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Home My Public Portal About5022 DOREEN AVE_Plumbing__ 76A667 -C ENSI7 5163 APPLICATION FOR PLUMB NG PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER G UILDINy BUILAND SAFETY DIVISION BAUILDIN J ZZ p ( (J JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY � �+ FOR APPLICANT TO FILL IN NEAREST CROSS ST. (.l: c..S NUMBER FIXTURE OR ITEM EACH FEE OWNER � � C WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS L- CITY -- TEL. NO. SHOWER 1.25 LAVATORY 135 CONTRACTOR .0 O SINK 1.25 ADDRESS �� f 1 DISHWASHER 1.25 CITY-AS 6 TEL. NO. LAUNDRY TUB 135 CONTRACTOR'S _ STATE REGISTRATION NO. ?J C�31NTY CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROLE D BY WATER HEATER 1.50 It Y OUTLETS I.50 o. GAS SYSTEM INDUSTRIAL APPROVAL O OUTLETS OVER 5 PER SYSTEM .20V INSPECTION RECORD I z.r /l /4/3 �` .� � � /rte I —�x�� ✓3 0 D_ N Z APPROVALS ATE NSPECTOWS SIGN T.RE PERMIT j 2 00 UNDER SLAB wORK y�l. ROUGH PLUMBING TOTAL FEEGAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ ICATION GAS VENT ANO STATE THAT THE ABOVE IS CORRECT AND COMPLY • / , WITH ALL COUNTY ORDINANCES AND STATE LATINp HOT WATER HEATER 1 �/ PLUMBING. G? �✓� 1 HEREBY CERTIFY THAT I AM PROPERLY REAND/OR PLUMBING FIXTURES LICENSED A5 REOUIflEp BY ANGE ES COUNATE OF CALIFORNIA OR THAT 1 A H LEGA OWNER END TO GAS TESTpE51OE IN, THE ABOVE O C Ep RESI ENTIAL UTILITY EO. NOTIFIED �5 J/ SIGNATURE A;tVK'Vi < OF PER FINAL // /� L , ALIDATION ROBERT A WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENG'R U)CO 2 4 2 5 Q NOV 12 5 D 6.2 5 NO 76A667A ICE 1317131- 11/76 11 APPLICATION FOR PLUMBING PERMIT LS BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINTOR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS 5022 North Doreen 41• WATER CLOSET LOCALITY Temple Cit BATH TUB NEAREST CROSSET. SHOWER OWNER Phillip M. Z lla LAVATORY AWL DRESS 5022 N . Doreen SINK CITY Temple City TEL.NO. 579-4579 DISHWASHER CONTRACTOR Bryant Heat. & Air Cond CLOTHES WASHER ADDRESS 1350 E. Las Tunas Drive SWIMMING POOL RECEPTOR aiv San Gabriel TEL.No. 286-1141 LAWN SPRINKLER SYSTEM STATE WATER HEATER LICENSENO. 221751 CLASS C20 1 GAS SYSTEM OUTLETS 3 OQ DISTRICT NOQQ GROUP ZON PRQS ESSED BY OUTLETS OVER Y 5 PER SYSTEM INDUSTRIAL G WASTE APPROVAL V INSPECTION RECORD at O u� W 0. N Plan check fee PLUMBING PERMIT ISSUING FEES 4 S 0 TOTAL FEE 7 50 Plan check applicant APPROVALS DATE INSPECTORS SIGNATURE Nerve UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES REQUIRED BY LOS ANGF,LElk COUNTY AND STATE OF CALIFORNIA OR TH AT I AM THE GAS TESTLa.r— LEGAL OWNER OF.ANdd INTEND TO RESIDE IN THE ABOVERESIDENTIAL PROPERTY. C I UTILITY CO.NOTLINED SIGNATURE �(J / OF PE RMITT �^ '� � FINAL PLAN CHECK VALIDATION CK. M,O! CASH PERMIT VALIDATION CK, M.O. CASH 1 5 4 i`+40V i.6 5 1 J4 7.5 0 e OS 76A667-C EN817 2-66 CITY OF TEMPLE CITY cDAPPLICATUNTY OF LOS EON FOR PLUMBING PERMIT LES B 251 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 5022 Doreen COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple City FOR APPLICANT TO FILL IN NEAREST E 1Mon to CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER Phillip Z Ila WATER CLOSET $1.25 MAIL DASH TUB 1.25 ADDRESS same SHOWER 1.2.5 CITY TEL. NO. LAVATORY 1,25 CONTRACTOR General Installation Co. SINK 1.25 ADDRESS 6558 West Blvd. DISHWASHER 1.25 CITY Los Angeles TEL. NO. PL 3-2541 LAUNDRY TUB1.25 L?CENSE NO, C-36 151839_ATE CLASS CLOTHES WASHER 1.25 DISTRICT NO. _ GR ZONE PROCESSED BY WATER HEATER 1.50 Oj/ GAS SYSTEM OUTLETS I.50 INDUSTRIAL WASTE APPROVAL i OUTLETS OVER 5 PER SYSTEM .00 ED INSPECTION RECORD U Z WATRASOFTKNHR 1 50 Ready for Inspection Now ED U W 0_ H Z APPROVALS DATE INSPECTORS SIGNATURE PERMIT J�NTENDTO 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE3 SO GAS PIPING HEREBY ACKNOWLEDGE THAT I HAVE REAP