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HomeMy Public PortalAbout5211 DEGAS AVE_Plumbing__ 76A,§7-CE810 10-62 ` APPLICATION FOR PLUMBING PERMIT COUNTY OF, LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING F SS 211 Degas Ave. JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING ITY Temple City FOR APPLICANT TO FILL IN "Ssr. RandwicicNUMBER FIXTURE OR ITEM EACH FEE R Dnal Corp. Q WATER CLOSET $1'25 2 0 MAIL 1 BATH TUB 1,25 1.25 ADDRESS CITY TEL. NO. 1 SHOWER 1.25 1.25 2 LAVATORY 1.25 2.50 CONTRACTORQWOn Bros. Plumbing, Inc. RINE 1.25 1,25 ADDRESS 426 No B ldwin Ave I DISHWASHER 1.25 1.25 CITY El Monte TEL. NO. 443-0078 LAUNDRY TUB 1.25 CONTRACTOR'S STATE REGISTRATION NO. 231741 COUNTY Ej CLOTHES WASHER 1.25 2 DISTRI'C`T NO. GROUP /ZO E /PROCESSED BY 1 WATER HEATER 1.50 1.50 / 1 J 1 GAS SYSTEM 5 OUTLETS 1'50 1.50 INDUSTRIAL v O WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD u 3 -L(o Co i�G.Kt S 5{ cL) A-T� 'GJ A. �O U - G 1V AND N v APPROVALS DATE INSPECTOR'5 SIGNATURE PERMIT s 2 00 UNDER SLAB WORK 4 ROUGH PLUMBING TOTAL FEE 16.25 GAS PIPING u 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES CE LINSEDAS REOUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF.AND INTEND TO ` RESIDE IN. THE ABOVE D SCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED _ SIGNATURE OF PERMITTEE - _ FINAL "L( VALIDATION ROBERT A. WOOD U /� � M.0. CASH SUPERVISING MECHANICAL ENG'R LI,,,L09345 ;i-lR 8 5 D 1625- 76A667-CEN8I7 2-66 City of Temple City B 13336 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 5211 Degas Ave, COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple Cit FOR APPLICANT TO FILL IN NEARS sT . olive & Baldwin NUMBER FIXTURE OR ITEM EACH FEE OWNER G . Byrand WATER CLOSET 31.25 MAIL BATH TUB 1.25 ADDRESS Same SHOWER 1.25 CITY TEL. NO. LAVATORY 1.25 CONTRACTOR General Installation Co. SINE 1.25 ADDRESS 6558 west Blvd. DISHWASHER 1.25 CITY Los Angeles TEL. NO. ?L 3-2541 LAUNDRY TUB 1.25 STATE LICENSE NO. C-36 151839_ LIC CLASS CLOTHES WASHER 1.25 DISTRICT NO. GR PRD WATER HEATER L77, 50 GAS SYSTEM OUTLETS 1'50 INDUSTRIAL y WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 Gi INSPECTION RECORD 1 WATEASOnTENEA 1 50 Ready for Inspection Now W O_ rn 2 APPROVALS DATE INSPECTORS SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 3 50 GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ APPLICATION ANO STATE THAT THE ABOVE ICORRECT ANO AGREE COMPLY GAS VENT WITH ALL COUNTY ORDI NAN<ES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF &NO INTEND TO RESIDE IN. THE ABOVE DESCRIBED REST/ IA R UTILITY CO. NOTIFIED SIGNATUREF OF PERMITTEE FINAL \IVALIDATION JACK R. ALLEN CASH SUPERVISING MECHANICAL ENG-R. Li�?.o.8 V 7. 7Q; �'rIr23 5 D 350- WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING (PERMIT I hereby, affirm that I'have a ceriificoteof:consent to self Tri- 20-0026 DPW 4787 - Y'L - n sure,or a certificate of Workers'Compensation Insurance, cr a 76A667A - ,'L-fll CE 817 REV: 8156) certified copy thereof (Sec. 3800, Lab. C.)' - - Policy No.. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING/ •�,%AL ,Certified copy is filed with the county building inspection ADDRESS G©1/J ' NUMBER FIXTURE OR ITEM - deportment. - � . . @ FEE LOCALITY A ,,Date - Applicant WATER CLOSET(TOILET) NEAREST Igoe CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB - CROSS ST. COMPENSATION INSURANCE' 'SHOWER OWNER (This section need not be completedif the work involved by MAIL ,�—�{ � '�}`�! _ the permit is for one hundred dollars ($100)or less.) - - LAVATORY MAIL Sdo�/ 11G�//J /n2 (.certify rued in the performance of the Zo ar w this per- SINK CITY /lffii g '7 mit is issued, shall not employ any p rson n manner so as to'become su b'ect to the Workers Co tionLaws. DISHWASHE �,.p�,./ ` / /GGO`N/ QO CONTRACTORS/y �Gu - Date + 0—:3Applicant CLOTHES WASHER �Q QNB ��- ADDRES ,.X/ NOTICE TO APPLICANT: If, afienmaking is Ificoteof, Ex- .SWIMMING POOL RECEPTOR q' � emotion,you should become subject o the W is'Co comp- CliO4WW— }/�/; sat ion provisions of the Labor Code, you must rt deemed comp- LAWN SPRINKLER SYSTEM Yrs lt��r�7 99�i /C.b ly,with such provisions or this permit shall be deemed revok- STATE a 7�?X/ LIC. ed. - - WATER HEATER LICENSE NO O� c! CLAS af1;?_ LICENSED CONTRACTORS.DECLARATION DISTRICT NO. PR BV I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM -OUTLETS 0 n - 9(commencing with Section 7000)of Division 3 of-the Business OUTLETS OVER O and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL �. fect. 4S . DATE - VALIDATION aLicense4mbLic. Clas )CL/ Vi���� FINAL ContracDate BVCFI a B. reason - Y r W Plan check fee - _ Date: -.PLUMBING PERMIT ISSUING FEE $' `'ZS Signature - TOTAL FEE _ SINGLE FAMILY - HOME OWNER-BUILDER DECLARATIONPlan check applicant • c I hereby affirm that 1 am exempt from the Contractor's License Nome r - Low for the following reason (Section 7031.5, Business and - Yr"1 a ' - Professions Code): Address I, as owner of the property, will Bothe work and-the City - Tel. No 330.3 , structure is not intended or offered for sale(Section 7044, 1 -TTEr.,-- Business and Professions Code): - ,D -rl�•f�L is _ CONSTRUCTION LENDING AGENCY - r hereby affirm that there is a construction lending agency for - CHECK She performance of the work for which this permit is issued - -- CHANGE (Sec. 3097, Civ. C.). - - Lender's Name _ - •, QI_II�Q-I I(„I)1 fl 1?i y,_ Lender's Address 1 certify that I have read this application and state that the - - 0blf y ;�:,,�j{:. above information is correct. I agree to comply with all County - ordinances aCi� ulating Plumbing, andhereby authorize phis County to enter upon the above- inspection url fs (� ` f� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ermitt a Date -