HomeMy Public PortalAbout9561 DAINES DR_Plumbing__ 76A6.67—CE 8174=68
APPLICATION FOR ' PLUMBING PEkM'IT
1' COUNTY OF LOS ANGELES
' DEPARTMENT OF COUNTY•ENGINEER
BUILDING AND SAFETY DIVISION BUILDING—
JOHN A LAMBIE, COUNTY ENGINEER ADDRESS fIWZp -
' " COLEMAN W JENKINS SUP T OF BUILDING LOCALITrk
Y t
I NEAREST
FOR-APPLICANT TO FILL IN (PR NT OR TYPE) CROSS ST. (w,4
B NUMBER FIXTURE OR ITEM EACH FEE ^' ¢
= OWNER a's
I WATER CLOSET 1 50 [TAIL ``*
I V BATH TUB 1 SO .ADDRESS
I ' SHOWER 1 50 CITY TEL. NO
LAVATORY 1 50 CONTRACTOR
.I
SINK 1 s0, ADDRESS ' Lftn
Ttm-
DISHWASHER 1 50 . CITY aar _ TEL. NOS '
CLOTHES WASHER 1 57. 0 S.....— LI
LICENSE NO rql ' A CLASS
r SWIMMING'POOL RECEPTOR 1.50 '
DISTRICT NO GROUP ZONE �—PROCESSED BY,
�
M1 LAWN,SPRINKLER SYSTEM 2'00
•� � s'" � �7_ r1�rf' V
WATER HEATER 150 INDUSTRIAL
'WASTE APPROVAL t LIJ_
" GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD
I OUTLETS OVER 30
'S'PER SYSTEM -
a g°A6"A CL
CL
i H
Plan�ch,eck fee 25% of above See reverse ,
' 4
PLUMBING PERMIT ISSUING FEE 9• 2 00
TOTAL FEE APPROVALS DATE INSPECTORS SIGNATURE
Plan check applicant UNDER SLAB WORK
Name V ROUGH PLUMBING
Address`r n ry �. "-,i'• r GAS PIPING r �
GAS VENT
' Git`y ,L' Tel No HOT WATER HEATER t.
r ,I HEREBY ACKNOWLEDGE'THAT I HAVE READ THIS APPLICATION
R .-c -
AND-STATE+THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY, PLUMBING FIXTURES -_
WITH. ALL,COUNTY ORDINANCES AND STATE LAWS REGULATING { { -
aPLUMeir'+G GAS TEST 1�yQ
1 'HEREBY'�CERTIFY ,THAT 1 AM PROPERLY' REGISTERED ANO/OR UTILITY CO NOTIFIED
�-� LICENSEDr AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ,
CALIFORNIA OR THAT 1 AM THE'LEGAL OWNER OF„AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY FINAL
_SIGNATURE '9.”
OF PERMITTEE�'� 'Y `^ '` �'`•"` .+.' t"%!o`iJACK R. ALLEN, SUPERVISING MECHANICAL ENG'R'
PERMIT'VALIDATIO CK M O CASH
PLAN CHECK VALIDATION,- CK M O CASH
r
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
1 hereby, affirm that I have a certifi,caite bf consent to self in- 76AA66DPW 4/90
sure,or a certif+cate of Workers'Compensation Insurance,or a
certified cbpy�thyereof (Sec 36�0►0,/Lab C ) � /
Policy No0J if 04eq?/3 o7p4ny -9 ?� COUNTY OF,LOS ANGELES DEPT. OF PUBLIC WORKS
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
❑ Certified copy is filed with the county building inspection ADDRESS (p
department NUMBER FIXTURE OR ITEM @ FEE LOCALITY
r
Date2 ppl scant - WATER CLOSET(TOILET) - NEAREST--
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST _
COMPENSATION INSURANCE OWNER
SHOWER '
(This section need not be completed if the work involved by _ MAIL;
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this per- SINK CITY TEL NO
mit is issued, I shall not employ any person in any manner so
as to become subject to the Workers'Compensation'Lows DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS 4
NOTICE TO APPLICANT If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen-
sation provisions of the Labo,, Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS CITY77_X
J ` TEL NO
ly with such provisions or this permit shall be deemed revok- STATE ! LIC
ed WATER HEATER LICENSE NO �� CLASS (�
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS O �v�
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER, G/
and Professions,Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION
fect '/ j HOSE BIB DATE -+��, ,�!
