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Home My Public Portal About9920 BROADWAY_Plumbing__ c zswsBTw IE e�vell Aln APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING DORE55 9920 E. Broadway NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET LOCALITY Temple Cit BATH TUB NEAREST � AA //�� CROSSST. C(�C.kt-✓L-°'>+J SHOWER OWNER Walter F. Diener LAVATORY MAIL o ADDRESS 9920 E. Broadway SINK CITY Temple City TEL.No.286-6511 DISHWASHER CONTRACTOR Bryant Heat. & Air Cond. CLOTHES WASHER ADDRESS 1350 E . Las Tunas Drive SWIMMING POOL RECEPTOR CITY San Gabriel rEL.No. 286-1141 LAWN SPRINKLER SYSTEM STATE 1IC WATER HEATER LICENSE NO. 221751 CL455 Q20 GAS SYSTEM OUTLETS 3 00 DISTRICT NO G3. ZONE PR SSEDBY- OUTLETSOVER O O 5 PER SYSTEM INDUSTRIAL V WASTE APPROVAL W INSPECTION RECORD U W d N Z Plan check fee PLUMBING PERMIT ISSUING FEE$ 7 00 TOTALFEE 10 00 Plan check opplicont Nome APPROVALS DATE INSPECTOR'5 SIGNATURE UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES HOT WATER HEATER AND STATE LAWS REGULATING PLUMBING. I HEREBY C Y THA PROP LY REGISTERED AND/OR LICENSED AS PLUMB NG FIXTURES REQUIRED BY L ANG L 60UNY AN 5 ATE OF CALIFORNIA OR THAT)AM THE GAS TEST (�{,(/QU LEGAL OWNER AN NT ND TO SID IN THE ABOVE DESCRIBED RES' GE PROPERrv. UTILITY CO.NOTIFIED SIGNATURE �/ O n n OF PERMITTEE T ¢INA! O $b p j/ 1 rmo O O O PLAN CHECK'VALIDATION cK. M.o. cpsH U '-'PERMIT-VALIDATION CK. M.o. CASH (% o (l1 0 ' 0 o cn n Co!S 3 CH 76A6�)-CE817 12/59 �//� - APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY RIVISION BUILDING JOHN A. LAMBIE, COUNTY NGINEER ADDRESS Y7..1-V lO/�.D ihI�GLJ � WILLIAM A. JENSEN. SUPT OF BUILDING ff ' LOCAL � � FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER L' 7' WATER CLOSET MAIL _ ADDRESS �U .O.I BATH TUB Z /E CI TEL NO. SHOWER LAVATORY CONTMC OR '� C- N 'P c3 - SINR ADDRESS DISHWASHER CITY TEL. NO.'t— . T"]Q CONTRACTOR'S STATE LAUNDRY TUB REGISTRATION NO. S j,) COUNTY ❑ CLOTHES WASHER DISTRICT O. OUP ZONE PR ESSED BY WATER HEATER - O GAS SYSTEM INDUSTRIAL WASTE APPROVAL 7D 'p INSPECTION RECORD 0 O U m O b U w y ' Z / 0 $1.00 PER ITEM t OR FIXTURE $ / APPROVALS DAT INSPL•TORS SIGNATURE PERMIT $ 2 00 UNDER SLAB WOR /y /C TOTAL FEE cT OZ� ROUGH PLUMBING 5 GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER 1 HEREBY CERTIFY THAT 1 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 A SIGNATURE CA.y� �1/ I•nnFJA� OF PERMIT'E FINAL e f�,�qA„qAC l+:.rcd_.,CyA ®r VALIDATION ROBERT A. WOOD, CK. Y.O. CASH SUPERVISING MECHANICAL ENG'R r� LIfCo38s9iAR1 !{ DD 3 .00 °'8'511" 25M SETS 11-46 1APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFE �� ' COUNTY OFF TY LOS LOS ANGELES L� WM. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION - DISTRICT NO. I GROUP1 ZONE PER-MIT NO. _ �( R. r ROUGH FIXTURES COMPLETE HEATER CESSPOOL SEPTIC TANK R IVED BY READY FOR DATEISSED FIRST INSPECTION AS MISCELLANEOUS •L{�� V APPLICAT/NT// FILL IN HEAVILY OUTLINED PORTION ONLY rLoNAM / /�u � � iJOB. _! J�1 �� < / , I AGGRESS ADDRESSS! 7 � ��"t W `I"�L� LOCALITYNEAREST CITY (iyL�A- "''� - . TELNo �� CRCBS STCERT No /- 0 J bEXPIRESCATION.OF•SEPTIC TANK, OR CESSPOOL z MAIL 3 ADDRESS NORTH O CITY TEL. 1 AM THE LEGAL POBB BOMFH BOVE L09 ANGELES COUNTY C L Po IONV PLUM 1 AM THE LEGAL OWNER OF THE PROPER [ DESCRIBED ABOVE. .