HomeMy Public PortalAbout5624 / 5628 GLICKMAN AVE_Plumbing__ WORKERS'COKPENSATION DECLARATION 7e Aee7A -
I hereby affirm that I he" a certificate of consent to self CK a„ (s-e.i APPLICATION FOR PLUMBING PERMIT
figure,or a certificate of Worken'Compensatton Insurance,or
s certified dopy hereof(Sec.3800,Lab.C.)
&fl 0 2-O MP.OF WAU$AU COUNTY OF LOS ANGELS BUILDING AND SAFE
y No. Compan i.
Certified Copy is hereby N ished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING
Certified cgpy it filed with the county building inspection NUMBER FIKRJR>=OR I1BN FEE ADDRESS �$4 GLICKMI�N
• �'��� CITY
1
de me LOCALITY
Dtte�.,�ppllcan WATER CLOSET NEAREST
BATH TUB CROSS ST,
CRTl1I CO OF SIUON$ORKERY'
COMPENSATION 8ROWE-R OWNER LIk MGTTI, JAMES
MAI('This section geed not be comed plas� hit the Rods #moLAVATORY ADDRESS
ved' A ORE88' � -
by the petis for one hapdred do & 13100) oe leis.) SINK CITY TENYLE CTIY TEL. 45-1892
1 certify that in the perfotmance of the,work for which this DISHWASHER CONT(fiACTOFi Trvr�i�r, HCC
permit Is issued, I&hall not employ any person in Sny manner r, O'
so as to become subjectenmH-
to thtr Work ' Compensation Laws. CLOTH-ES WASHER ADdRE88 �1?3!} N. P�,CA
Date
Applicant SWIMMING POOL RECEPTOR. Q
NOTICE TO-APPLICANT: If,"after making alis Certificate of CITY . MO= TEL. N _ C%
Lrtemption, you shoWd become subJect to the Workers' LAWN SPRINKLER)3YSTE-M. STATE LIG. Z
Compenlatibn provisions of the Labor Code, you must forth-
with comply with such ,provisions or this permit shall be WATER HEATER LIC NBE NO. CLASS
deemed reroked1 OAS SYSTEM OUTL�T8 .3 OQ DISTRICT NO. R EBBED BY
LICENSED CON` "CTO DECLARATION OUTLETS OVER LJ/ �(J
I hereby a h= that I sm,licensad under provisions of Chapter 5 PEq SYSTEM
9 (commencing WUh Section 7000}of Division 3 of the Busl- FINAL Ll
nese and Profeadons Code,�and my lican" is in full force and DATE 11 ✓7
effect.
rh
License Number 265094 Lic.Clara C-2QFINAL
Contractor TR.AN '"C Date
I am exempt from fhb llcepsint requirements as I am a Plan check fag
licensed ardhitect dr j' registered professional engineer PLUMBING PERMIT ISSUCNG FEE$
acting in my prof°ssi°n�al Capacity (Section 7051, Bur
Zn 7�
InW and Profesdont 4od,e). TQTAL FEE
v0
Lic.or i4.No. Date pion chock applicant
•HOME OVfNER,AUILDER DECLARATION am•
I hereby affI-m Thatam exempt from the Contractor's rcirbse
Lloense Laws for 4e fp1lowfng Yanon (5actfon.7031.5, Bud- City Tal,No.
nays and Professions Code
4 as owner pf the-0roperty, am exclualvety contracting /� 1 2 5 5 4 A
With licented contractors to construct the project
(Sectbo 7044,Busino"and Professions Codo).
-#. o oro 0 '05
CONSTRUCTION LENDING AGENCY 2 0.0 1• 0,00
I hereby afnM that jhWe L a construction lending agency
for,the performance 4f.4ite work for vdrich this permit is o 0 0 1. Q 0 0 6.
Issued(Sec- 3097;Ctv.C.),
Lender's Name
1Q0'9,-80
Lender's Address
I certify that I have read this application and state tho the
at>oye information is correct,I agree to comply with LU County SEE REVERSE FOR EXPLANATORY LANGUAGE
and State laws regulating Plumbing, and hereby
authorizer eoentativee of tbu County enter. upon the
a nod property for inspect
tura of Permlttee Date
76A667 D8817 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1
DISTRICT NO. ROUP ZONEP .
FOR APPLICANT TO FILL IN
PLUMB_ READY FOR
RECEIVED SY DATE ISSUED
FIRST INSPECTION /y
ADDRESS �` 1-
BUILDING �.--
_CITY ,p+ TEL. No. _ ADDRESS J
COUNTY LOCALITY G
LICENSE NO. EXPIRES
NEAREST
PERMIT FEES CROSS ST. ,
./
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER -
MAIL
WATER CLOSET(TOILET) @ 0.SO $ ADDRESS
BATH TUB @ 0.50 CITY TEL, N0.
SHOWER @ 0.50 i HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50
SIGNATURE OF
WATER HEATER @ 0.50 PERMITTEE
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 -1
Q
HOUSE SEWER @ 0.50 S Z
MISCELLANEOUS
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSPOOL Y_d
SEPTIC TANK: SEPTIC TANK _7
DRAIN ( ) PIT ( ) @ 1.00 SF_WER
PERMIT I 1.00 GAS TEST
TOTAL FEE
UTILITY CO.NOTIFIED
� III
FINAL
` 'COUNTY+OF LOS A_wuu m TEMPLE CITY $ 0508 PLUMING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0901120015
BU=ING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDIDG ADDRESS:
ON F= 5624 CMICNAN AV
FEE DESCRIP'T`LON: QUANTITY: UOM: AMOUNT: TE24P CA 917802710
ASSESSOR IXFORMATION NUN4BER: NEAREST CROSS STREET: LIVE OAK
8586-016-003 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY, C
07 BATH'ISDS/SHOWERS 1..00 FII 16.20
TENANT: 11 CLOTHESMASHER(9) 1.00 FII 16.20 ISSUED ON: PROC}iSSED BY: PIAN BY: EZPIRE.9 ON:
13 DISHMASHER(S) 1.00 FII 16.20 01/12/09 SR 07/11/09
21 HOSE BIBB(S) 1.00 FII 16.20
OWNER: TEL. NO: 25 LAVATORIES/SINKS 3.00 FII 48.60 FPULL DATE FiHAL BY: CODE:
WANG, GEORGE/AMY (626) 823-7968- 45 WATER CLOSEVURINAL 1.00 FII 16.20
5624 GLICKMAN AV 47 MATER HEATER(S) 1.00 WTH 16.20
TEMP 917802710 51 LOM PRS GAS 5 07= 1.00 SYS 16.20 DfSCRIPTION OF WORK
TOTAL FEES 189.75 PLUMING FOR KITCHEN AND BATHROOMS
APPLICANT: TEL. NO:
L K (626) 705-7998-
9080 TALSTAR AVE SPECIAL CONDITIONS:
EL MON TE, CA 91731
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
AMY S. WANG (626) 823-7968-
P.O. BOZ 99 LIC. NO UNDER SLAB WORK 11,
WALNUT, CA 91788-0099 NONE 6�i
WATER SERVICE
PLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER: TEL. NO:
T AND W CONSULTING ENGrNx'Ra.g (626) 288-0708- ROUGH PLUMBING
1168 N. SAN GABRTF'T. BLVD. #N LIC. NO:
R09E24EAD, CA 91770 35693 GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMING FIXTURES
LAWN SPR-TNKLS
GAS TS4T
.10
U'T'ILITY COMPANY NOTIFIED
CMV
GRAY HATER SYSTEM
W
REPORT ID: DPR263 ROUTE TO: B90508