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HomeMy Public PortalAbout9651 BROADWAY_Plumbing__ 76AG67C ICE 81)d) 11/76 11 �. . APPLICATION FORPL.UMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS WATER CLOSET 3oo LOCALITY NEAREST ' BATH TUB CROSS ST. SHOWER OWNERMAL / LAVATORY QO ADDRESS / SINK Z CITY X _�r TELNO. DISHWASHER CONTRACTOR lS .LJA�/I���� CLOTHES WASHER 3 v 0 ADDRESS P�. `JY � �r C7 SWIMMING POOL RECEPTOR CITY ' TEL.NO. - LAWN SPRINKCERSYSTEM STATE LIC. WATER HEATER LICENSE NO. , CLASS C GAS SYSTEM OUTLETS •f a U DISTRICT N4. 7UP ZONE ROCE ED BY OUTLETSOVER ✓ Q 'j " / 5PER SYSTEM INDUSTRIAL 6 WASTE APPROVAL O INSPECTION RECORD V O F U IL IL Plan check fee Z PLUMBING PERMIT ISSUING FEE$ D TOTAL FEE Plan check applicant , APPROVALS DATE INSPECTOR'SSIGNATURE Name n UNDER SLAB WORK ps."277� Address ROUGH PLUMBING City Tel.No. GAS PIPING v . I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GASVENT THATTHE ABOVEISCORRECTAND AGREE TO COMPLYWITH ALL COUNTY ORDINANCES HOT WATER HEATER AND STATE LAWS REGULATING PLUMBING. HEREBY CERiI THP Y RE STERE AND/OR LICENSED AS PLUMBING FIXTURES LEGAL O BYLOSANES !gRL TAPM THE GA$TEST / �'LEGAL OWNER OF.ANIN THE ABOVE CRIDED RESIDENTIAL PROPERTY, UTIUTYCO.NOTIFIED SIGNATURE of FINAL PLAN CH MALIDA710N�4� ca M D cAsr ! PERMIT VALIDATION cK M.D. cnsry C©PvEP-fit dS/ 10�y 9 O'rcL 22 5 U 22.5 0 &`�' "OZiCY HOLDER: POLICY NUS:32R: 76A667-CE817-11-57 APPLICATION FOR -PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER - -" - BUILDING AND SAFETY DIVISION BUILDING C , C JOHN A. LAMBIE. County.Engiv.. I t CASSATT D. GRIFFIN.'Sup t of Building_1_111 LOCALITY _ u"LENT e FOR APPLICATO FILL IN NEAREST CROSS ST. L NUMBER FIXTURE OR ITEM - WATER CLOSET OWNER — MAIL BATH TUB ADDRESS SHOWER CITY TEL. NO. _ Y LAVATORY CONTRACTOR ' SINE ADDRESS 44 , DISHWASHER CITY TEL. NO. LAUNDRY NB CONTRACTORS STAS p;; REGISTRATION NO. COUNTY ❑ CLOTHES WASHER DISTRICT NO. GROUP ZONE READY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD A- '1-tr, c� I A,,-I , APPROVALS @ 51.00 PER ITEM .� Q DATE ,1 NSPECTOR'S SIG ATURE /!J OR FIRTURE S 61=- UNDER 9P 48VVORK ,. yy S PERMIT § 00 ROUGH PLUMBING TOTALFEE Ou GAS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT v IV AND STATE THAT THE ABOVE IS CORRECT AND AGREETOCOMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. ^ PLUMBING FIXTURES It I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR GAS TEST Y n" rj- 1 LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTI FIED / . µ DESCRIBED RESIDENTIAL PROPERT .,� SIGNATURE OFPERMI7TE FINAL ' ROBERTA.WOOD. ©r VALIDATION SUPERVISING MECHANICALENG'R CN. M.O. CASH I.P:Ca 6 8 0 3 tau 19 5 A 8 ,0 0 WORKERS'COMPENSATION DECLARATION APPLICATION FOR IDG BACAII$�Ia IIrP PERMIT I hereby affirm that I have a certificate of consent to self. 76A667A APPLICATION PY II GSI I� II'(�Ir IL ICY/tl9ur GCI`L9 If�151i1GV9 I,.I insure, or a certificate of Workers' Compe safion Insurance, CE 817.(REV. 10/81) or a certified copy thereof (Sec. 3800, L c.) COUNTY OF LOS ANGELES DI G AND SM ETY Policy No, Compan) - Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / Certified copy is filed with the county but g inspec- ADDRESS (O tion department, NUMBER FIXTURE OR ITEM - L 'FEE- - . LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTIO FROM WORKERS' II BATH TUB CROSS ST. COMPENSATION INSURANCE - OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL /� ADDRESS I certify that in the performance of the.work for which this cin permit is issued, I shall not employ any person'in'any manner SINK CITY TEL. NO. )L a so as to become subject to the Workers"Compensation Laws.. / DISHWASHER - CONTRACTOR I /- Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS * 5p,r Exemption, you should become subject to the. Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. N a with cam with such provisions or this permit shall be LAWN SPRINKLER SYSTEM Py, P P STATE 1 Q UC. deemed revoked. WATER HEATER LICENSE NO.V /p � CLASS LICENSED CONTRACTORS DECLARATION. DISTRICT NO. P ESSFM I hereby affirm that I am licensed un der provisions of Chapter 9 GAS SYSTEM - OUTLETS /. (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER. , U } and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALd .L(�p1 � q. VALIDATION O license Numbe �/�� Lic. Class C DATE-,� `, � FI BYA ` - O Contractor_�f�,Date' C��`/•'F/'K-3— ❑ O�p��fY(Y CL V I am exem un er Sec J��Jj B.BP.C. for this reason / I p( ? Plan check fee // —Date:— PLUMBING PERMIT ISSUING FEE$ Q S� D / O Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 9 L 2 PI I hereby affirm thati am exempt from the Contractor's License ,02 gddress Law