= N OWHEp y CORRECTIONS SOUTH J DESCRIPTION OF WORK i / BATH TUB "FURNACE SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINKWATER SOFTENER ' FLOOR BINK SANDTRAP SLOP SINK FLOOR DRAIN - WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN n DATE INSPSCTOR•S NAME WATER HEATER DENTALLAVATORY ROUGH PLUMBING I Its METER GAB SODA FOUNTAIN -OUTL OAS PIPING OAS VENT I I CESSPOOL I I r TOTAL NUMBER OF FIXTURES Qo SEPTIC TANK I I CESSPOOI �+EPTIC TANK SEWER I 3 UTILITY CO.NOTIFIED I/`✓ �-��I r TOTAL FEE FINAL °'B'S'17 'S"SETS 2-47 APPLICATION FOR PERMIT DEPARTMENT OFNG AND SAFETY PLUMBING' COUNTY OX.F LOS LOS ANGELES WM.J. FOX,CRIER ENGINEER NATURE OF INSTALLATION D15TRIC NO. GROUP zo E PERMIT o, ROUGH _ FIXTURES COMPLEL HEATER CESSPOOL SEPTIC TRECEIVED BY READY FOR FIRST INSPECTION DATS ISSUED 6A8 MISCELLANEOUS � /L fJl' �y 7 APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY / B NAMLC. NOTTINGHAM CO. AUBDRESS < -141 M OF TEMPLE CITY m ADDRESS LOCALITY 2 i EST CITY TEMP F l'IT L(A��c cRoee sr. m,(/�s•lP A, Gt/,Ld%1L COUNTY /1-/f p,/ CERT.No. EXPIRES m NAME /(//��_ U/ AX)7Z,iib AA LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL ADDRESS NORTH O CITY TEL.No. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER IMAM/LEGAL OWNER OP THE PROPERTY DESCRIBED ABOVE. R D 3 M OWNER y CORRECTIONS SOUTH J DESCRIPTION OF WORK a z BATH TUB FURNACE C7 d ROWER DIBHWA9HfiR p LAVATORY REFRIGERATOR KITCHEN BINK WATER SOFTENER ` FLOOR BINK SANOTRAP SLOP SINK FLOOR DRAIN WASH TRAY URAFINAL APPROVALS WATER CLOSET DRDATE INSPRe R'e NAMR WATER HEATER DEROUGH PLUMBING METER-GAS SOAB PIPING I I OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURESEPTIC TANK I I CESSPOOI SEPTICTAAKSEWERUTILITY CO.NOTIFIED TOTAL FEE FINAL WQRKEPS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby.affirm'that I have a certificate of consent to self 76A567A insure; or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lob. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. ElFOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS y -i.y tion deportment. NUMBER FIXTURE OR ITEM @ FEE ' �� LOCALITY �e WI pi., Ci L Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ' BATHTUB i1 CROSS ST. BOA LA W rig 4 L�•p ue" Vu e S& COMPENSATION INSURANCE I SHOWER V/1 OWNER WaUff ; E,tieyF �• (This section need not be completed If the work involved by 1! t! the permit is for one hundred dollars ($100)or less.) LAVATORY OT MAIL ADDRESS y zJ iJ` `0 LQ 41U y I certify that in the performance of the work for which this permit is issued, 1 shall not employ any person in any manner SINK CITY 1ra✓ss p W C i I TEL. NO. 'i Z3 G SIS so as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR IJ D 1- G V Date ( " �.1 Applicant � xizl"�xizl"�� CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY ij({C nA 1/x TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION WFINAL PR BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS(commencing with Section 7000) of Division 3 of the Business OUTLETS OVERand Professions Code,and my license is in full force and effect. 5 PER SYSTEMVALIDAT N VLicense Number Lic. Classad O Contractor Dote H U OW 1 am exempt under Sec. Us 8.8P.C. for this reasonPlan check fee # Q 2 q Date: I o o 3 Q.5 0 i PLUMBING PERMIT ISSUING FEE$ U ,e o e 3 4,5 0 c� Signature TOTAL FEE 3 0 1.27=86 Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and Professions Code): City Tel, No. IV I, as owner of the property, will do the work and the 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 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 �Il•:,wtw r � !, I - 2-�-fib Signature of Permittee Date