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Home My Public Portal About8853 ELM AVE_Plumbing__ 76A667-CE817-8-58 APPLICATION FOR . PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS ' CASSATT D. GRIFFIN,Sup't-of Building LOCALITY FP FOR APPLICANT TO FILL IN NEAREST CROSS ST. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL BATH TUB ADDRESS d, CITY TEL. NO. SHOWER LAVATORY CONTRACTOR _ SINS ADDRESS .�I _ DISHWASHER CITY TEL. NO.A? 293 ,3 -5 , CONTRACTOR'S. .— STATE LAUNDRY TUBREGISTRATION NO. 5 COUNTY .❑ CLOTHES WASHER DISTRICT NO GROUP ZONE PROCESSED BY x WATER HEATER / GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD 4' APPROVALS OR FIXTURE $ DATE INSPECTOR'S SIGNATURE UNDER SLAB WORK PERMIT $ 2100 ROUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION „ GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST �$�/ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF _ CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL�JPROPERTY. ' SIGNATURE j`�L GL C.C�G C(! FINAL OF PERMITTEE ROBERT A.WOOD. OF VALIDATION . SUPERVISING MECHANICAL ENG'R r- . --- m:0..,.-...—.CASH=.. ��7868<, a1 � 5 A 3 .10 �U. .n WORKERS'COMPENSATION DECLARATION 6=dP HCAMN FOR P LIUJIIVIlENG PLSROV[10 ll I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company _ Certified copy is hereby furnished. BUILDING ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS �[ Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM ?i FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' _ BATH TUB // ° , CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL p the permit is for one hundred dollars ($100)or less.) 21LAVATORY ADDRESS O I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY /Z�j� G TEL. NO. �y 2- so as to become subject to the Workers'Compensation Laws. DISHWASHER , v _P CONTRACTOR Date Applicant CLOTHES WASHER DDRESS A ��rt✓� NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR _ 3 /� .Exemption, you should become subject to the Workers' CITY TEL. NO.&'v, Compensation provisions of the Labor Code, you must forth- p V �' -1,'� �S LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. P ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS V (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER15 11 and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALlIALIDATION V DATE License Number Lic. Class ' FINAL p? O Contractor Date BY r�aar U ❑ 06 I am exempt under Sec. t� B.&P.C. for this reason Z Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant Sj/&A,4 • _W4Z ' HOME OWNER-BUILDER DECLARATION Name S7-- -h4A I hereby affirm that I am exempt from the Contractor's License �� Law for the following reason (Section 7031.5, Business and Address `1'/ U (} " •- .�' Professions Code): City /� C�'J t Tel. No. c o o o.; ' 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, Business and Professions Code). o CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for _ r the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Lender's Address -- 1certify that f have read this application and state that the oD above information is correct I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize rep rese tatives of this County to enter upon the ??�;enti oned property for inspection purposes. 7 _ SEE REVERSE FOR EXPLANATORY LANGUAGE � � �.} J Signature of Permittee Date 4 • WORKERS'COMPENSATION DECLARATION AIf"FUCA7PO�]( FOR PL M p NG pER(�/ Y I hereby affirm that I have a certificate of consent to self 76A667A u v vuvu u v uUuvu insure,. or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. BUILDING In ^ ` ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) _ ' Certified copy is filed with the county building inspec- ADDRESS t L , tion department. NUMBER FIXTURE OR ITEM a FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by the permit is.for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY C TEL. NO. so as to become subject to the Workers Compensation Laws. . DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become,subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRI��yy..NO. �PROCESSEDBY GAS SYSTEM OUTLETS I hereby affirm that I am licensed under provisions of Chapter 9 f (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM DATE FINAL AEL _ VALIDATION 911. License Number Lic. Class FINAL Contractor Date BY O ❑ I am exempt under Sec. B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's License c /21 A Law for the following reason (Section 7031.5, Business and Address Professions Code): CityTel. No. °.°.° °;05 I, as owner of the property, will do the work and the Z.o 0 1 6-50 structure is not intended or offered for sale (Section ` 7044, Business and Professions Code). o 1.6. 50 F2 CONSTRUCTION LENDING AGENCY C,0 6 8 4 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 T-r -- _- - — -- - -•-- _r__ T --�- 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 r gulating Plumbing, and hereby authorize representatives ' County to enter upon the above-mentioned pro It inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 511 —��— X Signature of Permitted' Date • � s • COUNTY OF LOS ANGELES• TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0703230001 BUILDING AND SAFETY / LAND DEVELOVM$NT- TEMPLE CITY CA 91780 DUPLICATE PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 3623 LT: 101 UN: .002 8853 ELM AV (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801843 ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ROSEMEAD 15387-010-011 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 117 FLOOR DRAIN(S) 2.00 FIX 32.40 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 125 LAVATORIES/SINKS 1.00 FIX 16.20 103/23/07 JK 09/19/07 145 WATER CLOSET/URINAL 1.00 FIX 16.20 1 OWNER: TEL. NO: I TOTAL FEES 108.75 F AL DATE FIN CODE: IHWANG SHUWA;HWAN SHUN T (626) 285-7581- 1 1 18853 ELM AV I I TEMP 917801843 1 IDESCRIPTION OF WORK 1 IPLUMBING FOR FRONT HOUSE NEW BATHROOM APPLICANT: TEL. NO: SAME AS OWNER I I ISPECIAL CONDITIONS: (� ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I 1 LIC. NO I (UNDER SLAB WORK 1 IWATER SERVICE I IPLASTIC Y/N METAL Y/N I I (ARCHITECT OR ENGINEER: TEL. NO: I I I I 1 IROUGH PLUMBING l I LIC. NO: I I I- IGAS PIPING ' GAS VENT IHOT WATER HEATER I I I (PLUMBING FIXTURES ILAWN SPRINKLERS IGAS TEST I I 1 (UTILITY COMPANY NOTIFIEDI I 1 1CWV I GRAY WATER SYSTEM I I I I 1 I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 I I I 1 I I I I I I