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HomeMy Public PortalAbout5420 ENCINITA AVE_Plumbing__ 76A667A(UE 8178) 11/76 (`y APPLICATION FOR PLUMBING PERMIT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM @ FEE ADDRESS WATER CLOSET LOCALITY NEAREST BATH TUB CROSS ST 641 SHOWER OWNER LAVATORY ti MAIL J ADDRESS SINK CITY T5yINO J DISHWASHER CONTRAC CLOTHES WASHER ADDRES SWIMMING POOL RECEPTOR LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LICEN NO CLASS GAS SYSTEM OUTLETS O O DD�RI�NO G OUP ZQ%E PR SED By OUTLETS OVER 0 6 5 PER S TEM INDUSTRIAL WASTE APPROVAL U INSPECTION RECORD u LNC o z Plan check fee PLUMBING PERMIT ISSUING FEE$ —� TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR S SIGNATURE Name 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 ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDE PROPERTY UTILITYCO NOTIFIED SIGNATURE of RIKiTEE FINAL PLAN CHECK VALIDATION �� gyp^ �9e"1 7 ZVRMIT /� IDATION CK M O CASH O!`CY HOLDER: cc�vt� , c— 3 3 8 © 2.5 U f POLICY NUMBER: `9 z✓/," 76AS67C ICE 817-A)- 1 1/76 �N COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING NUMBER FIXTURE OR ITEM ® FEE ADDRESS o Q� WATER CLOSET LOCALITY MQ '�1-4 c'J NEAREST u kV BATH TUB CROSS ST. SHOWER OWNER 44 M 5 LAVATORY MAIL ADDRESS g SINK3 0(� CITY TEL.NO. DISHWASHER '00 CONTRACTOR CLOTHES WASHER ADDRESS d U sUT'`� & Gu Lc O✓ y SWIMMING POOL RECEPTOR CITY . ,pZ 48 TEL.NO.� LAWN SPRINKLER SYSTEM STATE LIC WATER HEATER LICENSE NO {� CLASS 6 GAS SYSTEM OUTLETS DISTRICT NO. GROUP /ZONE PRO ESSED B OUTLETS OVER "' :0- 5 PER SYSTEM INDUSTRIAL 9 WASTE APPROVAL INSPECTION RECORD u 6= Iz. ` Plan check fee PLUMBING PERMIT ISSUING FEE$ 00 TOTAL FEE ' Ivel ., I° Plan check applicant 0 APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK Address ROUGH PLUMBING LL 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 YaG•�o $ -„"�,-If�r�,,. REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE GAS TEST LEGAL OWNER OF,AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL ; PROPERTY. UTILITY CO.NOTIFIED . y' 't" SIGNATURE O E-R M�TT-EE - FINAL PLAN CHECK VALIDATION^ M ASH PERMIT VALIDATION ` CK. M.0. 1 CASH a `POLICY HOLDER: �= POLICY NUMBER. f� � 3 S-O SJ .4 U 44v ° WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I Yereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 Ins ur' ar a certificate of Workers' Compensation Insurance, 76A667A f.or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS 0 Policy No. Company Certified copy is hereby furnished. BUILDING y ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS g/G/,// 4 Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB /J ®0 CROSS ST. /y� A COMPENSATION INSURANCE SHOWER OWNER e (� ,_C��� (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS y�//L'y 1 certify that in the performance of the work for which this426 TEL. NO. permit is issued, I shall not employ any person in any manner SINK CITY � ir— C --y7 so as to become subject to the Workers'Coompensation Laws. DISHWASHER ��/�/g,e,7`� ray/� CONTRACTOR Date Applicant '/'fI r �j CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption,, you should become subject to the Workers' CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATIONISTS PROCESS D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS w'J ('SJ{ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL Q� ALIDATION 0� DATE J�/Z 7/0/ ®• License Number Lic. Class FI0, NAL � Contractor Date B ®, ❑ I am exempt under Sec. L411 B.BP.C. for this reason V' Plan check fee ® N Date: D Z PLUMBING PERMIT ISSUING FEE$ 'Signature TOTAL FEE Pian check applicant SINGLE FAMILY 5 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address ACCT.0 Law for the following reason (Section 7031.5, Business and Prof ssions Code): City Tel. No. 3307 52°50 1, as owner of the property, will do the work and the 1 ITE lS structure is not intended or offered for sale (Section ® Irk© �� 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 52°so I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANGEQl,l ° (Sec. 3097, Civ. C.). Lender's Name GWO-0001 8/24/89 Lender's Address 1 AN 9°,rr 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- entioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE OQ Signature of'Permitt a Date o , COUNTY OF LOS-ANGELES TEMPLE CITY # 0508 ,PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS `PL 0508 9901250022 • BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUI-L-DING ADDRESS:- ON FILE 5420 ENCINITA AV- FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803116 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 8588-031-016 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 01/25/99 UT 01/25/00 OWNER: TEL. N0: FINAL DATE EXPIRM: CODE: TSAI CHUNG CHE;TANG HSIAO L - 5420 ENCINITA AV TEMP 917803116 DESCRIPTION OF WORK CHANGE OUT OF WATER HEATER, APPLICANT: TEL. NO: MARSH PLUMBING (818) 407-1247- 7229 VARNA SPECIAL CONDITIONS: N. HOLLYWOOD, CA LES C CONTRACTOR: NG TEL. N407-1247- d®� �1/'� APPROVALS DATE INSPECTOR SIGNATURE MARSH PLUMB7229 VARNA AVE. LIC. NO UNDER SLAB WORK NORTH HOLLYWOOD, CA 91605 16425B/L WATER SERVICE Z PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. N0: 1111111 GAS PIPING VENT LF ' U ' VV 0 Ks HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS Ifit. GAS TEST L0 O �_�p UTILITY COMPANY NOTIFIED �® CWV sepF1G�� GRAY WATER SYSTEM * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: BS0508