HomeMy Public PortalAbout9055 GARIBALDI AVE_Plumbing__��7 6 A ( 3 6 7 - C E 8 1 7 3 - 5 9
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. ' b o 5 7 4 3 y F E B 5 A 3 . 0 D m
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGB.E.S BUILDING AND.SAFETY
FOR APPUCW TO FILL IN(PRINT OR TYPE) BUILgNG i
ADDRSS
NUMBER FIXTURE OR ITEM O FEE
LOCAL"
WATER CLOSET
NEAREST
BATH TU)B CROSS ST
SHOWU _k__L"I,NERezz 12
LAVATORY LESS
SINK CITY T Ei_
DISHWASHER C INSTALLERS
CLOTHES WASHER
SWIMMING POOL RECEPTOR �j
LAWN SPRINKLER SYSTEMMPI E TEL Y2 7c'
$TATE. LC
WATER HEATER L I CEiJSE NO. aAss
GPS SYSTEM OUTLETS APPROVALS DATE IM WECTOR-S SIGMATURE
„C LM DER SLAB W04ZK
ROUGH PLUMBING y.
GAS PIPING (¢�
GAS V ENT V
HOT.WATER FLFATER
PLUM$!NG FIXTURES
GAS TEST
Plan check fee uTILfrYCO_NOTIFIED _
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE FINAL
Plan�hecjc applkartt PLAN CHECK VALIDAT N
Name
Addreu
city Tel.NO. 1 6 9.9 A
I YM
HEREBY ACQWLCDOC THAT I HAVE It![AD THIS AJ•PLKJITIQN MMD STATE
THAT THE A&M LS CORRECT AMD AQR EE TO COMPLY WTFH ALL COUNTY ORDINANCES # O O O O D 5
AND-STATE LAWS1tEdULATTNG PLUM112. PERMIT VALIDATION
I HEREBY CERTTF!THAT I AM PROPERLY REQLSTEMED AMD/O!1 UCINUD AS 2 O O 1 a O O
REQUIRED BY LOS'AWFI FS COUNTY AND STATE OE CAUPORNLA QR THAT TAY THo
LEGAL OWNER OE.AND INTEND TO US UIE IN TRe ABOVE DELCM BE.q REE)DENTIAL O O O 1.Cl O 0
-PROPERTY. r� r7 p
AIQNA'R5 ' 7 O 7— I U
CIP PERM rrTGE
DISTRI NO. BY
INDUSTRSAL
WASTE APPROVAL
WORKERS COMPENSATION DECLARATION 9/� APPLICATION FOR PLUMBING PERMIT
76AEE7A
I heret••af1,•m that I have a oertifloete aT consent to self Insure,
or a 4e tat Worker's Compensation of,
or a cerWled
copy thereof(Seo.3840 lab.C.) (CITY OF TEMPLE CITY)
COUNTY OF LOS ANGFl FR DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Po" NMIC
❑ Certffled copy Is hereby furnished.
FOR APPLK.AN-r TO FILL IN(PPoNT OR TYPE) BUILD4rCi
® Certffted copy is filed with the county building Inspecd. ADDRESS
depmtn-t NUMBER FDCTURE OR ITEM • FEE LOCALITY
Date Q, 1 19-4 App ENERAT, INSTAT.1 WATER CLOSET T
iMttEaT
CERTIFICATE OF EXEMPTION FROM WORKER;9BATH TUB
' ASSESS ST. .
COMPENSATION INSURAyCE -MAP PAGE PARCEL
(This section need not be completed if the work Involved try the SHOWED
permit is for one hundred doltara(8100)or leea.) LAVATORY OWNER KENTON BRINRELY
I certtty that In the performance bf the work for which this permit MAIL
Is Issued, I shell not employ any person In any manner so as to SINK AMP1=88 9055 GAR113ALDI AVEI
become subject to the Workers' Compensation Laws.
