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Home My Public Portal About5033 GLICKMAN AVE_Plumbing__ 76A667 17 25M SETS 7-48 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING i COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER DiSTRIL.I NO. GROUP ZONE PERMIT NO. FOR APPLICANT To FILL IN PLUMBER Superior P.Lb . Service RECEIVED BY READY FOR DATE 19BUED c_ ADDRESS �t 2b2O E. Valle Blvd FIRST INSPECTION CITY El lionte TEL. NoTO Q-1963 ADDRESS H� 5 Cr,1i r.lrman COUNTY LICENSE NO. EXPIRES LOCALITY `VAmIlle City 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS NEAREST ANGELES COUNTY LICENSE. _, CROSS ST. w OWNER D. A. Gannon MAIL V- Broadway PLUMBER ADDRESS PERMIT FEE IS $1.00 FOR THE FIRST FIXTURE OR CITY Temple City _ TEL. No.. ITEM LISTED BELOW, PLUS SOC FOR EACH ADDITIONAL I AM THE LEGAL OWNER OF THE RESIDENTIAL PROP- ITEM. FOR EACH SEPTIC TANK AND PIT OR DRAINFIELD ERTY DESCRIBED ABOVE. $1.00. MINIMUM FEE FOR ANY PERMIT $1.00. EACH GAS SYSTEM IS A SEPARATE ITEM. OWNER NUMBER TYPE OF FIXTURE OR ITEM CORRECTIONS WATER CLOSET (TOILET) BATH TUB SHOWER l LAVATORY (WASH BASIN) KITCHEN SINK LAUNDRY TUB OR TRAY GAS SYSTEM_OUTLETS WATER HEATER SLOP SINK 'J Q FLOOR SINK Z FLOOR DRAIN O Ix DISHWASHER (] DRINKING FOUNTAIN URINAL MISCELLANEOUS APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT r �� CESSPOOL SEPTIC TANK - DRAIN ( ) PIT ( ) $ SEPTIC TANK CE5_5POOL $ SEWER HOUSE SEWER $ GAS TEST UTILITY CO.NOTIFIED TOTAL FEE $ 4 50 FINAL ' "3 "-`1 L 76A667 17 25F.A SETS 7-48 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY PLUMBING COUNTY OF LOS ANGELES Wm. J. FOX, CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURESCOMPLETE HEATER CESSPOOL H SEPTIC TANK RECEIVED BY READY FOR DATE ISSUE FIRST INSPECTION Q GAS- MISCELLANEOUS , APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY C� NAMEcorzorn 1 r`j ' JOB ADDRESS d i � G�£2EC!' . /G ADDRESS /G✓. e- LOCALITY NEAREST CITY T[ N CROSS ST. IL COUNTY - w. LICENSE NO. EXPIRE Ix NAME W LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL 3 ADDRESS NORTH O CITY fes' TEL.No. IOF THE ABOVE LOS A ATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. y� D 3 f// OWNER `I CORRECTIONS SOUTH J DESCRIPTION OF WORK _z BATH TUB FURNACE (Y SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTORS NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER SODA FOUNTAIN GAS PIPING GAS VENT I I CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I s __.__CESSPOOI aEPTIC TANK _7SEWER S UTILITY CO.NOTIFIED TOTAL FEE FINAL WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm That I have a certificate of consent to self in- 20-0026 DPW 4/87 sure,or a certificate of Workers'Com satio Insurance, •r a CE 817 A P CE 817(REV. 8/86) certified aq�� e eof_�gc. 3800, Lab C.) fl Policy N _L 800, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Y Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING y ertified opy is filed with the c unt uil ing inspection ADDRESS (J depart nt NUMBER FIXTURE OR ITEM @ FEE LOCALIT IL WATER CLOSET(TOILET) Date Applicant NEAREST ` CERTIFICATE OF EXEMPTION FROM WOR BATH TUB CROSS ST. S' i COMPENSATION INSURANCE OWNER SHOWER (This section need'not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TE 7 ' as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRALTO -e Date Applicant CLOTHES WASHER ADDR t ",Q (] J NOTICE TO APPLICANT: If, after making this Certificate of Ex- 24 SWIMMING POOL RECEPTOR vt�' emption,you should become subject to the Workers'Compen- CITY TEL. t � �`l sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such'provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATE LICENSE NO. CLASS 7C� LICENSED CONTRACTORS DECLARATION I DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM , 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, ciAd my license is in fullNe rce and ef- 5 PER SYSTEM FINAL VA fect. DATE LFDAT.LON IL License Numb ��'-L`Ic. Class $- �� v (� -- 72,jii lz •�ErfJ FINAL '= Contractor Date BY 's»;:;:^ F_ I am exempt under Sec. TOTAL B.