HomeMy Public PortalAbout9441 DAINES DR_Plumbing__ 78A887 -CE#817 12-84 �9O s"7 A ( 5 � t �� �•�A��� �i
APPLICATION FOR L MBING PERMIT
COUNTY OF LOS ANGELES {
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ADDRESS '3 J p "'SJOHN A. LAMBIE. COUNTY ENGINEER
.COLEMAN W. JENKINS, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER
WATER CLOSET $1.25MAIL _^ ��
BATH TUB 1.25 ADDRESS a?�1'—\
CITY f-4 ; TEL. NO.
SHOWER 1.25
LAVATORY 1.25 CONTRACTOR ���� (c-
SINK 1.25 ADDRESS t C
DISHWASHER 1.25 CITY (" TEL. NO.
LAUNDRY TUB 1.25 CONTRACTOR'S g STATE
REGISTRATION NO. t` COUNTY ❑
CLOTHES WASHER 1.25 DISTRICTNO. GROUP ZONE PROCESSED BY
WATER HEATER 1.50A ��
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL $�
WASTE APPROVAL p�
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 OC UNDER SLAB WORK
r , ROUGH PLUMBING
TOTAL FEE ,3 J ® " GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE.THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
�. PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR '^: PLUMBING FIXTURES --
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND IN END TO
RESIDE IN,THE ABOVE DESCRIBED RESIDE TIAL PROPERTY. UTILITY CO. NOTIFIED AI
;- SIGNATURE
OF PERMITTEE
FINAL
LIDATION ROBERT A. WOOD
K. M.O. CASH SUPERVISING MECHANICAL ENG'R/�'
Lisl,ti.Lt. 'j 9 $E 7 5 3.5 V a
WORKERS'COMPENSATION DECLARATION 76A667A y� n p PLUMBING
p p p�� (�� (��
I hereby affirm that I have,a certificate of consent to self CE fin (2-80) l� L� 0®1�I lh 1�1 tl�711 0 0�l u�Tll
insure, or a certificate of Workers'Compensation Insurance,or � IT
".., e -
a certified copy thereof(Sec.3800,Lab.C.)
COUNTY OF LOS ANGELES . BUILDING AND SAFETY,
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
QADDRESS F (�.
Certified copy is filed with the county building inspection NUMBERI FIXTURE OR ITEM O FEE r I �-i
department. LOCALITY. P V'1
Date Applicant., b/✓� . WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'
0,,/e— BATH TUB CROSS ST. O P�
COMPENSATION INSURANCE SHOWER. OWNER G' r �,�•
MAIL �"/
(This section need not be completed if the work involved b1/ LAVATORY ADDRESS /�� Q!�}I/ C S (/� a
by the permit is for one hundred dollars ($100) or less.) SINK _ h O
CITY 1 C TEL. NO. � U
I certify that in the performance of the work for which this DISHWASHER cc
permit is issued, I shall not employ any person in any manner CONTRACTOR 0
so as to become subject to the.Workers'•Compensation Laws. CLOTHES WASHER• U
dime '
Date Applicant ADDRESS W .
SWIMMING POOL RECEPTOR d
NOTICE TO APPLICANT:.If, after making this Certificate of CITY TEL. NO. to
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Z
Compensation provisions of the Labor.Code, you must forth- LICENSE NO. CLASS
with, comply with such provisions or this permit shall be WATER"HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRRIIC N/O/. PROCESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER 1 +iQd
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect:
FINAL
License Number Lic.Class BY
Contractor Date
I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ ,
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE D
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
.ness and Professions Code): c2 3.`7.7 9 A
I', as owner of the property, am exclusively contracting
with licensed contractors to construct the project #.0'o.o o 5
(Section 7044, Business and Professions Code).
12 0=0 2.4,50
CONSTRUCTION LENDING AGENCY v
z
I hereby affirm that there is a construction lending agency o[a!-'2 4,'5 O.c�
for the performance of the work for 'which this permit is '
issued(Sec. 3097,civ.C.). o Q 2 b,—8,2
Lender's Name
Lender's Address
I certify that I have read this application and state that the
above information is correct.1 agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned ro ert y for inspection purposes.
igna r of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1109220018
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
_ ON FILE I 9441 DAINES DR i
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803113 I
(ASSESSOR INFORMATION NUMBER: I I. NEAREST CROSS STREET: CLOVERLY
18588-027-014. 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
1 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.30 I
(TENANT: 164 WATER PIPNG <= 1 1/2 1.00 LIN - 16.30 (ISSUED ON: PROCESSED BY: PLAN BY: 1
1 TOTAL FEES 60.40 109/22/11 SR I
(OWNER: TEL. NO: I IF A�JTE FINAL BY: CODE: I
BLANTON VICTOR E;AUDREY R (562) 755-3948— I I (/I/�j'19441 DAINES DR I I ` l (X 1
ITEMP 917803113 ID SCRIPTION OF WORK 41
I I IWATER AND GAS SERVICE REPLACEMENT FROM METER TO HOUSE I
(APPLICANT: TEL. NO: - -I
IPEDROZA, DAVID (626) 355-3496— 1
SPECIAL CONDITIONS:
I I I I
(CONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE 1
IG—E—M PLUMBING INC. (626) 355-3496— I 1--
1140
—1140 E MONTECITO AVENUE LIC. NO I IUNDII7R. SLAB WORK I I I
ISIERRA MADRE, CA 91024 111308 C36 *I I
IWATER SERVICE
1 I I PLASTIC Y/ MET Y/N
(ARCHITECT OR ENGINEER: TEL. NO: I I a
IROUGH PLUMBING
LIC. NO: 1. I__. I I
IGAS PIPING I
IGAS VENT I I
I
I IHOT WATER HEATER II I
I I PLU.�SING FIXTURES I I
ILAWN SPRINKLERS I'
I IGAS TEST I I I
I (UTILITY COMPANY NOTIFIEDI I I
i ICWV I I
I I I I i I
I (GRAY WATER SYSTEM
I I I I I I
I I I I I I
I I I I
I I I I I I
I* ADDITIONAL DATA ON FILE I I
I I I I I I
IREPORT ID: DPR263 ROUTE TO: BS0508
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