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Home My Public Portal About4526 FIESTA AVE_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0205100008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285 0488 EXT LEGAL ID FEES PAID BUILDING DDRESS TR 12998 LT 15 4526 FIESTA AV FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917804209 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET LOWER AZUSA 8592 001 028 01 PERMIT ISSUANCE FEE L( 75 THOMAS PAGE 597 GRID A5 LOCALITY TEMPLE CITY 47 WATER HEATER(S) 1 00 WTH 16 20 TOTAL r;-:ES 43 95 ISSUED ON �PKGLLSSEU BY PLAN BY EXPIRES ON 05/10/02 ik 11/06/02 O!'NER� TEL NO FIN- -ATE FINAL BY CODE BRUNO ARMANDO BERTHA (626) 448 6950 --?/ 4526 FIESTA AV en( TEMP 917804209 DESCRIPTION OF WORK WATER HEATER C/O APPLICANT TEL NO ACTION CONTRACTORS (310) 515 1311 17111 S BROADWAY SPECIAL CONDITIONS GARDENA 90248 - — - - CONTRACTOR TEL NO - APPRCVALS DATE INSPECTOR SIGNATURE ACTION CONTRACTORS INC (310) 515 1311 17111 S BROADWAY LIC NO �� r' �f �\ UN-DEF-SLAB WORK GARDENA CA 91775 652535C36 f - WATFR SERVICE PLASTIC Y/N METAL Y/N ARCHITECTNGINEER TEL NO I� �i I ROUGh PLUMBING LIC NO 1 � I ' GAS PIPING GA VENT HOT WATER R / 4 PLWBIN / LAWN SPRINKLERS G�1 S i f UTI UTY COMPANY NOTIFIED CWV SYSTEMGRAY WATER REPORT ID DPR263 ROUTE TO BS0508 76A687 CE#817 2 62 7 APPLICATION FOR LU ING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE COUNTY ENGINEER ADDRESS S ® C / WILLIAM A JENSEN SUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST �r �v CROSS ST NUMBER FIXTURE OR ITEM EACH FEE !" ✓� WATER CLOSET SI 25 OWNER a i^ o�S MAIL BATH TUB 1 25 ADDRESS SSCP / SHOWER 1 25 )J CITY TEL NO LAVATORY 1 25 ' CONTRACTOR tg/ h SINK 1 25 ADDRESS el DISHWASHER 125 CITY TEL NO LAUNDRY fUB1 ZS CONTRACTOR S STATE ❑ REGISTRATION NO COUNTY ❑ CLOTHES WASHER 1 25 DIST N ^- GROUP ZONE PR jED BY WATER HEATER 150 GAS SYSTEMOUTLETS 1 50 INDUSTRIAL WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD / y l3 -A0 n .�w.-,(�A�/��a�.C�e A W CL APPROVALS DATE INSPECTOR 5 SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING 2 d' , �W v TOTAL FEE ZZ GAS PIPING v IH ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH IIUMBING COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES (t,? 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 FINALIV VALIDATIOW-) ROBERT A WOOD CK M o cs SUPERVISING MECHANICAL ENG R 8 3 5 2%1; DEC 13 5 0 575- 4 v WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby arh that I have a certificate of consent to self 76A667A *► insugr a I�rtr;.cate of Workers Compensation Insurance CE 817(REV 10/81) ` or a certifiedl�opy thejeof (Sec 3800 lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ��n �/�S IRCertified copy is filed with the county building inspec ADDRESS �6 tion d partment NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET �J Date '2 Applicant v NEAREST � w CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST COMPENSATION INSURANCE OWNER R�/4 �.0 O (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less ) LAVATORY ADDRESS J 2 co /C Sl f/p MAIL I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner SINK CITY f�,J9pe27 TEL NO so as to become subject to the Workers Compensation Laws DISHWASHER 7 +o w / � CONTRACTOR 409 Dote. Applicant ®i1�,..e..�,..H��zoja /R CLOTHES WASHER NOT1,6E T APPLICANT If after making'this Certificate of ADDRESS Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code you must forth CITY TEL NO LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE` LIC deemed revoked WATER HEATER LICENSE NO CLAS LICENSED CONTRACTORS DECLARATION DISTRICT NQ P CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER d and Professions Code and my license is in full force and effect 5 PER SYSTEM FINALDATE /_ VAL ATION U License Number Ltc Class IM FIN Ct Contractor Date B ~ QV I am exempt under Sec IOU. B&P C for this reason Plan check fee Z 0100 Date PLUMBING PERMIT ISSUING FEE$ D Signature , TOTAL FEE 6 S Plan check applicant SINGLE FAMILY �4 2 4 1 A HOME OWNER BUILDER DECLARATION Namem N�& # 0 0 0 o a 5 1 hereby affirm that I am exempt from the Contractor s License 04RAddress ,/ A �+ Law for the following reason (Section 7031 5 Business and 1 sa ��/7 G I o o 5 O Professions Code) City �1F�l�1�OLIC/r Tel No !/��69s� ® I as owner of the property will do the work and the f o 0 o 1 650r-! structure is not intended or offered for sale (Section 00, O 317-86 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 ) r 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 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