&P.C. for this reason Plan check fee PON. Date: PLUMBING PERMIT ISSUING FEE$ Signature lJ TOTAL FEE SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Plan check applicant i2'•_!`_(. —1 i�`?i =. „ I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and 4 Professions Code): Address ElI, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 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 inforayrngn is correct. I agree to comply with all County ordinances nd tate laws regulating Plumbing, and hereby authorize epres nt hives of this Co ty�tpetiter upon the above-me tion p rty for ins ctij , SEE,REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee 'Date WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A I hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy theAa)f(Sec. 3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. El Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 6®33 /1 •,(•o 6 Certified copy is filed with the county building inspection ADDRESS (� department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER �� rye�/ �� '< I certify that in the performance of the work for which this permit LAVATORY -�'T!� is issued, I shall not employ any person in manner so a to MAIL SINK KIT T ADDRESS v 13 ( i'�Y� E� become subject to the Workers'Compens n /p DISWASHER CITY TEL.N04Q_11(j 2_ Date ,~�r^Cd Applicant. I CLOTHES WASHER Y r CONTRACTOR NOTICE TO APPLICANT: If, afte ,mag this Certificate of Exemption,you should become subject to t Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER ®. (commencing with Section 7000) of Division 3 of the Business and STATE LIC. Professions Code, and my license is in full force and effect. GAS SYSTEM $f pq/�OUTLETS LICENSE NO. CLAS OUTLETS OVER DISTRICT NO. PR ED BY 5 PER SYSTEM License Number Lic.Class v FINAL n ATION W a DATE ., 1{ VALI Contractor Date Z F-1 FINAL I am exempt under Sec. BY B.&P.C.for this reason Date: Plan check fee ' Z. r Signature PLUMBING PERMIT ISSUING FEE$ C ❑ TOTAL FEE — SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name j ^L..Z_ I hereby affirm that I am exempt from the Contractor's License Law3 for the following reason (Section 7031.5, Business and Professions 'Address OT $ "- 5 Code): City Tel. No. i. EC) 35.5` ` EKI,as owner of the property,will do the work and the structure ,"H3i`'f',C ,j�%I is not intended or offered for sale (Section 7044, Business "'`If' "'' and Professions Code). , CONSTRUCTION LENDING AGENCY )f¢!z-i13 ;j l y I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec. 3097, .0 1 AM 1—42 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 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0309260002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 10821 LT: 6 BL: C 5033 GLICKMAN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804023 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8585-013-019 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 09/26/03 JK 03/24/04 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 OWNER: TEL. NO: TOTAL FEES 92.55 FINAL DATE FINAL BY: CODE: LIN; SUSAN (626) 825-9398— 7 // 5033 GLICKMAN AV TEMP917804023917804023 DESCRIPTION OF WORK PLUMBING FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER — SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: - APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER — LIC. NO - UNDER SLAB WORK WATER A ER S ERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. LIC. N0ROUGH PLUMBING —i: � —— — ----- GAS PIPING s GAS VENT HOT WATER HEATER -— PLUMBING FIXTURES LAWN SPRINKLERS j. GAS TEST � _;.. UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508