HomeMy Public PortalAbout5031 GOLDEN WEST AVE_Plumbing__ 76A867{i%eI 7 1-88
APPLICATION FOR LIMBI PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AICD SAFETY DIVISION 1IIII,DDra .y /
JOHN A. LAMBIE, COUNTY ENGIN[[R ADDI13/ O�7J
COLEMAN W. JENKINS. SUPT. OF BUILDING
FOB APPLICANT TO F21 IN NEARnT
ow
NUMBER rl R]E OR IT]EM ]EACH F[E
owls
WATER CLOSETKRA
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LATH T07 1,15 AD �
SHOWER, 116 TE--m
LAVATORY lis CO
bbiX 115 ADDS Q
DISHWA>1ffi I u CtrY TEL x d 0
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LAUNDRT rR Im B LIG
LICCENEN SE CLAS
CLOTHES MASHER I m DI�ICT Ng. G� [ P">C er
WATER EEAT91 1.50 0 "
GAS eYaTE>wt OUTLETS 1.50 MUBTRULL
WASTE APPROVAL
OUTLETS OVER I PER aimll 10 n1RPEMOx RECORD' 8
0
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APPROVALS DATE INsPS.CToA•s siaNATum
PE=RMIT s Q 00 UNDER BLAB WORK
ROUGH PLUMBING
tOTA1L FEE GAB PIPING
1 HooY AC)MOWL[D" *NAT I HAV[ IQAD THIS ,X"UCATION GAS VENT
AND STAT[ H
TRAT TI MOVE 16 COftMCl ANQ AalMK TO COMPLY
wren ALL COUKrr ORAINANQJ AND STAT[ LAW IROULATINO
FLU MSINa. HOT WATER HEATER
I HS:Ie>mY CS.rT1Fn.
Y THAT I AM P D*KlY ME PLUMBING FIXTURES
Uc><NSaa AS Loa AN COUNTY AHD I of GAS TEST
ULIFORk U\ O T I AFI Lffa:L wliR OF,ANO 1 D TO
w1 DE IN, AROW AL PROP[RTY. UTI-LITY CO. NOTIFIED
91GNA E
OF F[R
FINAL /r
JACK R. LL
cic. M.o' CASH SUPERVISING MECHANICAL ENG'R.
9 X14 } 25.5-0- 4
WORKERY COMPENSATION DECLARATION App�����fp FOR PLUMBING PERMIT hereby crffirm that I have a certificate of onsent to seff .764667A .�"
Insure, or a certlflcate of Worker' Com to nturance, Cf 617(REV. 10/81)
or a certifled copy theredf(Seca,380(}, L ) COUNTY OF LOS ANGELES BUIL G AND SAF
Policy No. Compa❑
Certified ropy Is hereby furhlshed
FOR APPU(ANf TO RLL IN(PRINT OR TYPE) BUILDING
Certlfted copy rs filed with the county build]nfl i ADDRESS
tlo ')Pa nt, NUAAM FIXTURE OR ITEM O FEE LOG41rrY t
-Date �� Af>pll4ant `�'� WATER CLOSFr
NEAREST
CERTIFICATE OF QG-MPTION FROM WORKERS' BATHTUB CROS.SST.
COMPENSATION INSURANCE SHOWER OWNER
(This se-q*n nomad nbt be cbmpleted ff the Mork Invoh.ed by MAIL
th*permtt is for"*hund+isd doper. ($100)pr fen,) - LAVATQRY ADDRESS
I certify that In-the performance Of the work foc whrrh this
permit Is Issued,i shall not employ anyy-perton in any manner
so as to become subject to the Workers Compensation Laws.
. DiSI-MASIR- CONTRACTOR rt
Dat6 _Applicant. CLQTHES WASHER
NOTICE TO-APPLICANT:
if, df-ter making this CertLflcate of ADDRESS /
Exemption, you should become sublect to the Workers SWLYM NG P� CEPTOR �Y NO
ab
Cornpensatlon provisions of the Lor Code,you must forth- iAWN SPrtINKiH2 SYSTEM
with comply with such pFovlslons or thts permit shall be STATE UG
deemed revoked.' WATER HEATER CLA SS
LICENSEDCONTRACTORS DECLARATION DISTRtC1 Na. BY
1-hereby affirm that I am Itcerued under provisions of Chapter 9 GAS SY$TEM OUTLETS � QA
(com"ncing with Bator 7000) of Dlvtslon 3 of tfle I}uslnou OUTLETS OVER d
bred Professlgns Coda,and my license Is In full force drid effect. 5 SYSTt� FINAL �, VALIDATION O
DATE V
License Nu rj / lc.Class t
/ fl CI
Contra r Ddte 14
❑ *
m T
I am exau � .`, � �
8.&P.C. fdr this reason -
• Plart cheCl�dee ' �vf/ 7//
Date: PLUMBING PERMIT ISSUING WE$
Signature �_—� }
TOTAL SEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DEdARA110N Name
I hereby affirm that I am exempt from the Con4ractorrs Ucenab �O
Low for the following reason (Section 703].5, Business arld � fe4f I o o,)
rfP--r--o��fessions Code): City Tel. No.
L-1 I; as owner of the property, will do the work and the
structure Is not intended or offered for sale ($action ,
70", Buslnesi and Professions Code} 0 o fj cJ O
CONMUGTIQN LENDING AGENCY 'I V2 R —
Ihereby affirm that ther6 Is a construolon l6nding agency for
the perforrnante of the wQrk for which this permit 1s Issued
(Sec.3097, Clv. C J
Lender's Name
Lenders Address
I certify that I have read this application and state that the ,
above information is correct_I ggree to comply with all County
ordinances and State laws regufatin$Plumbing, and,hereby
authorize presentatives of this County to enter upon The
obova- n on L�property fpr I spectioh purposes.
SEE REVERSE FOR EXPLANATORY LANGl1A¢E
h
Signature of Permittee Date
COUNTY OF LOS ANGELES TWLE CITI # D508 PLUBING PERMIT
DEPARTMENT OF PUBLIC WORKS 97011 LAS TUiAS PL 0508 0302070018
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (624) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING
TR: 14832 LT: 19 BL: .001 5031 GOLDEN WEST•AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803939
ASSESSOR INFOR.MATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
8589-018-014 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOVERS 3.00' FIX 48.69 `
25 LAVATORIES/SINKS 2.DO FIX 32.40 ISSUED ESSED BY: PLAN BY: tFYIKt:b
45 WATER CLOSET/UIINAL 2_00 FIX 32.40 02/10/03 . JK 08/09/03 .
TOTAL FEES 141.15
uwwtK: TEL. NO: FI FINAL BY:
PHAN;FAANKIE - CODE:
5031 GOLDEN WEST AV
TEMPLE CITY 91780 DE&MIPITW UF WORK
PL IIiG FOR ADDITION
OPLICANT: TEL. NO:
SAME AS OILIER -
SPECIAL CONDITIZINS:
PN(',ELES C0TEL. NO: APPROVALS
��
SAME AS OWNER
LIC. NO UNDER lbhli-WORK
WATER SERVICE
ARCHITECT TEL. NO: PLASTIC Y/N METAL Y/N
t ROUGH PLUMBING
LIC. MO GAS��11111 PIPING4
W VENT
HOT WATER HEATM--
BUC WOO '-aKS
U ED PLUMING FIRTWy
G,
O ❑ JGAS TEST
UTILITY CWAMT
Setviee Th/
REPORT ID; DPR263 ROUTE TO: 13SO508