HomeMy Public PortalAbout6222 BURTON AVE_Plumbing__ J6A66 APPLICATION FOR PLUMBING PERMIT 1
aeG.IT(DIVISION OF BUILDING AND SAFETY
Departnent of County Engineer
County of Los Angeles rADDRESS
ILDING
JOHN A. LAMBIE. COUNTY ENGINEER O�
CASSATT D. GR I FFIN"•SUPT OF BUILDING Lj�, . .
CALITY .fG(/(/1/rr�(�(�'�(�L(„�
FOR AP/P�LICAgNT�TO FILL IN NEARS sT. !/I/tl
OWNER ! zz )"'✓L))T��✓✓L' ,l DISTRICT NO. GROUP ZONE I READY FOR INSPECTION
MAIL
ADDRESS
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CITYITEL. NO. INDUSRIAL
WASTE TAPPROVAL
PLUMBER rCG�rr, t-iGbt. C^ INSPECTION RECORD
ADDRESS i/ 'T4S F 't /- "-Cz K`FI✓7''AP-67'h -0 1Ole T
CITY�'� W TEL. NO!7r/ '3.4 14-A--re--M .4,��c/41-6App.�a L.!_"A/< /N eT
LICENSE NO. 97s
NUMBER TYPE OF FIXTURE OR ITEM FEE ���,�T/��% G�/,�FC'r/O/✓S iJ/v'T
WATER CLOSET (TOILET) @ $1.00 5
BATH TUB @ $1.00 2.3��6 O L✓/_F q
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $I.00
WATER HEATER @ $1.00 ao
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTORS SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
.t GAS PIPING
TOTAL FEE J GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THATAM THE LEGALOOWNEK, OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBED RES]DENTIA P,RO^PERTIY�.� `
SIGNATURE ✓vL1� �` ,L Lf�
OF PERMITTEE FINAL
I
JOHN A. LAMB 17. CODNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. Y.0. CASH
:_,T,02 8 6 ?w) My 2 9 3 2.0 0 n
_ VVrORKQRS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
"•i
� 1 her�`dffirm;thS�I;Rave a r_ertificafe of consent to self ]6A66]A
'+�E�eS..ee;�gcertificate of Workers' Compensation Insurance, CE gI�(REV. 10/81)
or a t tied copy thereof (Sec. 3800, Lob. C.) a'f/'/// COUNTY OF LOS ANGELES BUILDING AND SAFETY
ZZ) � "
_Policy o. Compony� +!
}K�Jf Certfied copy is hereby furnished. BUILDING _
L1 Certified
APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS
Certified copy is filed with the county building inspec-
tion department. NUMBER FIXTURE OR ITEM @ FEE
LOCALIT�
Dote-'U-17e'6Applicant �f� WATER CLOSET DO NEAREST '
CERTIFICATE OF EXEMPTION FROM WORKERS' `3 BATH TUB d d CROSS ST.
COMPENSATION INSURANCE
_.f�
(This section need not be completed if the work involved by SHOWER OWNER
MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY J 4 ADDRESS S
I certify that in the performance of the work for which this p
permit is issued, shall not employ any person in any manner SINK U CITY _ TEL NOs� '�35
so as to become subject to the Workers'Compensation Laws. / DISHWASHER Q O
�} CONTRACTOR
Date Applicant CLOTHES WASHER Q (/ ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers" SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL NO.
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTT tJO. PROCESSED BY
I hereby affirm that t am licensed under provisions of Chapter 9 , GAS SYSTEM S OUTLETS G}
191
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER / }
and Professions Code,and my license is in full force effect. 5 PER SYSTEM FINAL LIDATION d
License Number 7-w Lic. Clas� DATE V
FIN /
ContractorDate B
V
❑ W
I am exempt under Sec. O.
B.BP.C. for this reason N
Plan check fee U 4 / Z
Signature
Date: PLUMBING PERMIT ISSUING FEE$ O
T O
TOTAL FEE Q V V
LAdd,ess
applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Low for the following reason (Section 7031.5, Business andProfessions Code): Tel. No.
❑ I, as owner of the property, will do the work and the # o o e o e 5 -
structure Is not intended or offered for sale (Section ,
7044, Business and Professions Code). I o ' 00.50 Q50
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 o e 100506
(Sec. 3097, 0, C.),
I 028-85
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 re acing Plumbing, and hereby
authorize representaI s r?
is County to enter upon the
above-mentioned I, or inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature o Pe tee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 r �PttlMBTNG PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS Pt-o568 00006090014
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: ES PAID BUILDING ADDRESS:
TR: 5903 LT: 6 UN: .002 6222-BUR7QH-AV-N7
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: SGAB-CA 9177523'33
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN
5386-006-045 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: G2 LOCALITY: TEMPLE CITY
47 WATER HEATER(S) 1.00 WTH 16.20
TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
06/09/00 UT 12/06/00
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
SMITH JOSEPH F;KERI 0 (818) 309-1364- 1 �,�
6222 BURTON AV 10"
SGAB 917752633 DESCRIPTION OF NDRK
f-OU
APPLICANT: TEL. NO: yIATER-MEAT R_CH"G
ACTION CONTRACTORS (310) 515-1311-
17111 S. BROADWAY SPECIAL CONDITIONS:
GARDENA, CA 90248 _
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ACTION CONTRACTORS (310) 515-1311-
17111 S. BROADWAY LIC. NO UNDER SLAB WORK
GARDENA CA 91775 LOMITA
WATER SERVICE
�• / _ �" `\� -
ARCHITECT OR ENGINEER: TELPLASTIC Y/N METAL Y/N. NO: � � '
ROUGH PLUMBING
LIC. NO: -
r I � GAS PIPING
GAS
HOT WATER HEATER
PLUMBING FIXT RES
LAWN SPRINKLERS
•� :� � GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR263 ROUTE TO: BS0508