HomeMy Public PortalAbout5116 DOREEN AVE_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY N 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1209260005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS:
IBK: 254 PG: 39 PQ 2 5116 DOREEN AV 91780
1 IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I TEMP CA
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: FREER
18585-022-045 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: GRID: LOCALITY: TEMPLE CITY, CI
1 107 BATHTUBS/SHOWERS 1.00 FIX 16.20
(TENANT: I11 CLOTHESWASHER(S) 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY:
1 125 LAVATORIES/SINKS 4.00 FIX 64.80 109/26/12 SR I
145 WATER CLOSET/URINAL 2.00 FIX 32.40 1 1
(OWNER: TEL. NO: I TOTAL FEES 157.40 IFINAL DATE FINAL BY: CODE:
KEY COMMUNITY HOUSING -
15116 DOREEN AV ILD
ITEMP 917803438 IDE> IP?�-OOF WORK
(PLUMBING FOR BATHROOMS AND LAUNDRY ROOM
(APPLICANT: TEL. NO:
ISCOTT BROWN DESIGN (323) 256-6336-
11444 POPPY PEAK ISPECIAL CONDITIONS:
PASADENA CA 91105
I I I I
(CONTRACTOR: TEL. N0: I (APPROVALS DATE INSPECTOR SIGNATURE I
IMICHAEL G ROELLE PLUMBING (626) 960-0344- 1 I
15057 LANTE STREET LIC. NO (UNDER SLAB WORK
BALDWIN PARK CA 91706 743562BCIG
I IWATER SERVICE
PLASTIC Y/N METAL Y/N
(ARCHITECT OR ENGINEER: TEL. NO:
IHELOU STRUCTURAL ENG (818) 345-7646- IROUGH PLUMBING
15585 RESEDA BLVD. 105 LIC. NO: I
ITARZANA, CA 91356 NONE IGAS PIPING
I IGAS VENT I
I
(HOT WATER NEATER
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I PLUMBING FIXTURES
(LAWN SPRINKLERS
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I I IGAS TEST I I I
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I I (UTILITY COMPANY NOTIFIEDI I I
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(GRAY ATER SYSTEM
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I I` ADDITIONAL DATA ON FILE I I I I
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I (REPORT ID: DPR263 ROUTE T0: HSOSOB I I I I
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WORKER'S COMPENSATION DECLARATION 28-0826 DPW 9/69]6A66]A APPLICATION FOR PLUMBING PERMIT d
I hereby aFlirrrl that hfieve a certificate of consent to self insure,
or a certificate Of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab.C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF"PUBLIC WORKS DIV. -
Policy No. Company
❑ Certified copy is hereby furnished. �J
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
❑ Certified copy is filed with the county building inspection ADDRESS I7 /� rf VC•
department. NUMBER FIXTURE OR ITEM ® FEE
- / LOCALITY (� y 'I'7
Date Applicant / S WATER CLOSET O CEARESTROSS ST. (_�/ t/�C•��
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION.INSURANCE ASSESSOR
(This section need not be completed it the work Involved by the 7j SHOWER MAP BOOK - PAGE PARCEL
permit Is for one hundred dollars($100)or less.) OWNER ST�•� `�j�
I certify that in the performance of the work for which this permit MAIL
LAVATORY � �y� l
is issued, I Shall not employ any person in any manner so as to SINK ADDRESS, � �[�r•-��^v V6
become subject to the Workers'Compensation Laws.
DISWASHER CITY'7�M �, G TEL.NO. ,��—QS
Date Applicant CLOTHES WASHER ,
NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ,
provisions of the Labor Code, you must forthwith comply with such ADDRESS - -
provisions Or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM -
LICENSED CONTRACTORS DECLARATION I CITY TEL.NO. d
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER '
(commencing with Section 7000 of Division 3 of the Business and STATE LIE
( 9 ) LICENSE NO. CLASS
Professions Code,and my license is in full force and effect. � GAS SYSTEM 3 OUTLETS - U
OUTLETS OVERI DISTRICT NO, p BAGGY
W
5 PER SYSTEM O A -�O, pIl Q
License Number Lic.Class (r 5110
~
FINAL
DATE VALIDATIODMS W
_ a
Contractor Date / FINAL TOTAL 3378 _5OZ
❑ 1 am exempt under Sec. BY CHECK 3815.511
B.BP.C.for this reason Il
Plan check fee - CHANGE ,I30
Date:
Signature PLUMBING PERMIT ISSUING FEE$ oa'(Lf
❑ TOTAL FEE O 01000-001111 J„y11.211D
SINGLE FAMILY �
Plan check applicant '7777 1 AMI 11
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the fallowing reason (Section 7031.5, Business and Professions Address
Code):
❑ City Tel.No.
I,as owner of the property.will do the work and th
e 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
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
representatives of this County to enter upon the above-mentioned
propert r inspe tion purposes. Q SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date _