for the following reason (Section 7031.5, Business and '}f o 0 o a e 5 Professions Code): - City Tel. No. ' ❑ 1, as owner of the property, will do the work and the ,2 a-' 1 65 0 structure is not intended or offered for sale (Section. ' 7044, Business and Professions Code). _ D s.e a T 6 5 05 CONSTRUCTION LENDING AGENCY 0 6 1 6-8.3 '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 D above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby " authorize representati of this County to enter upon .the above-ment' ned pro erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa Permittee 1,2 _ r� WORKER'S COMPENSATION DECLARATION '20-0026 DPW 91139 6ASI APPLICATION FOR PLUMBING PERMIT u 1 hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a cerci f' tl copylhereof(Sec.3800 Lab.C.) olCOUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. ❑ Pwy No. 7�Compan Codified copy is hereby furnished. BUILDING ^ J FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS U•GVf T/ Cenified copy is filed with the county building inspection d�epa-n(me NUMBER FIXTURE OR ITEM @ FEE LOCALITY k Data Applicant WATER CLOSET NEAREST CERTIFICATEOF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by thev� SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)Or less.) OWNER hcertify that in the performance of the work for which this permit LAVATORY ' is issued, I shall not employ any person in any manner so as toMAIL Q - SINK ADDRESS O become subject to the Workers'Compensation Laws. DISWASHER CITY TEL,NOL Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT`. If, after making this Certificate of n _ Exemption;you should became subject to the Workers' Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code, you must forthwith comply with such /// provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER d (commencing with Section 7000) of Division 3 of the Business and -- STATE LIC. 0 Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE DIS CLASS V DISTRICT NO. PROCESSED BV OUTLETS OVER O 1 / 5 0- SYSTEM �D� - 2 �_ . F_ License Number �llc,L� Lic.Class_ A J9 `� .✓" U FINAL VALIDATION LU Contractor �/� "" „" pate �I- 7 I DATE[ al ❑ I am exempt under Sec. FINAL VAL ? B.BP.C.for this reason Plan check fee Date: / Signature PLUMBING PERMIT ISSUING FEE$ El - TOTAL FEE �p c Plan check applicant _ SINGLE FAMILY A, . a HOME OWNER-BUILDER DECLARATION Name - I hereby affirm that I am exempt from the Contractor's License Law "-1,1 llifor the fallowing reason (Section 7031.5, Business and.Professions Address Code): - 1 ITEM- City Tel:No. _ r� e ❑ I, as owner of.the property,will do the work and the structure I_!i HL —?0 is not intended or offered for sale (Section 7044, Business and Professions Code). n ,-i11 CONSTRUCTION LENDING AGENCY - - - - - _:}-ANGE 'e Do I hereby affirm that there a construction lending agency for the performance of the war f vhich this permit is issued (Sec. 3097, - Civ.C.) 111�11t —fjl i,,j �% ''Y1 Lender's Name Lenders Address certify that I have read this application and state that the above - D information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 (PCUMBFNG-PERMITN DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL-0508-9803060003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING-ADDRESS: . _ ON FILE 965.1-BROADWAY- FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803211 N ASSESSOR INFORMATION NUMBER: NEAREST,�CROSS .STREET: 8588-009-032 01 PERMIT ISSUANCE FEE 27.75 THOMAS'PAGEF 597 GRID: A3 LOCALITY- TEMPLE-CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.35 TENANT: 11 CLOTHESWASHER(S) 1-00 FIX 16.35 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 25 LAVATORIES/SINKS 1.00 FIX 16.35 03/06/98 UT 03/06/99 45 WATER CLOSET/URINAL - ;1:OO: FIX(! .16.35 OWNER: TEL—NO- 47 WATER HEATER(S)' 1.00 WTH' 16.35 FINAL DATE FINAL BY: CODE: 9651SILVERTHORNBROADWAY CAROIYN R;ROGERS JAMES (626) 292-1715- 51 LOW PRS GAS 5 OUTLET, 1-00, SYS 16.35 -f 1W -?. Y� I ,„ril_sr1 p) 9651 BROADWAY r, TOTAL FEES ' 125.85 �C� A'h./ l.Ji' 1'�-•�ie TEMP 917803211 DESL IPT, ON-OF-WORK— � C PLUS-F,OR-INTERIOR-ADDLLIONAL-BATHJ APPLICANT: TEL. NO: WESTEC CONSTRUCTION (818) 760-8530- SPECIAL CONDITIONS: ANGELES CO S CONTRACTOR: TEL. NO: O Ar APPROVALS DATE INSPECTOR SIGNATURE WESTEC CONSTRUCTION (818) 760-8530- V ✓ 6207 BABCOCK LIC. NO UNDER SLAB WORK NORTH HOLLYWOOD, CA 6682608 WATER SERVILE 1 PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: L. 0: Ir h =�\— \ ROUGH PLUMBING LIC. N0: i1t 1111 GAS IPING T GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS i GAS TEST ^ " UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM . \� - REPORT ID: DPR263 ROUTE TO: BS0508