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HomeMy Public PortalAbout9557 BROADWAY_Plumbing__ 76A667-CE#8I7 9/63 L /J . ' APPLICATION FOR PLUMBIN6' PERMIT C COUNTY OF 'LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Bu ILD 95 7 Broadway JOHN A. LAMBIE, COUNTY ENGINEER WILLIAM A. JENSEN. SUPT OF BUILDING LOCALITY Temple City_ FOR APPLICANT TO FILL IN CROSS sT. Temple City .Blv]NO. 3u NUMBER FIXTURE OR ITEM EACH FEE OWNER NOel Baldwin- 18 aldrnny 18 WATER CLOSET $1.25 22 50 p ADD 4116 Baldwin B 6 BASH NB L25 1 O ADDRESS SHOWER 1.25 7 50 CITY El Monte TEL 18 LAVATORY 1.25 22 50 CONTRACTOR Owen Bros P 6 SINK 1.25 7 50 ADDRESS 4265 N. Bald 6 DIsHWASHEA 1.25 7 O CITY El Monte TELLAUNDRY TUB 1.25 CONTRACTOR'S REGISTRATION NO. 6 CLOTHES WASHER 1.25 O DISTRICT NO. GROUP 2,10 P B SSED BY 6 WATER HEATER 1.50 9 OD 6 GAS SYSTEM 5 OUTLETS 1'50 9 OO INDUSTRIAL a WASTE APPROVAL Q OUTLETS OVER 5 PER SYSTEM .20 $ INSPECTIOWRECORD /_, U u ' "a)f, ' APPROVALS DATE INSPECTOR-S-S'IIGANATURE PERMIT S • 2 Co. UNDER SLAB WORK _/Z•- �� /" ROUGH PLUMBING TOTAL FEE3 \ •� lOZ 5O GAS PIPING V 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT 1 AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS .REGULATING HOT WATER HEATER PLUMBING, 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AN. PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY -ANO STATE OF GAS TESTS CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN, THE ABOVE LCF O RESIDE TTI QROP'�E))RTY. UTILITY CO.NOTIFIED SIOF PERMITTEE_ FINAL _ / �/6 + VALIDATION ROBERT A. WOOD cK. M.O. CASH SUPERVISING MECHANICAL ENG'R ' LAC01_4 VAY11 5 D 10 2.5 O~ �2G?=-cam 76A667A (OE 81i j 4/77 ' ,,APPLICATIONnFOR PLUMBING PERMIT T, BUILDING.AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPEI BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST. P Y SHOWER OWNER A LAVATORY MAIL ADDRESS S C SINK CITY TEL,NO DISHWASHER 3. CONTRACTOR ' �`L J CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR [/ - CITYX' J �' TEL.N11 LAWN SPRINKLER SYSTEM STATE LIC. WATER HEATER LICENSE NO. /�� CLASS GAS SYSTEM OUTLETS DISTRI NO ROUP -Z NE ROCESSE BY OUTLETS OVER 16 _3 SPER SYSTEM INDUSTRIAL V WASTE APPROVAL 0 INSPECTION RECORD U W a N Z Plan check fee I I - PLUMBING PERMIT ISSUING FEE$ 76 TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK ' Address ROUGH PLUMBING City Tel. No. GAS PIPING / I HEREBY ACKNOWLEDGE THAT.L NAVE READ THIS APPLICATION AND.STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR'LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES-COUNTY AND STATE OF LIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF.AND INTEND TO RESIDE IN THE VE DESCRIBED RESIDENTIAL PROPERTY. ,n UTILITY CO.NOTIFIED SIGNATURE C/.r OF PERMITTEE FINAL `PLAN CHECK VALIDATION _ CK. M.O. CASH PERM( VALIDATIONM.o. 'cASH 3..1 9- ..AJC L) 1 G:.O.U Az,,l- 6 '-. WORKERS COMPENSATION DECLAR4F ON- - • ffum hereby a :-tho1 haJe'a certificdte of consent to,self .'76A667A - APPLICATIO.N"FOR PLUMBING :PERMIT insure, or a certificate,of Workers' Compensation Insurance, .CE 817'(REV..10/81') • i or a certified copy;thereof (Sec:3800,Lab. C) - - COUNTY OF;LOS ANGELES BUILDING AND SAFETY . Policy No _ CoepcnY Certified copy s hereby furnished. - • - - .. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ! l Certified copy is filed,w _/ith the county build mg.inspec ADDRESS J 57—' hon department. NUMBER ', FIXTURE.ORREM' FEE'. , ` '.CWATER:CLOSET LOCALITY Date Applicant "'r NEAREST CERTIFICATE OF EXEMPTION FROM,WORKERS'- BATH TUB _ . � - +.CROSS ST:" ,COMPENSATION INSURANCE - -SHOWER. _ ER ar ��' - A (This section need not be completed.if the work in4oWed by' ' - . • "- - OWNER F .the ermit is for one hundred dollors;(S100 or less. - - . MAIL P ) ,I - LAVATORY - ADDRESS" I cerhfy'that in the performance of the work for which'this r - .permit is issued, I shall not employ any person in any manner' SINK CITY'., p - �, - TEL.,NO. y C) so as to became subject to the Workers'Compensaiion'Lows: DISHWASHER' - - CONTRACTOR Date Applicant ' " CLOTHES:WASHER - - - - NOTICE TO,APPLICANT:.If;softer making this Certificate of ADDRESS . Com e ono'toyour'should become, subject ,to the `Workers' SWIMMING POOL RECEPTOR - _ - ou must forth - - - CITY TEl NO p provisions of the,Labor'Code, y SPRINKLER SYSTEM - ;v'ith comply with such p-rovisions or,this permLAWN it .shall be. STATE UC deemed.revoked.' -' WATER HEATER LICENSE NO. CLASS' LICENSED CONTRACTORS DECLARATION-. •v DISTRICT'NO.. - CESSED"Bv - GASSVSTEM OUTLETS .I hereby bffirm'Ihotl"am licensed under provisions of Chapter 9, _' '�� - 16 (commencing with.Section 7000) of Division 3,of the Business • OUTLETS OVER - G and Professions Code, and my license is in foil force.and.effect 5 PER SYSTEM DAN EL .VALIDATION License Number L c. Class' - - - , ` of FINAL . �. O Contractor Date - - BY V El >u 4 am exempt under Sec: � B.BP C.'for-this reason3 -® z ch . Plan, eck fee- ,A 9.3,9.4 A Date: °PLUMBING'PERMIT ISSUING FEE$ ' Signature - ,. '#je-oa ass 5-• TOTAL FEE' Plan'check applicant - 21e e'1 4.50 _ ,SING LE FAMILY• - tJ • jHOME OWNER-BUILDER DECLARATION Nome r , U'S -~ •. I hereby offirm;that I am exempt from the Contractor's License .Address - - - T 0A 2,7'- 8`3 "Law;for the,following-reason.(Section 7031':5;,Business'and', — Professions Code): - _ - r City - Tel. No. .. - - ©'. 1, as owner:of the property, will,do the work;and the - structure'is,.not intended or•offered:for-sale'(Section ", 7044 essions e). Business and ProfCod - - - CONSTRUCTION LENDING AGENCY` - - t - hereby affirm that there is�a construction lending agency for - ihe'performance'of the work for which this permit is issued ,.(Sec:3097 Civ..C:). .. .. Lender s,Ndme Lender's Address - - I certify that I have read 1his.applLcation'and state that the: ,'above information's correct..)ogree to comply with all'County ordinances and.State.laws iegulanng Plumbing, and hereby authorize representatives of,this'Countyto enter upon the .above mentionedproperty for inspection purposes. - • 'nr . ' ' /' t - - - 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 0912230003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: ITR: 30243 UN: 24 1 9557 BROADWAY 5 1 EEE DESCRIPTION: QUANTITY: DOM: AMOUNT: 1 TEMP CA 917803159 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: TEMPLE CITY BLVD. 18588-005-058 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: S4 LOCALITY: TEMPLE CITY, Cl 125 LAVATORIES/SINKS 2.00 FIX 32.40 1 (TENANT: 141 TRAP PRIMER(S) 1.00 SYS 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: T I TOTAL FEES 76.35 112/23/09 SR 12/23/10 TOWNER: TEL N0: (FINAL DAT FINA��'L BBY���: CODE: IOLSZEWSKI MARIE (626) 309-2850- 19557 BROADWAY - , 11 ITEMP 917803159 IDE RIPTION OF WORK IREPLACE KITCHEN SINK/DISPOSAL REPLACE DISHWASHER REPLACE IBATHROOM LAVATORIE (APPLICANT: TEL. NO: MATHSON (323) 806-2840- 1900 DALMA DR. (SPECIAL CONDITIONS: ARCADIA, CA 91006 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE MATHSON, STEVE (323) 806-2840- 1 1 900 DALDMA DR. LIC NO (UNDER SLAB WORK ARCADIA, CA 91006 NONE i (WATER SERVICE (PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: I - (ROUGH PLUMBING 1� ^/ I Lv' LIC. N0: (GAS PIPING GAS VENT (HOT WATER HEATER IKEUMB ING FIXTURES LAWN SPRINKLERS TGA£ TEST (UTILITY COMPANY NOTIFIED( CWV GRAY WATER SYSTEM I I I I II I IREPORT ID: DPR263 ROUTE TO: BS0506 T I