DiSWA8HEA CITY
50-55
DaW APpnt CLOTHES WASHER CONTRACTOR
- -
�
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption,you should become subject to the Workers'•Compenmtlgn 8M MING POOL RECTOR
provislona of the Labor Code, you must forthwith comply with such ADDRESS 6558 WEST BLVD.
provisions or this permit shall be deemed revoked. LAWN SPRINKLM SYSTEM
UC04SED CONTRACTORS DECLARATION C TY � TE-
WATER HEATERLES -
� I hereby nttlrm that I nm licensed under provisions o1 Chapter (a 1 4. 5 STATE �
2,541
(oommencing with Section 7000) of Dtvtslon 3 of the Business and c3AsSYS� � LICE�sE No 1 51 8 3 9 CLASS MC 3 6
Code,ode, and my license Is In full force end effect
OUTLETS OVER DISTRICT NO. PROCE83M BY
6 PER SYSTEM
License Number 1512-19 Lk.Cleve r 3 6 ~ D
� :�• VALIDATION
contraot
o W,O. PROVIN Date 4/93
ElALY-�I,
I am exempt under Seo. BY
B.BP.C.for this reason
Dein:
Plan check fee f
sr'�• ' ��,��'�If �
3lgneturo PLUMBING PERMIT ISSUING FEE S
❑ TOTAL FEF
c
SINGLE FAMILY
Plan check appkant
- 1 i
_ f'�
cif._~,
HOME OWNER-BUILDER DECLARATION Name _
I hereby affirm that I am exempt ,-.�1 from the Contractor's License Lew l- _
for the following reason (Section 7031.6, Business and Professions Addreea T;
Code):
❑ City Tel.W.I, es owner off the property,will do the work and the structure TllrL OSx .30
Is not Intended ox offered for sale (Section 7444, Business T['y -l�
and Professions Code). •r
CONSTRUCTION LENDING AGENCY1�r� .CQ
I hereby affirm that there to a construction lending agency for the -
performance of the work for which this permit Is Issued (Seo. 3097, -j 1 1111 U
1 AM 9:32
Lender's Name 1
Lenders Address
I certify that I have read this appligation and state that the above ,
Into m A on Is correct. I agree to oomply with all County ordinances
and State Tawe regulat!W2jmblng, and hereby authorize
represen tfvea of un enter upon the above-mentioned
prop for o u SEE FtRVE7t8E FOR EXPLANATORY LANQUAliE
10/2/92
Igneture lttee Date
' COUNTY O7 IAB ANGELES TBWLZ CITY f 0508 PLUMBING P81(IT
DZPARTKZNT OF PIIBLIC MORXB 9701 LAB TQnS PL 0508 060713001E
BUILDING AND SA.YYT7 / LAND DEVELOPMENT TMULE CITY CI 91780
PHONMi (626) 285-0488 ZZTs
LEGAL ID. FIMS PAID BUILDING IDDRZSSi
TR. 5904 LT: 190 UI: .003 9055 GARXBALDI AV
YZE DESCRIPTION. QUIRTITYI UOMz AMOUNT, TMG CL 917801620
ABBZB80R INIORMATIOA AWUB.ZRi NEARMST CROSS BTRj=:
5384-008-001 01 PZRMIT ISSUANCE PI.9 27.75 THOMAS PAGE: 596 GRIDI H2 LOCALITY: T13(PLE CITY, C
51 IAA PRB GAB 5 OUTLET 1.00 SYS 16.20
TIMAATi TOTAL PEES 43.95 ISSUED ONc PROCZ88ED BYi PLAN BYi ROLPIRJS ON.
07/13/06 JZ 01/09/07
OANZR: TEL. MO. )IaL DATA PIYIL By. CODMi
PATRICIA YARA (626) 282-7383-
9055 GAnIBALDI AV 6 �—
TWO 917801620 DZS IOM O1 WORK
GAS LINZ FOR HVAC BYSTZM
APPLICANT i TEL. NO:
LIADI JORDIA (626) 963-3313-
129 S. HACIKVDA SPECIAL COIDITIONS,
GLXKTnRA, CA 91741
COATRICTORi TML. YO. APPROVALS DATE INSPI=R SIGNATURE
JORDAKLIR (626) 963-3313-
129 S. HACIEADI AVENUE LIC. NO UNDZR BLAB WORK
GLZNDORA, CA 91741 560429 B +
AATZR SIOMCZ
PLASTIC YIN M1TIL Y/N
ARCHITECT OR ZNGINEAR. TEL. NO:
ROUGE PLUMING
LIC. HOS
GAB PIPING
GAB VZRT
HOT IOITM E3DTZR -
PLUMBING FIXTURES
LAMP SPRTXXLKRA
GAB TEST
UTILITY COMPAAY NOTIIIZD
CAV
GRAY MATER SYSTZM
• Al2DITIOMUT DATA ON IILZ
RZPORT ID. DPR263 ROUTZ TOS DS0508