License Number �`7' ��d Lic ClassFIN��v'' ��Tdg O
Contractor Date BY AL 3303 43.41-�'�
U
❑ I am exempt under Sec 1 ITEMS 0
B 8P C for this reason
TOTAL 43 - 4
Plan check fee � � ► CHECK �`e4�
Date PLUMBING PERMIT ISSUING FEE$
Signature TOTAL FEE CHANGE n 0c1-
SINGLE FAMILY Plan check a licant
HOME OWNER-BUILDER DECLARATION pp WW—OMI 6/lel/Q6
hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031 5, Business and 6861 1 AM 9'18
Professions Code) Address
1, as owner of the property, will do the work and the City Tel No
structure is not intended or offered for sale(Section 7044,
Business and Professions Code) ,
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
t
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 regulating Plumbing, and hereby
authorize representativevq this County to enter upon the
abov e boned proper or inspection purposes
r SEE REVERSE,FOR EXPLANATORY LANGUAGE ,
Signature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0806270012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
(LEGAL ID I FEES PAID 1 BUILDING ADDRESS 1
ITR 15820 LT 4 I 1 9561 DAINES DR 1
I IFEE DESCRIPTION QUANTITY UOM AMOUNT 1 _ TEMP CA 917803145 1
(ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET TEMPLE CITY 1
18588-026-014 f 101 PERMIT ISSUANCE FEE 27 75 1 THOMAS PAGE 597 GRID A4 LOCALITY TEMPLE CITY, Cl
1 107 BATHTUBS/SHOWERS 1 00 FIX 16 20 I 'I
(TENANT 125 LAVATORIES/SINKS 1 00 FIX 16 20 11SSUED ON PROCESSED BY PLAN BY EXPIRES ON 1
145 WATER CLOSET/URINAL 1 00 FIX 16 20 106/27/08 SR 12/24/08 1
I 1 TOTAL FEES 76 35 1 I
(OWNER TEL NO I (FINAL DATE fTNg ®BY CODE 1
IBEERMAN RAYMOND B,SANDRA J (626) 485-0440- 1 1 � 1 9
19561 DAINES DR ���®®®999999 999��taaa 9�
I
(TEMP 917803145 1 (DESCRIPTION OF WORK 1
_ IPLUMBING FOR BATHROOM REMODEL
(APPLICANT TEL NO 1 I I
1CRAWFORD (909) 599-7924- I I I
12077 WHITE BLUFF OR (SPECIAL CONDITIONS 1
ISAN DIMAS, CA 91773 I I I
(CONTRACTOR TEL NO I, (APPROVALS DATE INSPECTOR SIGNATURE 1
(GEORGE J CRAWFORD (909) 599-7924- 1 1
(JOANNE R CRAWFORD LIC NO I 1UNDER SLAB WORK I I I
12077 WHITE BLUFF DRIVE 246174 B 1 I I 1 I
ISAN DIMAS, CA 91773 1 (WATER SERVICE 1 I I
I (PLASTIC YIN METAL YIN I 1 I
ARCHITECT OR ENGINEER TEL NO - TROUGH PLUMBING I I
LIC NO
IGAS PIPING
I I IGAS VENT I 1 I
I IHOT WATER HEATER I 1 1
1 (PLUMBING FIXTURES I I I
I I I I I I
I (LAWN SPRINKLERS 1
1 IGAS TEST I
(UTILITY COMPANY NOTIFIEDI I I
I I I I
CWV
I GRAY WATER SYSTEM I 1
I I I I I I
I I I I I I
I I I I I I
(REPORT ID DPR263 ROUTE TO BS0508 I I I I
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