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Home My Public Portal About5036 FIESTA AVE_Plumbing__ 76A667-CE#817 4-67 APPLICATION FOR PLUM IN PE MIT COUNTY, OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS 5036 'sesta -COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple ity FOR APPLICANT TO FILL IN NEAREST caoss sr. Ea Rosa NUMBER FIXTURE OR ITEM EACH FEE OWNEsNorman Parker WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS 5036 Fiesta p SHOWER 1.25 CITY Temple City TEL. NO. 286-9301 LAVATORY 1.25 CONTRACTOR Pacific Installers SINK 1.25 ADDRESS 10920 E. Grand Ave. DISHWASHER 1.25 CITY emple CityATETEL.TEL. NO. 442-7070 LAUNDRY TUB 1.2S LIC LICENSE NO. 21.1890 CLASS C-20 CLOTHES WASHER 1.25 DISTRICT NO. GR1P ZONE I PRO CES ED BY �- WATER HEATER 1.50 0 -5- 7" orz GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a V WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD O W APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT 5 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 3 O GAS PIPING � I HEREBY,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 CERTIFYI 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 ESIDE TIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE 12�` OF PERMITTEE lll��(�.. ...CCC--��- FINAL f� C�, LIDATION JACK R. ALLEN CK. M.0. CASH SUPERVISING MECHANICAL ENG'R. Lill 7 8 1 s D"c31 5 D 3,J 5 0- WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) CITYN OF TEMPLE CITY or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY ,. � 21739 Policy No. 201916 Company SCI READY PC-1110N Dl Certified copy is hereby furnished. ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �. Certified copy is filed with the county building inspec- ADDRESS 5036 Fiesta Ave . tion department. NUMBER FIXTURE OR ITEM � FEE LOCALITY TeMiple city Date 41/1 /83 Applicant General install . WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. Lov'?er Azusa COMPENSATION INSURANCE SHOWER OWNER Freres Petteruto (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS same I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.286 4365 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR General Iristallatlon Date Applicant CLOTHES WASHER ADDRESSWest X31 Vd e NOTICE TO APPLICANT: If, after making this Certificate of 6558 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM g CITY LOS Aneles TE`' "7 53-2541 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. 1 WATER HEATER LICENSE NO. 15 1 5 3 9 CLASS C 3 6 3a LICENSED CONTRACTORS DECLARATION DISTRICT NO. BROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER 6 and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION QO DATE License Number '+ 91 p3 a Lic. ClassS'�h FINAL :7 Contractor V-7 .0..PrOVln Date 4/5/55 BY ❑ 6 I am exempt under Sec. � B.BP.C. for this reason g Date: Plan check fee PLUMBING PERMIT ISSUING FEE$ e 50 Signature TOTAL FEE 50 Plan check applicant C C V6, I. SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name ' O o h I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and 6. 5 Q Professions Code): City Tel. No. 5 I, as owner of the property, will do the work and the O F1 structure is not intended or offered for sale (Section ( - 2 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 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 Olt r ' �Ar l•��f��^ ..;`.: .` `. .. -' ��I�E �� •�`~ '�� fie + amourrot tH f # s - " e f OpQM!Wt. A-Wpi rk _ 4 ell ��~ �;- �'.•:� MAI �"� �',,; � '` Ivv1A�1� II NL diva - cow- 0 !AN"t-"GAL OWNpI 4W t*IOLNTIAr.�NO►• ' ,N1i0'l1��1.OIM�IINMIt� TirT1►OtM�Nt11M►.�¢w`�' '. r. �} �'' �.. VR _ �Tt1�lw°.,, .�� •..p4tlifIT, ��.� �LAnM� w,.-::.-r;''�, ,rr�� '' ;;;;.. QMa� TOUNTAIN .1 >i ,: . .. 1® ' 9 ., .Allft V'XL8 e ` r bA rlt ►NMstnOWS "ANN *Mow oLumelsow-- OAO ♦AIIK +•QMAtN f f !., i r •- Y fQ" AM �- - .�-��. , `- OLT Jb z� ,, fm _ Oc M APPLWATYON FOR PERmI'r t � ►t AM SAFETY � ti Uoil r�r ML lk CMDr11VA 0I w AOY 1011 N' OTC I1tpU[t7 F • IIpf1'INrKdtlt7 �� jag � poll x � 660 val"I"llpol >1.0[tdLti'r V Te., ,}y�, yam. K A0011tog ' ;yam" .•_ _.___..._..,:... - _� y- ---•- ...__ x _ 0t,�.---:-+,- ;-»u ._.. _ ,a:= ��__..._ 3.:._._._.-_.._._- - r't t�lrtt Iii +rr.�o t►Orlir ►ixruKs IL�MT �r, 'NjA'td*wo ApOmom" A r M tNC Ltif1AL C"Itp Or'1'Mt ptrfbs"tIAL Iltopm, "two MN emus W`Io'��IIItA11oo!'r oRA1M1�1tLo' tpTY otlClt�rCD Arob� • 91.0m, molowllft, ANY ftftmf*;it.�' tJtttM . x l�11t MatM 1r A IIIA 1M . ywNta wrs ai #fXftllt an #UN WRRECI'IONS WATCH Maw I ulaTI� rA'1'N ?US, LAYhTO t ., rArlNl i1A! 1111111►t�: ......Rt1Tt 7 WAi1t11 SLOW OINK --_--- rLti011'OINK__ ._ s.. __�:�� .._ ._.-_ -_ .....�._,•„__ - tfISNWArNtR. 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