ICATION AND STATE THAT THE ABOVE IS CORRECT AND COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE ULATING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REAND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OANDEND TORESIDE IN.THE ABOVE DESCRIBED RE$IO TIALPflUTt LITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL /}7ALIDATION JACK R. ALLEN M. CASH SUPERVISING MECHANICAL ENG-R. C( 0 6 5 2 KlR17 5 0 3.50- v '°"` 17 12' APPLICATION FOR PLUMBING PERMIT DeB I) FoWffON OF BUILDING AND SAFETY Dep. ent of County Engineer County of Los Angeles _ • WM. J. FOX. COUNTY ENGINEER ADDBUILREDING 5 a�- Z De/'• `�-' SS CA66Att D.GRIFFIN. 6uP'i of BUILDING �O® FOR APPLICANT TO FLOCALITY ILL IN NEAREST P PS CROSS ST. OWNER DISTRIC I GROUP NE I EEADi FOR INSPECTION MAIL ADDRESS INDUSTRIAL CITY TEL. NO. WATEeAPPROVAL PLUMBER 'P-O 4 e',e INSPECTION RECORD LI ADDRESS O Q P CIT ^J�(i TEL. NO 7-120 2_0A LICENSE NO. /O/ / D r 15lJ 1 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) BATH TUB SHOWER LAVATORY (WASH BASIN) KITCHEN SINK DISHWASHER LAUNDRY TUB OR TRAY CLOTHES WASHER TOTAL NO. a 0.60 �I �`• ��,APPROVALS / II DATE INSPESTOR'S SIGNATURE GAS SYSTEM—OUTLETS ® 1.00 R�Y� 4,a_ .C�e-1 WATER HEATERUNDER SLAB WORK ROUGH PLUMBING �.E.✓.C.l PERMIT y 1 00 �/ GAS PIPING TOTAL FEE S 90 GAS VENT ttt��l / !� 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER _ >//* AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ PLUMBING FIXTURES PLUMBING. GAS TEST U `LV�S.S 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS ?MLICENSED AS REQUIRED LOS ANGELES COUNTY AND E AB OF UTILITY CO. NOTIFIED �s DESCRIBED SI THAT N THE LEGA OWNER OF THE ABOVE DESCRIBED RESIDEN L ROPERT . SIGNATURE OF PERMITTEE FINAL t! WILLIAM J. FOX. COUNTY ENGINEER VALIDATION kGo1615!A wAR15 3 5.80By " EPUTY WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent-to self 20-0026 DPW 6/87 C, insure, or a certificate of Workers' Bompens6tion Insurance, 76A667A lul or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Z Z PC'iTFf./✓ Certified copy is filed with the county building inspe<- ADDRESS tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY TFL` C (T y Dote Appligant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. A DFS COMPENSATION INSURANCE. SHOWER OWNERrjAC� WOnJ _ (This section need not boolIf the work involved by MAIL `aysiC_ the permit is for one hundredred dollars rs ($100)or loss.) LAVATORY ADDRESS 7 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE C. deemed revoked. WATER HEATER LICENSE NO. C LICENSED CONTRACTORS DECLARATION OC D I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER I and Professions Code, and my license is in full force and effect. 5 PER SYSTEM r FINAL ALI ATION a DATE License Number Lit. Class U FINAL Contractor Date BY Q ❑ I am exempt under Sec. U LU B.BP.C. for this reason a Plan check fee Date: Z PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY jIC K w'7// � `t HOME OWNER-BUILDER DECLARATION Name C �L 1 hereby affirm that I am exempt from the Contractor's License � /' i v✓ / ✓i Address O 2 AI-•L•T.i Law for the following reason (Section 7031.5, Business and P Professions Code): City �F L - C ( y Tel. No. t 3-6C17 23.CII I ❑ I, as owner of the property, will do the work and the I TEEMS structure is not intended or offered for sale (Section _ _ 7044, Business and Professions Code). CIT 28 - 00 CONSTRUCTION LENDING AGENCY CHECK 22.00 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANGE .110 (Sec. 3097, Civ. C.). / Lender's Nome L11300-11I3Q1 6/23/90 Lender's Address /`r c3-7 1 AM 7%44 1 certify that I have read this application and state that the loop above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the obove-mentioned property for inspection ppuurposes. q _ _ (�f26// � SEE REVERSE FOR EXPLANATORY LANGUAGE saw Signl�ure of Permittee Dote