HomeMy Public PortalAbout9401 DAINES DR_Plumbing__ t 7GA667 DBS 17 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY ' G
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
-- DISTR NO. GROUP I ZONE PIT NO.
r FOR APPLICANT TO FILL IN
v
PLUMBERa CEIVED BY READY FOR DATE ISSUED
_ FIRST INSPECTION
ADDREBS 8500 E • Garvey Ave.
�j
BUILDING _
CITY Garve Ca11fTEL. NO. At .021717 ADDRESS !f }p{D Aviiaal r `
COUNTY ��Q•l� 6/52 LOCALITY it C U
L CENSE NO. EXPIRES � S
NEAREST rr�� l e- y v-
PERMIT FEES CROSS ST. !��/% Y
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER �� $r'�N Y "U VPN
MAIL
WATER CLOSET(TOILET) @ 0.50 $ ADDRESS �° ,�, D Y C% i�=a e °✓ ¢I!��
BATH TUB @ 0.50 CITY L a TEL. NO U,,
SHOWER @ O.SO 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND 13TATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
1CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 Llj, ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTI��L PROPERTY DESCRIeo
GAS 9YSTEMUTLET6 @ 0.50
SIGNATURE OF
WATER HEATER @ O.SO PERMITTE
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50 / t^ s'
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0:50
HOUSE SEWER @ 0.50 Z
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MISCELLANEOUS
p 0
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Y
APPROVALS
/D�ATE INSPECTOR'S NAME
p/ ROUGH PLUMBING J/
GAS PIPING /!
l� GAS VENT �e/ l {' Y
CESSPOOL @ j„00 CESSPOOL
SEPTIC TANK: J SEPTIC TANK
DRAIN ( ) PIT ( ) @`lj 1.00 SEWER
PERMIT 1.00 GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE $ p
FINAL v
n
yypR ERS'COMPENSATION DECLARATION APPLICATION FORPLUMBING PERMIT
1 hereby,affrm that I have a certificate of consent to self 76A667A ®�• IVa
insure, or*certificate of Workers' Compensation Insurance, CE 817(REV. 8/86)
or a certifed copy thereof (Sec. 3800, Lob. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
policy ro. Company
/Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGADDRESS �Y
/Certified copy is filed with the county building inspec-
tion depar m t. NUMBER FIXTURE OR ITEM @ FEE
/ LOCALITY
Date 2 Applican WATER CLOSET NEAREST
CE IF CATE OF EXEMPTION FROM ORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE l ,_ OWNER t
(This section.need not be completed if the work involved by SHOWER
the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL
ADDRE
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTO
c
Date Applicant CLOTHES WASHER ADDRESS
NOTICE"TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL. NO
LAWN . �SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STAT p LIC. f�
deemed revoked. WATER HEATER LICENSE NO.a2 9 S CLASS V
LICENSED CONTRACTORS DECLARATION ' DISTRICT NO. OCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS O�
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATIO
License Number2—�•7 �-7 6 Lic. Class w-C DAl'E g�
FINAL
Contracto to_ BY
❑ 1 on. exempt u der Sec.
B.BP.C. for this reason �
Plan check fee
Date: i
PLUMBING PERMIT ISSUING FEE$.•. V
Signature
TOTAL FEE
f
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.❑ 7 3 Q,1 A I, as owner of the property,.will do the work and the
structure is not intended or offered for sale (Section ® # 0 0 0 0 0 5
7044, Business and Professions Code). 1 0,5.0
CONSTRUCTION LENDING AGENCY c, ° ° 1 6 5 0 5
I hereby affirm that there is a construction lending agency for 0 701 -87
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 r id this application and state that the
above informatio rrect. I agree to comply with all County Poo
ordinances an S laws regulating Plumbing, and hereby
outtv.ize re e n tives of this County to enter upon the
abov en d action purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee ate
COUN OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1201030024
,BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID I BUILDING ADDRESS:
ON FILE - 1 9401 DAINES DR
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803113 1
(ASSESSOR INFORMATION NUMBER: I I --'NEAREST CROSS STREET:
18588-030-016 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI
1 107 BATHTUBS/SHOWERS 2.00 FIX 32.50
(TENANT: Ill CLOTHESWASHER(S) 1.00 FIX 16.30' IISSUED ON: PROCESSED BY: PLAN BY:
1 113 DISHWASHER(S) 1.00 FIX 16.30 101/03/12 SR
1 121 HOSE BIBB(S) 2.00 FIX 32.50 1
10WNER: TEL. NO: - 125 LAVATORIES/SINKS 4.00 FIX 65.10 IFI AL DATE FINNALIQY: CODE:
ICHANG, GEORGE (626) 285-8132- 127 PRESS REG DEVICE(S) 1.00 DEV 16.30 1
19401 DAINES DR 145 WATER CLOSET/URINAL 2.00 FIX 32.50 1 .
ITEMP 917803113 147 WATER HEATER(S) 1.00 WTH 16.30 (DESCRIPTION OF WORK 1
164 WATER-PIPNG <= 1 1/2 1.00 LIN 16.30 [REPLACE PLUMBING ON THE KITCHEN, BATHROOMS, WATER HEATER ANDI
I TOTAL FEES 271.90 IWATER MAIN I
[APPLICANT: TEL. NO: II
IBIRDSALL PLUMBING (909) 994-6886- 1 1
1263 S. FIRST AVE. I ISPECIAL CONDITIONS:
[UPLAND, CA 91786
1 I I I
11 CONTRACTOR: TEL. NO: 1 [APPROVALS DATE INSPECTOR SIGNATURE
IBIRDSALL PLUMBING (909) 994-6886- 1 1 I
1263 S. FIRST AVENUE LIC. NO (UNDER SLAB WORK
[UPLAND, CA 91786 915624 C36
1 IWATER SERVICE 1 1
IPLASTIC Y/N METAL Y/N I I
[ARCHITECT OR ENGINEER: TEL. NO: 1_-
1 - 1 (ROUGH PLUMBING 1 1
LIC. NO: - I
I IGAS PIPING I I -
I I I I I
IGAS VENT
. I [HOT WATER HEATER 1 1 1
. P1�UMBING. FIXTURES
LAWN:SPRINKLERS I
_ IGAS TEST 1
[UTILITY COMPANY NOTIFIEDI I _
1 11 ICwV I
[GRAY WATER SYSTEM
i I I I i I
I I I I I I
IREPORT ID: DPR263 ROUTE TO: BS0508 I 1 I
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