply with all County
ordinances and State lows regulating Plumbing, and hereby -
authorize representatives of this County to enter upon the -
a - nfioed ro>party inspection purposes. / - -
r�._ SEE REVERSE FOR EXPLANATORY LANGUAGE
-Sign lure of'Permittee ..Date