HomeMy Public PortalAbout9821 GARIBALDI AVE_Plumbing__ j 76A667-CE817-8-57 R16-11AIR
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APPLICATION FOR PLUMBING PERMIT h
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS �9 C..� y`"
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY ..,�
NEARESTv
FOR APPLICANT TO FILL IN CROSS ST.NUMBER FIXTURE OR ITEM1-44 AZ
OWNER
") WATER CLOSET MAIL
BATHTUB ADDRESS
SHOWER CITY TEL.NO.
f LAVATORY CONTRACTOR
SINK ' ADDRESS " ;� fr. A-1
DISHWASHER CITY /y/ 0 a l fl0(jf 'TEL.NO. Q
LAUNDRY TUB CONTRACTOR'S STATE
REGISTRATION NO. a Q COUNTY ❑
CLOTHES WASHER
DISTRICT NO. GROUP Z15/ READY FOR INSPECTION
WATER HEATER
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
DATE INSPECTOR'S SIGNATURE
@ $1.00 PER ITEM
OR FIXTURE $ �- UNDER SLAB WORK
PERMIT $ 1100
ROUGH PLUMBING T —
GAS PIPING _
TOTAL FEE I (? GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATERAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXTURES
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST QI - Y.
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED —
DESCRIBED RESIDENTIAL PROPERT,`.(�.
SIGNATURE
L4 ke&64��,
OF
IOF PERM TTEE '�,' ' .t ,,f r�. FINAL Z _G
ROBERT A. WOOD,
VALID
�Pls SUPERVISING MECHANICAL ENG'R
CASH
� I
1
WORKERS'that
I have
DECLARATION APPLICATION' FO"R PLUMBING PERMIT !�
V A')0024 DPW x/87
I hbreby;Tafflrm that I have a certlfloate of consent to self In- 7&4.667A
lyre,or a certlflctrte of Wbrkers'Compensation Insurance,or a (IE.817(REV. 8/86)
certified ereo Sec. 3800, Lob.•C
Pollc7y INCompany COWNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
El Certlfled copy Is hereby furnished. t
FOR APPLICANT TO FILL IN(PRINT OR TYPB) BUILDING
�Certlflgd copy Is filed with the county bul]�Ing rnspdctlon' ADDRESS
clapaltmInt. NUMBER FIXTURE OR ITEM 8 FEE t
F LOCALITY
Date-MMM' nt
WATER QOSIET(TOILET)
ApplicaNEAREST ,
CERTIFICATE OF ED(EMPTIOrf FROk4-WORKER$'
BATH TUB. CROSS ST.
COMPENSATION INSURANCE OWNER
rAPER
(This section need not be completed If the work involved by MAIC
the pefmlt Is for one hundred dollars ($100}or 6&s,) LAVATORY ADDRESS
55
1 cprlrfy that In the performance of the work for which this-per- NK
mR Is Issued, I shall hot employ any person In any manner so CffY TH
as•tc b-awme subject to the Workers'Compensatlon Laws. JISHWS�ER CONTRACTOR
DMe �Applicant' CLOTHES WASHER ADDRESS /
Al
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
etuptlon,you-should becomes-ublIecttdthe Workers'tompen- �Y
satlon provisions of the Lobor ,you must forthwith comp- LAWN SIRINKLfR SYSTEM �V
ay with such provlsl6ns or this permit shall be deemed revok- STATE UC-
ed. WATER HEATER LICENSE NO. CLASS
0CtT,ISED COtJTRACTORS DECLARATION - - I GAS SYSTEM L OATS DISTRICT NO. PROCESSED BY
'r hergby Ufflrm that I am licensed under provisions Of Chapter
9(commencing With Sectlon 7000)of Division 3 of the Suslness OVER
and Professlor,s Code, and my license is In full force and ef- 5 PER SYSTEM FI
fact. NAL VALIDATION
DATE 2CL
License Number' Llc lass 6 e y O
U
FINAL Q
Contractor '++Date BY O
�. (;am exempt under See. W
B.BP.C. for thla reason Plan check fee ,
DcYt°' PLUMBING PERMIT ISSUING FEE$
Signature TOTAL Fly
SINGLE FAMII,Y
HOMEOWNER-BUILDER DECLARATION Plpn,check dppllcant l
F C
J hereby affirm that I am-exempt from the Contractor's License Norrie. i
Law for the-foUowlnq reason (SectlQn 7031.5, Byslness and llJ
Professions Code): Address. I7 ,'[J, t
I, ai owner of the property, WIH do the wwk,and the CIry Tel. No. .
