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Home My Public Portal About4502 FIESTA AVE_Plumbing__ WORKERS' CbMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT -�here ipffifTn that I have a certificate of consent to self in- 20-0026 DPW 4/87 76A667A sure,or«certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified c y ereof (Sec. 3800, Lab. C.) Policy No. Company� S. Ux �� COUNTY OF LOS ANGELES DEPT: OF'PUBLIC WORKS` a Certified copy'is hereby furnished. BUILDING FOR APPLICANT TO FILL IN (PRINT OR TYPE) ADDRESS �O �G 9'�.%r✓ 'certified copy is filed with the county building inspection �`department. NUMBER FIXTURE OR-ITEM @ FEE LOCALITY Date/ Applicantf WATER CLOSET(TOILET) 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 ($100)or less.) LAVATORY ADDRESS 'C7'Z I certify that I the performance of the work for which this per- SINK CITY' �ze TEL.N14o 4L mit is issued, 'shall not employ any person in any manner so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR �� Date Applicant CLOTHES WASHER V` NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS�� tion, you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR em P Y I Compen- TEL. NOQ�• ��' sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM a v ly with such provisions'or this permit shall be deemed revok- STATE --IV// LIC. ed. WATER HEATER LICENSE NO. !d 6 CLASS / LICENSED CONTRACTORS DECLARATION DISTRICT NO.,/ OCESSED Y I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of.the Business OUTLETS OVER v/0 and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL �1/J�y V IDATION fect. -� DATE i, License Number � Lic. Class z 9 5 9,2 A G v y F L Contractor/' / �� LDate, ,, #`0 0 0 0 0 5 O I - - 28.50I am exempt under Sec. LU B.&P.C.'for this reason Plan Check fee ► o 0 028,505 � Date: PLUMBING PERMIT ISSUING FEE$ 05, 1288 Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant 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 I, as owner of the property, will do the work and the City Tel. No r 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 L/ 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Per tee Date 78A887 -CE#817 12-84 09877 CITY OF TEMPLE CITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS 4502 No, Fiesta Ave. JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS, SUPT OF BUILDING , LOCALITY FOR APPLICANT TO FILL IN NEAREST Tmnplq City CROSS_ST. Wjer Azusa Rd® NUMBER FIXTURE OR ITEM EACH FEE OWNER Albert T®s ®PIiBfrO WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS Spam CITY TEL. NO. SHOWER 1.25 LAVATORY 1.25 CONTRACTOR General Installation Co. SINK 1,25 ADDRESS 6558 West Blvd. DISHWASHER 1.25 CITY Los Angeles TEL. NO. PL 3254CONTRACTOR'S STATE1 LAUNDRY TUB 1.25 REGISTRATION NO. C-36 151839 787COUNTY CLOTHES WASHER 1.25 DISTR ICT NO. GROUP ZONE CESSED BY WATER HEATER 1.50 Y`/. �- �_— GAS SYSTEM OUTLETS 1.50 INDUSTRIAL WASTE APPROVAL �+ OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD C) I water softener Ready for Inspection Now I- w z I I APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 1 3 50 GAS PIPING IH ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE.THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. / I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESID, AL PROPE Y. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTEE FINAL Q Xl1d''�V�� 1f•�N�c' ..r.. LIDATION ROBERT WO CK. M.0. CASH SUPERVISING MECHANICAL ENG'R JuN 28 5 D 3.5 UN t 76A667 CE4817 6 65 APPLICATION FOR PLUMB NG PER COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACHFEE OWNER r r WATER CLOSET 31 25 P MAIL BATH TUB 1 25 ADDRESS r SHOWER 125 CITY TEL NO �. LAVATORY 125 CONTRACTOR SINS 125 ADDRESS/0 DISHWASHER 1 25 C /y TEL NOSATE _ Q LIC LAUNDRY TUB 125 LICENSE NO p` '�' CLASS —/ CLOTHES WASHER 1 25 D I ST�p ICT N GRO P ZONE I P C Y WATER HEATER 1 50 0 GAS SYSTEM OUTLETS 1 50 INDUSTRIAL n� WASTE APPROVAL Q OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD V O uuj APPROVALS DATE INSPECTOR S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK 3 ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE Iff 1 ffV//VV✓ //� / FINAL (1 LMAnON CK M O CASH Lko7773"lo MAR 28 5 0 350 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0012120007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 12998 LT: 30 4502 FIESTA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804209 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8592-001-045 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 12/12/00 UT 06/11/01 OWNER: TEL. NO: FINAL DATE FINA BAY: CODE: MELOHN;VIVIAN (626) 444-9243- 4502 FIESTA AV 12-is`z' TEMP 917804209 DESCRIPTION OF WORK GAS LINE FOR NEW HVAC SYSTEM APPLICANT: TEL. NO: AIR-TRO, INC. (626) 357-5311- 1630 S. MYRTLE AVE. SPECIAL CONDITIONS: MONROVIA, CA 91016 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE AIR-TRO INC. (626) 357-5311- 1630 S. MYRTLE AVE. LIC. NO UNDER SLAB WORK MONROVIA, CA 91016 258228 C20 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: - ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS ZEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508