HomeMy Public PortalAbout10645 DAINES DR_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0610270003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 10645 DAINES DR
IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917802815 1
ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET:
18586-010-,044 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY, Cl
121 HOSE BIBB(S) 2.00 FIX 32.40
TENANT: 147 WATER HEATER(S) 1.00 WIN 16.20 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
163 WATER PIPING BR/FIX 6.00 FIX 54.00 110/27/08 SR 04/25/09
( 164 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 1
OWNER: TEL. NO: TOTAL FEES 146.55 FINAL. DATE FINAAjj,, BY: CODE:
GOODRICH, NANCY (626) 579-4707-
110645 DAINES DR. 1 / �n
ITEMPLE CITY CA 91780 1 SCRIPTION OF WORK �l
I ICOPPER REPIPE TO B EXISTING FIXTURES CHANGE OUT WATER HEATERI
I IAND WATER MAIN
(APPLICANT: TEL. NO:
IBROOKS JOHN (800) 649-7511- 1 1
11371 TITAN WAY I (SPECIAL CONDITIONS: 1
IBREA, CA 92821 1 1
I I I I
1CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
ICAL-COAST REPIPING INC. (800) 649-7511- 1
11371 TITAN WAY LIC. NO UNDER. SLAB WORK
IBREA CA 92821 636649 1
WATER SERVICE
PLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER: TEL. NO:
11 - 111 IROUGH PLUMBING _ I
LIC. (�
NO:
GAS PIPING
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1 1 (GAS VENT I I I
HOT WATER HEATER
PLUMBING FIXTURES
I 1LAWN SPRINKLERS I I I
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I I 1cAs PEST I I I
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I I (UTILITY COMPANY NOTIFIED(
I I IGWV I I I
I I (GRAY WATER SYSTEM 1 I
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I 1REPGRT ID: DPR263 ROUTE TO: BS O508 I I 1 I
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WORKERS' COMPENSATION DECLARATION APPLICATION FOR C"LUEtltlIDING V"ERMI L CL icf{ / � I
I hereby affirm that I have a certificate of consent to self 16Ab67A 1. /,JL/ ILII
Insure, ar a certificate of Workers Compensation Insurance, CE 817(REV. 10/81) (((
or a certified copy thereof (Sec. 3800, Lab. C) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished.
El Certified
APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING F .
Certified copy is filed with the county building inspec- ADDRESS
tion department. - NUMBER FIXTURE OR ITEM C FEE LOCALITY—
. Date Applicant WATER CLOSET NEAREST RX
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER C-1c] r k)
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS -
I certify that in the Pride man of t e work f which this r
permit i5 i5sue,l 1 shall not em toy a person i any manner SINK CITYYT � TEL. Nu-�
su as t ec t to th W rs Comp ns t' w . I
DISHWASHER CONTRACTOR
Dat Appli CLOTHES WASHER ADDRES
NOTIC T LICANT: If, it in his Certtf to o
Exemption, you should be me subject to the Workers' SWIMMING POOL RECEPTOR
Compensation.provisions of the Labor Code, you must forth- CIT TEL. N
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC. ('�
deemed revoked. WATER HEATER LICENSE NO CLASS U
LICENSED CONTRACTORS DECLARATION DISTRKi 0n a r i OCE ED BY
I hereby affirm that I am licensed under provisions of Chapter 9. GAS SYSTEM � OUTLETS J l/
(commencing with Section 7000) of.Division 3 of the Business OUTLETS OVER A
and Professions Co n my I' full forcq arp/d ef(f t. 5 PER SYSTEM FINAL '! �/ (DATION
License Nu b r Class DAT a
U.
Contracto at / Y
d'
to e t under Sec '
B.BP.C. for this reason 0
Plan check fee �6 9 5 5 A a'
LU
Date: PLUMBING PERMIT ISSUING FEE$ # o e e o e 5 z
Signature -
TOTAL FEE :( 650
Plan check applicant
SINGLE FAMILY a 0.0.1 6.5 0 5
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address o 5 2 8 7
Low for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No.
❑ I, as owner of the property, will do the work and the
structure is npt intended or offered for sale (Section D
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
Ihereby 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 mf rmationj1e
ect. I agree to comply with all County
ordinanc s and Sts regulating Plumbing, and hereby ,
with ri presesofhis Cho - e ned fffw/ SEE REVERSE FOR EXPLANATORY LANGUAGE
Si n t r o Dat