HomeMy Public PortalAbout9658 GARIBALDI AVE_Plumbing__ 76A667
1APPLICATION FOR PLUMBING PERMIT l
D®5.17DIVISION OF BUILDING AND SAFETY ,
Department of County Engineer
County of Los Angeles BUILDING ^
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN,SUPT OF BUILDING
LJCALITY .
FOR APPLIC4NT TO FILL IN I NEAREST
CROSS ST. 1-7
OWNER DISTRICT NOj GROUP ZONE READY FOR INSPECTION
MAIL
ADDRESS
INDUSTRIAL
CITY TEL. NO. WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS
CITY L. NO .3 9
_LICENSE NO. ^ .� oe'
NUMBER TY���P"'E:`OF FIXTURE OR ITEM FEE
WATER OSET (TOILET) @ $1.00
BATH TUB @ $1.00
SHOWER @ $1.00
y' LAVATORY (WASHBASIN) @ $1.00 00
KITCHEN SINK @ $1.00 —
DISHWASHER @ $1.00 -
LAUNDRY TUB OR TRAY @ $1.00 'r•- `rj�. �"• -
CLOTHES WASHER @ $1.00 b
WATER HEATER @ $1.00 /'s
GAS SYSTEM @ $1.00
tit
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER S B WORK )0`4i J1,,,
PERMIT $ ] 00
ROUGH PLUMBING'-ro
GAS PIPING �` �Z �" "'0
TOTAL FEE d 7 GA S VENT
I HEREBY ACKNOWLEDGE THAT I 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 I 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 U-ILITY CO.NOTIFIED, '.-7
DESCRIBED RESIDENTIAL ER. — --"--
SIGNATURE — -
OF PERMITTEEFINAL
-
JOHN A. LAMBIE, COUNTY NGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. Y.0. CASH
WORKERS'COMpEN.SATICLN DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby, afflrci tha'i I have a certtflcate of consent to self In- 20-0026 DPW�'E7
76A667A
sure for 0 certlflcate of Workers'Comppnsatlon Insurance,or a CE 817(REV. 6/86)
ctirttfled-copy thereof (Sec. 3800, Lab. C.)
PolIcy No. Company.
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
'
0 Certlfled copy Is hpreby furnlshed:
KA APPLICANT TO FILL IN(PRINT OR TYPE) BUILE)1NG E r _ C�
f—I Certified copy is hied with the county building Inspectlon 1WRESS `l
�J department. NUMBER' FIXTURE OR 17EM e FEE
LOCAL"
Data Applicant
WATER CLOSET(TOILET) NEAREST
�• -
CERTIFICA E OF li E.MPTION FROM WORKERS' I BATH TUB CROSS ST'
COMPENSATION INSURANCE R OWNER s
This s*ctlan n**d riot bo completed if the work ImrpFwd bry MAIL•
the pertnff Is for oite hundred dollars ($1100y or less.) LAVATORY ADDRESS
I cer'tlfy that In the ppeerformdn�e of the work for which this per- SINK CITY t}OCtI
mit Is Issued, I sholl'notemploy any person In any manner +��[//
os•fo Z?P;FQ
bJbet to the Worker's'Compensatlo La
DISHWASHER' CONTRACTOR
Date Applicant CLOIHESWASHEk ADDRESS J�
NOTI TO PPLICAN7: If, afidr making this C.1ff tate of SWb%"NG POOL RECEPTOR `vc► V+^
emptlon,you should becorne sub ect to the Workers'Com n-
patloB p.rovlslons of thb'Labor Code, yob must forthwith c p- CITY �Y r
1A4ytFSPR1NKLER SYSTEM /
ly with such provlsfons or thli permit shall be deemed rbvok- STATE
ed. WATER HEATER LICENSE TJ0 J r?T
LIC1rNSEQ CONTRACTORS DECLARATION. Y
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 4�Q Twt)
9.(commencing with Sectloh 7000)of Division 3 of the Busir)eu OUTt;;TS ,
and Professions Code End my Ilce9se Is In full force Ond at- 5 PER SYS11EMFINAL
fest' LIDA 6N >
u
License NmbeDATE
r /�. Llc. Clazi"�� I� AL U
Contractor ( . at6 r� BY p
Q
I am exempt under Sec. W
B.BP.C. for this reason
Elan Check fee , 1W
Date: PLUMBING PERMTT ISSUING FTE; 0
Signature
TOTAL FEE �Q
SINGLE FAMILY 2 F2
ROME OWNER-BUILDER DECLARATION Plan check applitarit
r-hereby off lrm that I am exempt from the Contractor's License Name ACCT.V
Law for the following reason (Settlon 7 .5,•Busineu and
PTofeulans CodA)i 031Address x+07 28.00
El T, as owner of the property, w11I do the work and the City Tel.No. 1 Ili
structure Is not Intended or offergd forsaie(Sedlon 7044,
Business angr Professlons Code. TOTAL 28 ��
CONSTRUCTION LENDING ACrENCY. CWK 23.f,I
I hereby affirm that There Is a construction lending agency for CAW, ■00
the performance of the work for which this permit Is Issued
(Sec. 3097, Civ. C.).
p 01a-Q0101 4/ 3/90
LerSde-r'i Name 9870 1 AM 7:56
Lender's Addreas
I certify.that I have,read this appllcatlon and state that the '
above Information Is correct. I agree to comply with all County ,
r ordinonces and State I ulating Plumbing, and hereby
authorize a of ves this County to nter on the
o- ed for edlon u
SEE REVERSE FOR EXPLANATORY LANGUAGE
Ig aturb o Per ee to
• COURTY OF L09 A,N9EL•RS TEXPLE CITY # 0508 PLUMB119G PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1206250021
BUILDING AND SAFETY / LAPID DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 ETT:
LEGAL ID: FEELS PAID BUILDING ADDRESS:
TR: 6561 LT: 156 UN: .003 9658 GARIBALDI AV
FEE DESCRIPTION: QUANTITY: QOM: AMOUNT: TEMP CA 917801737
ASSESSOR INFORMATION NUMBER: NEAREST CROSS SRI=: TEDGq R CITY
5385-018-026 01 PERMIT ISSUANCE FEE 27.80 THODA.9 PAGE: 597 GRID: A,2 LOCALITY: TEMPLE CITY, C
47 WATER HEATER(S)- 1.00 WITH 16.20
TENANT: TOTAL FEES - 44.-00 ISSUED ON: PROCESSED BY: PLAN BY:
06/25/12 SR
OWNER: TEL. NO: FINAL,DATE Y: CODE:
HUANG VICTORIA L (626) 286-9586-
9658 GAR BALDI AV
TEMP 917801737
DaSCPIPTION OF WORK
RPPAZE WATER HEATER LIKE FOR LIFE
APPLICANT: TEL. NO: .
CABRERA, CALEB (626) 378-2393-
1167 E. BROOKPORT 9T SPECIAL CONDITIONS:
COVINA, CA 91724
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ELITE CONSTRUCTION (626) 378-2393-
1167 E. BROOKPORT STREET LIC. NO UNDER SLAB WORK _
COVINA, CA 91724 841247 B
fI7aTER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR E9GI2=: TEL. NO:
ROUGH PLUMBING
LIC. NO:
GA.9 PIPING
GAS VENT
. - HOT WATER HFATE v
PLUMBING FISTVRFS
LAHN S PR TN]ELE.R.S
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508
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