struttorels not Intended or offered for sale(Section 70", t ,
Business and Professions Codnj, _ TOTAL-. 20X50
CONSTRUCTION LENDING AGENCY , I>ECK 56
1 hereby affirm that thbre.Is a construction lending agency}or � � `
the performance of the work for Whlcb this permit Is Issubd
(Sec. 3097, CIV. C.}.
LendeCs Nome
Lender's Address iC► 1 AM 9'5i
I certify that I'have read this application and stdte that the
above Information I;correct. I agree to comply with all Counly ,
ordinances,and Stare laws requlatrnq Plumbing, and hereby
authorl rip mmntctive4 of this County to enter upon the
a6ov ed openly for Inspectlon puDies.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature o PermitteeDqte
COUNTY OF LOS ANGELES TEMPLE CITY 0508 PLUMBING PERMIT
y DEPARTMENT OF-'PIBLIC.WORKS 9701 LAS TU.AS PL 0508 9911030009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 9821 GARIBALDI AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801713
53a5_026_ONFORMATIONNEAREST CRDSS STREET: GOLDEN HEST
5385-026-013 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20
TE)MT: TOTAL FEES 43.95 .-
11/04/99
11/04/99 UT 05/01/00
OWNER: TEL. NO: FI CODE:
BLANK;MARK KIM (626) 292-7211-
9621 GARIiULDI AV (
T EMP 917801713
REPA R GAS LINE
APPLICW SAME AS OWNER � -
SPFCi I AL CONDITIONS:
INSPECTOR SIGXAT0ffF--
CONTRACTW.— TEL. NO: 5 PNGELES Co i
, SAME AS OWNER ��Ty
LIC. NO UND
SERVICE
PLASARCHITECT OR MOM-: TEL. NO: TIC Y/N METAL Y/N –
LIC. NO
EM rIPING
111111
QAS 7T
U'LEIL C W(OR"K-3 HOT WATER HUTSF-
0
GAS,o 0 $ r
ServiceIRA) WATER SYSTEM
That
� I
REPORT ID: DPR263 ROUTE TO: BS0508
COUNTY OF LOS AN3E ua TEMPLE CITY # 0508 PLUMBI19G PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1309160029
BUIIZING AND SAFETY % LAPID DEVELAP►lEST THm:FLE CTTY CA 91780
PHONE: (626) 285-0488 FST:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ON F= 9823 GARIBATnI AV
FEE DH9CRIPTION: QUANTITY: 0004: AMOUNT: TEMP CA 917801713
ASSESSOR INFORMATION NUMBER: NRnRMT CROSS STREET: GOLDEN WEST
5385-026-012 01 PERMIT ISSUANCE FRS 27.80 THOMAS PAGE: 597 GRID: A2 LACALITY: TEPLE CITY CA
47 WATER HEATER(S) 1.00 SETH 16.20
TENANT: TOTAL FEES 44.00 ISSUED ON: PROCESSED BY: PLAN BY:
09/16/13 SR
OWNER: TEL. NO: F N44 DATE F124AL BY: CODE:
HEALa DAN= A;CAROLR M (626) 286-2265-
9823 GARIBALlI AV I 1
TEMP 917801713 DDASCRIPTION OF WORK
REPLACE HOT WATER BEXTER
APPLICANT: TEL. NO:
SAME AS OWNER
R -
SPECIAL COFIDITIONS:
CONTRACTOR: TEL. 190: APPROVALS DATE INSPECTOR SIGiRAT17RS
SAME AS OWNER -
LIC. NO UNDER SLAB WORT
WATER SERVICE
PLASTIC YIN METAL Y/N
ARCTTTTECT OR ENGINEER: TEL. NO:
- ROUGE PLUMBING
LIC. NO:
GAS PIPING
GAS VENT
HDT WATER HEATER �—
PLUMBING FIXTVRFS ISL— NJ
LASdN S PR-12ZLE 3
GAS T
UTILITY COMPANY NOTIFIED
CON
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508