HomeMy Public PortalAbout5912 BURTON AVE_Plumbing__ .76A667A.
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL I N(PRINT OR TYPE( :BUILDING -
ADDRESS 5912 N . Burton Avenue
NUMBER FIXTUREORITEM' ® FEE
WATER CLOSETLOCALITY San Gabriel
'
'NEAREST
BATH TUB CROSS ST..
SHOWER OWNER Burwell , David ,
LAVATORY ADDRESS 5912 N . Burton
SINK CITY San Gabriel TEL.No. 287 -91131
DISHWASHER CONTRACTOR�Builder ' s' Center A/C
CLOTHES WAS I HER ADDRESS 1911 Chris Lane
SWIMMING POOL RECEPTOR,
CITY Anaheim 7 TEL.N0..937 -01.00
LAWN SPRINKLER SYSTEM STATE UC.
WATER HEATER LICENSE NO. 36562 CLASS C-20
1 GAS SYSTEM 1 OUTLETSAPPROVALS DATE INSPECTOR'S SIGNATURE
3 00
OUTLETS OVER UNDER SLAB WORK
5 PER SYSTEM ROUGH PLUMBING j.
GAS PIPING' d
GAS V ENT V
as
HOT WATER HEATER C
PLUMBING FIXTURES
GAS TEST ev,/6 N
Plan check fee UTILITY CO.NOTIFIED Z
PLUMBING PERMIT ISSUING FEE S 7 00
TOTAL FEE 10 0 0 FINAL
Plan check applicant - PLAN CHECK VALIDATION '
Nome
Address Ce ZO362 Q cf T-S 87
City , TEL No. 516 2 5 A
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION.AND STATE ,
THATTHEABOVE ISCORRECTAND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES # O O O e O 5
AND STATE LAWS REGULATING PLUMBING. PERMIT VALIDATION
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS O a
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE
LEGAL OWNER OF,AND INTEND TO RESIDE IN THEADOVE DESCRIBED RESIDENTIAL O O U
PROPERTY.
SIGNATURE 0 9,1 2—7 9
OF PERM ITTE
DISTR T NO. R $ED BY _
J
INDUSTRIAL "
WASTE APPROVAL
WORKER'S COMPENSATION DECLARATION 200026 DPW 9189 '
LI
I hereby affirm that I have a certificate of consent to self insure, 76A667A APPLICATION FOR PLUMBING PERMIT
or a certificate of Worker's Compensation Insurance, or a certified -
copy thereet(Sea 3800 Lab. C.) -
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OFPUBLIC DIV.
Policy No Company
Certified copy is hereby furnished.
Fl - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspection ADDRESS
department, - NUMBER FIXTURE OR ITEM 6 FEE LOCALITY 6.9 /g/_I-
g
Date Applicant - WATER CLOSET drO
NEAREST of
CERTIFICATE OF EXEMPTION FROM WOflKERS' BATH TUB CROSS ST. IL
p
COMPENSATION INSURANCE ASSESSOR
MAP BOOK �, 0 PAGE Q/ - PARCELG '
(This,section need not be completed if thawork involved by the SHOWER � �-� -.
permit.is for one hundred dollars($100)or less.) LAVATORY ! OWNER
I certify that in the performance of the work for which this permit ✓
is issued, I shall not employ any person in any manner so as toMAIL
SINK ADDRESSp� ly
become subject to the Workers'Compensation Laws.
DISWASHER CITY- TEL.NO. —O�y
Dale Applicant CLOTHES WASHER -
NOTICE TO APPLICANT: If, atter making this Certificate of - CONTRACTOR - Q
Exemption,you should become subject to the'Workers' Compensation SWIMMING POOL RECEPTOR
provisionsofthe Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION - CITY TEL.NO.
I hereby affirm that I am licensed under provisionsof Chapter 9 WATER HEATER d
(commencing with Section 7000)of Division 3 of the Business and STATE LIC. O
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS Q
OUTLETS OVER DISTRICT NO. PROCESSED BY O
• 5 PER SYSTEM i('.. v F
License Number Lie.Class
FINAL > %rALIDATION w
DATE (L
Contractor Date �^•� i
❑ Z
I am exempt under Sec. FI HiI.4T a
FINAL i -... .. .. � � Z
3,07 0.UJ
B.&P.C.for this reason EtEEEEEE / n
Plan check fee ;. 1 ITENS
Date: —
Signature PLUMBING PERMIT ISSUING FEE$ a�!05 D TOTAL 70- 65,
❑ TOTAL FEE D.IvS ._ NECK7iJ•�'�I
Plan check applicant •L
SINGLE FAMILY ,_ CHANGE 0
HOME OWNER-BUILDER DECLARATION Name'
I hereby affirm that I am exempt from the Contractor's License Law 11rf / 4 r
for the following reason(Section 7031.5. Business and Professions Address
Code):
rviCity _ 'Tel. No. - 8235 - 1 0111:41
3c
I, as owner of the property,will do the workand the structure -
is not intended or offered for sale (Section 7044, Business .
and Professions Code). D
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.CS)
Lender's Name
Lender's Address _
I certify that I have read this application and state that the above t 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 ins on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee D
r COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0404090021
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: - FEES PAID BUILDING ADDRESS:
TR: 5903 LT: 99 UN: .003 5912 BURTON AV N
ASSESSOR INFORMATION NUMBER:
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB CA 917752630
NEAREST CROSS STREET: HERMOSA
5386-014-054 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 2.00 FIX 32.40
TENANT: 21 HOSE BIBB(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
25 LAVATORIES/SINKS 2.00 FIX 32.40 04/09/04 VG 10/06/04
45 WATER CLOSE(/URINAL 2.00 FIX 32.40
OWNER: TEL. NO: TOTAL FEES 141.15 FI LT F IAL BY: CODE:
TRAN KIEN H;NGO CAROLYN (626) 451-0336-
5912 BURTON AV
SGAB 917752630 D IPT/U! OF WORT
PLUMBING F R ADDITI
APPLICANT: TEL. NO:
T B CONSTRUCTION (626) 675-1119-
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
T B CONSTRUCTION (626) 675-1119-
520 N. MOORE AVE. LIC. NO UNDER SLAB WORK
MONTEREY PARK, CA 91754 746963 B
WATER SERVICE
ARCHITECT OR ENGINEER: TEL. NOPLASTIC Y/N METAL Y/N:
ZHANG, R (626) 233-5640- ROUGH PLUMBING
7220 N ROSEMEAOSEMEAD BLVD LIC. N0: L Z
STE 202-8 043767 TAS PIPING
SAN GABRIEL, CA 91775
GAS VENT
HOT-WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS
UTILITY COMPANY NOTIFIED
CWV
GRAYWATER SYSTEM
REPORT 10: DPR263 ROUTE TO: B50508