Loading...
HomeMy Public PortalAbout5340 ENCINITA AVE_Plumbing__ 17 12 54 DBS APPLICATION FOR PLUMBING PERMIT DBS 17 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles WM J FOX, COUNTY ENGINEER BUILDING ADDRESS .alb L!r /1 l0 CASSATT D GRIFFIN, SUP T OF BUILDING LOCALITY FPR APPLICANT TO FILL IN NEAREST ROSS s OWNER DISTRICT NO I GROUP I ZONA, I READY FOR INSPECTION MAIL ADDRESS -� INDUSTRIAL CITY TEL N WASTE APPROVAL _ PLUMBER V INSPECTION RECORD ADD SS � •S ti ��' {"L.� 4A1 �P Fl 0-'F'-pp Q ia1 t l�Ia�"'.� CITY TEL NO ��.ovw,l.f✓ Q�„psG, 1X3.aC.Q�(.JL.,� LICENSE NO c- pt&-- 6 O -9 NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) BATH TUB O/Gn C'aYgLr� lLct-L SHOWER LAVATORY (WASH BASIN) r KITCHEN SINK DISHWASHER / LAUNDRY TUB OR TRAY � CLOTHES WASHER C TOTAL NO `� @ O Bo APPROVALS DATE INSPECTOR S SIGNATURE GAS SYSTEM OUTLETS @ 1 00 UNDER SLAB WORK ' A WATER HEATER @ 1 00 1 ROUGH PLUMBING 3� . .� �o(} PERMIT S I 1 00 GAS PIPING TOTAL FEE 9 L2 GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATCR HEATER _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES PLUMBING GAS TEST I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR _ — LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF UTILITY CO NOTIFIED ^d CALIFORNIA OR THAT 1 AM THE L AL OWNER OF THE ABOVE DESCRIBED RESID L PROW.VJY E r SIGNATUR �' OF PERMITTE FINAL WILLIAM J FO C LINTY ENGINEE VALIDATION ,T,0 3 3 5 2U-1 MAV 3 3 8.6 0 BY FDEPUTY 76A667 CE#817 5 61 -D 12326' City of Temple City APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 5340 Encinitas WILLIAM A JENSEN, SUPT OF BUILDING LocALrn Temple Cit FOR APPLICANT TO FILL IN C$0�sT Roemead & Broady NUMBER FIXTURE OR ITEM OWNER F. Hall WATER CLOSET buuL ADDRESS Same BATH TUB CITY TEL. NO. SHOWER coNTRAcroR General Installation Co. LAVATORY slNs ADDRESS 6558 west Blvd. DISHWASHER CITY Los Angeles TEL. No. PL 3-2541 CONTRACTOR'S STATE LAUNDRY TUB REGISTRATION NO. -36 151839 COUNTY CLOTHES WASHER DISTRICTNOGROUP /ZONE PR D Y WATER HEATER s• 0 0 -F I GAS SYSTEM INDUSTRIAL V WASTE APPROVAL ' IIiSPECTi N RECORD ♦ 0 u 1 - 1744 O $1 DOPER ITEM O8 FIXTURE $ APPROVALS v DAT/E ,�--INSPECTOR'B BIONATURE PERMIT $ 2 00 UNDER SLAB WORK / TOTAL FEE ROUGH PLUMBING3 12 GAS PIPING t } I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION p ANO STATE THAT THE ABOVE 13 CORRECT AND ACRES TO COMPLY GAS VENT o WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING �I I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST A CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMMEE r2�0 � FINAL T J /}TALMATION ROBERT A rWOOD �CK M O CASH SUPERVISING MECHANICAL ENG R 3.5 L&O 4�2 1 4 SEP 12 5 D " x. WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A6667A PW 4/87 sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) 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 Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) Date Applicant 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 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 mit is issued, I shall not employ any person in any manner so CITY TEL NO. 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 Ex- emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM 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 } 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER p and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. DATE License Number Lic. Class J FINAL ti Contractor Date BY } I am exempt under Sec. -C B.BP.C. for this reason Plan check fee C a Date: PLUMBING PERMIT ISSUING FEE $ Signature SINGLE FAMILY TOTAL FEE Plan check applicant HOME OWNER-BUILDER DECLARATION pp I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and 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). 101111".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 101111'.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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS' COMPENSATION D€CLARATION APPLICATION FOR PLUMBING PERMIT I hereby,'affi m that I have a certificate of consent to self in- 20-0026 DPW 4187 f L 76A667A `dull sure..1) a certificate of Workers'Compen"cation Insurance,or a CE 817(REV. 8/86) certified•copy thereof (Sec. 3800, Lab. C COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. BUILDING 34 FOR APPLICANT TO FILL IN (PRINT OR TYPE) 2 O � Certified copy is filed with the county building inspection ADDRESS u F,-tx c 1',7, 1 department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER or— /q eA,� (This section need not be completed if the work involved by MAIL C the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS t34 0 I certify that in the performance of the work for which this per- SINK �A r mit is issued, I shall not employ any person in any manner so CITY ��•t _1,}. TEL. NO. 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 Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM 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 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER v f —1X_—z � and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION } fect. DATEZ1 License Number Lic. Class O U FINA Contractor Date BY O I am exempt under Sec. IA2 /° d B.&P.C. for this reasonPlan check fee ► '� z Z Date' PLUMBING PERMIT ISSUING FEE $ Signature V TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and -- Ffsstructure ions Code): Address N�'t�'t �T as owner of the property, will do the work and the City Tel. No. ,`3Ct is not intended or offered for sale(Section 7044, Business and Professions Code). , _ 3 CONSTRUCTION LENDING AGENCY HEC I hereby affirm that there is a construction lending agency for 3- `-t''. the performance of the work for which this permit is issued1•-,- -. (Sec. 3097, Civ. C.). `=•�IANGIE" •al-' Lender's Name - _ 'JU UIJ Ul ill Lender's Address -s� 1 M "7 I certify that I have read this application and state that the r J (d•t �} 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 property for insp on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of rmittee Date is WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,affirm-that I have a certificate of consent to self 20-0026 DPW 6/87 insure,"or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Policy No Company i ❑ Certified copy is hereby furnished r FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 3 EJCertifiedcopy is filed with the county building inspec- ADDRESS tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER 3 � (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars ($100)or less ) LAVATORY ADDRESS U &,L nl\` I I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY ( TEL NO 0 so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR .—,e�LZfJ-3�-?✓✓ _ Date V Applicant(,/ CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM ap with comply with such provisions or this permit shall be STATE LIC deemed revoked 1AJWATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY II I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER v and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION DATE License Number Lic Class ' 8 FINAL Contractor Date BY ' 1 0 ❑ I am exempt under Sec I a (j W' I B 8P C for this reason �-` 'J. Date Plan check fee ® ; C2211PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE © - Plan check applicant SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Name - yhhe by affirm that I am exempt from the Contractor's License Address1TSror the following reason (Section 7031 5, Business and __sions Code) City Tel No .i( � �9 - .�� j, as owner of the property, will do the work and the L 70° structure is not intended or offered for sale (Section ti 7044, Business and Professions Code) `I CONSTRUCTION LENDING AGENCY _ I hereby affirm that there is a construction lending agency for �C the performance of the work for which this permit is issued Ill li ji t—!?I tI if if �,! I (Sec 3097, Civ C ) J 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 jaws regulating Plumbing, and hereby authorize reprelentotives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o ermittee Date