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HomeMy Public PortalAbout9637 BROADWAY_Plumbing__ 76A667-CE917 12/59 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEERTA ING BUILDING AND,$AFETY DHNISIONESS �o�'/ JOHN A. LAMBI COUNTY NGINEER WILLIAM A.JENSEN, SUPT Or BUDDING LITY FOR APPLICANT TO FILL IN EST S ST. NUMBER FIXTURE OR ITEM ER WATER CLOSET BATH TUB ES :7COUNTY SHOWERLAVATORYCONTRACTOA SINE ADDRESS DISHWASHER LAUNDRY TUB REGISTRATION NO. CLOTHES WASHER DISTRICTNO. G OUP ZONE P ESSED BY WATER HEATER Ji O GAS SYSTEM INDIISTRW, WASTE APPROVAL INSPECTION RECORD w r f_ V G O , V O1 w z z ® ORE PER ITEM S APPROVALS DATE// INSPECTOR'S SIGNATURE PERMIT b 2100 UNDER SLAB WORK TOTAL FEE�� ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATUREOF PERMITTER ! ! ►a"— FINAL •Z2 /Nj I-:WA�✓IYiNI��f ®ePYA 0. ON ROBERT A. WOOD. M. m.D. cnsH SUPERVISING MECHANICAL ENG'R t a 3 4 8 3 S JUL 1 2 5 0 J .L 0 0 76A667-Cce17�59 M/DDLE APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION PBUILDENG TORN A. LAMBIE. County En ineez DRESS '7 CASSATT D. GRIFFIN. Supt of Building CALITY L FOR APPLICANT TO FILL IN AREST OSS ST. I, NUMBER FIXTURE OR ITEM NER WATER CLOSET BATH TUB DRESS, IT SHOWER CITP a„ LAVATORY CONTRACTOR SINK ADDRESS / DISHWASHER CITY /J) , "--.;f TEL. NO. CONTRACTOR'S ! STATE LAUNDRY TUB REGISTRATION NO. ~ -7 COUNTY CLOTHES WASHER DISTRICT NO. GROUP I /ZONE PPR/9C_ESSED BY3 WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD AISPAI E�u_t,s'n 7MU 4Af..- (36'7' 1-71-ARS !✓e 16-V c AAlt MIT CA&I P)?a v/Of_=0 74 FLOG✓ OA FIXTURE $ /0 j Z,0-1 To./NS!'i✓lPE©UJ'TEp— APPROVALS (( DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER �`NORK —.2L—(0 � TOTAL FEE ROUGH PLUMBING / 'J- GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT p WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES CE LINSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTE FINAL ®F VALIDATION ROBERT A. WOOD, CK. B.Q. QAZH SUPERVISING MECHANICAL ENG'R �AQ�p 5 5 4 9�B JAN 2 2 5 A 1 2.0 0 WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby;affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 sure,or a certificate of Workers'Compensation Insurance,or a 76A667A certified copy thereof (Sec. 3800, Lab�.�Cr�)?�� �IILJIII Policy Ncd 70'01 Company.7.*4vW Ukib - 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 inspection ADDRESS u department. U !� NUMBER FIXTURE OR ITEM ,@/( FEE Date Q� /�� t /Applicant �rZ- ��a/� ! A •'Y�� NEAREST � V ! n WATER CLOSET(TOILET) CERTIFICATE OF EXEMPTION FROM WORKERS' r BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER - OWNER J (This section need not be completed if the work involved by MAIL l the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITV TEL. NO. as to become subject to the Workers'Compensation Lows. DISHWASHER CONTRACTOR �� – Date Appticont - CLOTHES WASHER ADDRESS �. C 2 NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption, you should become subject to the Workers'Compen- CITY, EL.NOi5�f-7 sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE rte' y LIC. ed. WATER HEATER LICENSE NO. /T/ d Y CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINALg VALIDATION fect. ssyy33 HOSE BIB DATE�J`z�j6 y a License Number �7 'r� Lic. Class J3 Iq js� / FINAL 0 Contractor✓h�,Q– III' ME- 8,�` � Ag lb _ . �' !y BY 2 Z� 1 F '.it0 o ❑ I am exempt under Sec. ITEM,: U LU B.BP.C. for this reason Plan check feeIi ► IAL 119 . 10 0. Date: -.L!r;.t,, r± y1;Z PLUMBING PERMIT ISSUING FEE il;o_ Signature p r TOTAL FEE SINGLE FAMILY t'j.{ HOMEOWNER-BUILDER DECLARATION Plan check applicant I 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 526_:' ! i't E] I, as owner of the property, will do the work and the City - Tel. No. structure is not intended or offered for sale(Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 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.). 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 lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the �a ave-m�e/n�'°ne ro t f r inspection purposes.ses. , L f7 y�.,J 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 0506 0606010026 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 2B5-0488 ERT: LEGAL ID: FEES PAID BUILDING ADDRESS: _ ON FILE 9637 BROADWAY - FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: TEMP CA 917803211 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8588-009-020 01 PERMIT ISSUANCE FEE 27.75 THOMAS, PAGE: .5__97 GRID: A3 LOCALITY:_TEMPLE CITY, C 13 DISHWASHERS) 1.00 FIX 16.20 `r TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL FEES 60.15 06/01/06 SK 11/28/06 OWNER: TEL. N0: FINAL GATE FINALE: INDA BROADWAY A;MONICA M X626) 285-0180- 9637 BROADWADWA N1Y U TEMP 917803211 DESCRIPTION OF WORK KITCHEN REMODELING SINK, DISHWASHER APPLICANT: TEL. NO: MORAD (818) 519-7706- 12348 MAGNOLIA BL. SPECIAL CONDITIONS: VALLEY VILLAGE 91607 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE HIGH STAR CONSTRUCTION (888) 272-6868- 18375 VENTURA BLVD. %206 LIC. NO UNDER SLAB WORK TARZANA, CA 91356 877520 B 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