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HomeMy Public PortalAbout10022 DAINES DR_Plumbing__ 76Ae67 17 a-BO ID APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES ., PLUMBING 1 WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. cs / • R/ ©9 93 / PLUMBERRECEIVED BY READY FOR DATE ISSUE44 22 141� / FIRST INSPECTION �� ADDRESS L �/ I/I' � � U.SBUILD /009 //., ADDRESS o ✓C //Q./✓.I rl ///�/� NG CITY / Ci//!/U /e �/��TEL. NO. / L,/ �dG��f✓ COUNTY LOCALITY / LICENSE NO. ^/D Q i� EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER r /' / �/'� Zti MAIL WATER CLOSET (TOILET) @ 0.501$ ADDRESS BATH TUB @ O 501 CITY TEL, NO. / I SHOWER Q O 50 I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND / LAVATORY (WASH BASIN) @ O SO AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ O 50 STATE LAWS REGULATING PLUMBING. I T CERTIFY THAT I' POSSESS HE ABOVE VALID LOS LAUNDRY TUB OR TRAY Q 0.50 1 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER GAS SYSTEM OUTLETS @ O 50 1 OF THE RESIDENTIAL ROPERVY DESCRIBED ABOVE. SIGNATURE OF WATER HEATER @ O 50 I PERMITTE SLOPSINK @ 0 501 INSPECTION RECO FLOOR SINK @ O 50 FLOOR DRAIN Q O 501 DISHWASHER @ 0,501 DRINKING FOUNTAIN @ O Sol URINAL @ O So HOUSE SEWER @ O 501 Z MISCELLANEOUS c� APPROVALS DATE INSPECTOR'S NAME r • ROUGH PLUMBING GAS PIPING GAS VENT 1 CESSPOOL @ 1 00 I CESSPOOL SEPTIC TANK: 1 SEPTIC TANK DRAIN ( ) PIT ( ) Q 1.00 SEWER PERMIT GAS TEST ot. o / UTILITY COOTIFIED / ✓ _.n TOTAL FEE I $ O FINAL ��°� 7,6A6,67 (CE-817)-4/72 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES _ f DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO BUILDING 2Z.. ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET 1.75 OWNER MAIL BATH TUB 1.75 ADDRESS SHOWER 1.75 CITY TEL. NO '3 LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESSI -JAI 2 V DISHWASHER 1.75 CITY TEL NO 0-33 7-17 1 SWIMMING POOL RECEPTOR 1.75 CLOTHES WASHER 1.75 STATE LIC ��77�� LICENSE NO 66 CLASS,6-/ � C G(/ DISTRICT NO GROUP ZONE PROCESSED BY LAWN SPRINKLER SYSTEM 1.75 „r1 V C WATER HEATER 1.75 INDUSTRIAL p. WASTE APPROVAL t: GAS SYSTEM OUTLETS 1.75 J INSPECTION RECORD V OUTLETS OVER - 30 5 PER SYSTEM F•- ' W d N Z Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR 4 SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address- GAS PIPING City Tel No / GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REOU I RED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE PERT Y FINAL SIGNATU RE OF PERMITTEE PERMIT VALIDATION / cK M.O CASH PLAN CHECK VALIDATION CK. M O CASH �' AoQ_s 1 SN OCT 30 5 4.75N I WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that"I have a certificate of consent to self' 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A _ orya(certified copythereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS PolicwN� "L-0�Oompariy"2eS)L- ICAh ❑ Certified copy is hereby furnished FOR-APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING VL,Certified copy is filed with the county building inspec- ADDRESS tion epartment NUMBER FIXTURE OR'ITEM @ FEE LOCALITY „ WATER CLOSET Date 3 Applicant NEAREST CERTIFICATE OF EXEMPTION FIR&WORKERS' 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 ($100)or less.) LAVATORY MAIL r + ADDRESS 2n er- I certify that in the performance of the work for which this permit.is issued, I shall not employ any person in any manner SINK CITY T TEL NO 7,9 so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR Q i 14A ' Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ,? 0 1.5 Ahl Exemption, you, should become subject to the Workers' SWIMMING POOL RECEPTOR ADDRESSr/ Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY M V' TEL N with comply'with such provisions or this permit shall be STATES UC deemed revoked WATER HEATER LICENSE NO it, CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business i OUTLETS OVER �L and Professions Code,and my license is in full force and effect , 5 PER SYSTEM FINAL ( / /Z VALIDATION it License Number DATE V,Lic Class FINAL / a Contracto eJZazha BY 0, ❑ I am' exe pt under Sec O B 8P C for this reason Plan check fee ® U) Date Z' PLUMBING PERMIT ISSUING FEE$ ' Signature TOTAL FEE C Plan check applicant SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Name ,.-•� I hereby affirm that I am exempt from the Contractor's1icense Address Law for the following reason (Section 7031 5, Business and Y ;^r 7 at Professions Code) City Tel No .1 L,k- y3 ❑ i, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® -1,r: _1_9 r' ��.„ 7044, Business and Professions Code) t `� m "" C _•t.c,t: 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 �^ A I certify that I have read this application and state that the above information rs correct I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby -authorize reprelentatives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE � s a Signat�o Permittee — � ,�� Date CQUJNTY•OF- LOS ADIGELES4t AMPLE CITY # 0508 PLUMBING PERMIT ' DEPARTMENT OF PUBLIC WORKS, 9701 LAS TUNAS 2L-0508-9908130009 BUFLDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES D IL G_ : ON FILE C11UC122 DAINES ' R FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ITMP CA 917802704 ASSESSOR INFORMATION NEAREST CROSS STREET: BALDWIN_ 8586-023-010 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 13 DISHWASHERS) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 25 LAVATORIES/SINKS 2.00 FIX 32.40 08/13/99 UT 02/09 00 45 WATER CLOSET/URINAL .1.00 FIX 16.20 OWNER: TEL. NO: TOTAL FEES 124.95 FINAL DATE FINAL BY: CODE: ERDMANN ROBERT W JR;BARBARA (626) 579-4949- 10022 DAINES DR. TEMP 917800057 DESCRIPTION OF WORK PLUMBING FOR BATHROOM AND KITCHENMODELING APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: GIE. S C® CONTRACTOR: TEL. NO: � APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT R ENGINEER: ROUGH PLUMBING _ LIC. N0: 1111111 Z3GAS PIPING AS NT G)U B UC` WYCo HK� WATER HEATER o PLUMBING FIXTURES 0 LAWN SPRINKLERS GAS TESTEl UTILITY D CWV C -epVIC����� WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508