HomeMy Public PortalAbout6157 ENCINITA AVE_Plumbing__ Tpg56,1710.55 APPLICATION FOR PLUMBING PERMIT -
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DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDINGy
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUP T'OF BUILDING /
LOCALITY `'•//'= a2Li,. CLC/
FOR APPLICANT..TO_ FILL INNEAREST q
I_ I �c J I CROSS ST.
OWNER ,I L. L�(J�yy�.,.� G`7✓y..L�'J�' DISTRICT I O� GRO� ZONE/ READY FOR INSPECTION
M AIL
ADDRESS �O/�.j / (I G!`L LO'i4.�LL✓ U/I\
CITY �' GC ./6 4NDUSTRIPR
�I, TEL. NO. WASTE APPROVAL
PLUMBER 6`411;—'n Cv - T INSPECTION RECORD
ADDRESS G I }}I t c,' r F (✓G![v/ /'�i/
CITY I I U / t TEL. NO.
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEW FEE
r/ WATER CLOSET (TOILET) @ $1.00_$
BATHTUB @ $1.00
SHOWER @ $1.00 >. // �,�r:k' �lY•IA /1`I_/Li.+r'4iyir��
/
LAVATORY (WASH BAS IN) @ $1.00
KITCHEN SINK @ S1.00 -
DISHWASHER @ $1.00
/ LAUNDRY TUB OR TRAY- @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @ $1.00
GAS SYSTEM @ $1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
n UNDER SLAB WORK
PERMIT $ 1 00., ROUGH PLUMBING
GAS PIPING
TOTAL FEE U G
GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
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 1 AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY. '
SIGNATURE -�11/L'f�L'L' 1 r ( L )`.
OFPERMITTEE FINAL I
JOHN A. LAMBIE, COUNTY EN t INFER' ,.-VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR '
K. M.0. CASH
TO 0
Wfirm th t I have
a cerNDECLARA once APPLICATION II•®Ift PLUMBING Ir"SAFETY
hereby WORK that I have o TION cate.DECLARATION
of consent to sell 76A667A - v
insure, or o certificate of Workers' Compensation Insurance, CE 817(REV. 10/8I)
or a certified copy thereof (Sec. 3800, Lo--. G.) COUNTY OF LOS ANGELES + UILDING AN
Policy No. Company
Certified copy is hereby furnished.
r_1 Certified
APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / �/
Certified copy is filed with the county building inspec- ADDRESS {7 �5 7 /F Ch C'/ `h 1;L,,
tion
+ s,
tion departme M. NUMBER FIXTURE OR ITEM @ FEE LOCALITY // ; .{
�2 f't't (C. /
Date AppliSa nt WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. _ P
COMPENSATION INSURANCE OWNER
(This section need not be completed If the work Involved by SHOWER
e.
the permit is for one hundred dollars($100)or less.) LAVATORY AMIE
ADDRESS
I certify that in the performance of the work for which this _
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.. CTC / /5
so as to become subject to the Workers CONTRACTOR
Compensation Laws. DISHWASHER D V a
?1G
Date �O - _Spplicant •s"^"'�'� CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this 46erfificale ofADDRESS
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR -
Compensation provisions of the Labor Code, you must forth- CITY TEL.NO,
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT No. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �I�O �/ 7p
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER C" t— Y
d
and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL
Wet DATE VALIDATION O
License Number—tic. Class lr a' i�2' )
FINAL O
Contractor Date BY
ElL/ V
I am exempt under Sec. O y
B.BP.C. for this reason Date: D Plan check fee Z
Signature
PLUMBING PERMIT ISSUING FEE$
O �
TOTAL FEE Z —0 is 3 E P
Plan check applicant ° ° ° - 5
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name !+ - 2250
1 hereby affirm that I am exempt from the Contractor's License
Law for the following reason (Section 7031.5, Business and Address c o 2 2 5 0 ti
FProfe C ions Code): City Tel. No.
IC26-_ 3
I, 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).
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
1 certify that I have read this application and state that the D
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
fQ ti 10-76-5'x'
'Signature of Pe ittee Date
I.OUNTY OF-JOS ANGELES � TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT f PUBLIC WORKS 9701 LAS TUNAS PL 0508 0105030023
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL _ FEES PAID BUILD ING-ADDRESS:
TR: 5904 LT: 288 BL: .001 6157 ENCINITA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801637
ASSESSOR A7 0 BER: NEAREST CROSS STREET: LONGDEN
5384-012-019 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE,CITY
25 LAVATORIES/SINKS 1.00 FIX 16.20
TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED B AN BY: EXPIRES ON:
05/03/01 UT 10/30/01
OWNER: TEL. NO: FINAL PATE FIN CODE:
JOHNSON LOWELL;MARGARET TRS (626) 286-6634- —' li--�
6157 ENCINITA AV
TEMP 917801637 D LUN0 0 K
AD WASH BASIN (SINK) TO GARAGE- TO EXISITNG DRAIN
PLIC TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
�N
CONTRACTOR: TEL. N0: C,ELES CO�O�j iVa,� APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. N0: _ �j
ROUGH M f p
LIC. N0: __ t 1111111 PING
_j (K
GAS VENT
,�� t � I HOT WATER HEATEV-
PLUMBING FIXTURES
� � — O �� ➢b4.�1i
LAWN SPRINKLERS
t.,
GAS TEST
UTILITY COMPANY NOTIFIED
7'a�2
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508