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Home My Public Portal About5124 GOLDEN WEST AVE_Plumbing__ 7BA667 (CE-4117)-4/72 T'b�I✓ / ,iii�I/ - / 1-t- (� APPLICATION FOR PLUMBING PERMIT _Y COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION I MAKE CHECKS PAYABLE TO: BUILDING ADDRESS 5124 Golden West A � HARVEY-T. BFZANDT, COUNTY ENa1NQ6R LOCALITY Temple City, FOR APPLICANT TO FILL IN (PRINT OR TYPES NEAREST CROSS ST. I NUMBER FIXTURE OR ITEM 0 FEE WATER CLOSET 1.78 OWNER Suitor . MAIL BATH TUB 1,75 ADDRESS Same SHOWER 1,75 CITY ' TEL. NO. _ LAVATORY 1.75 CONTRACTOR Trane H . C. C. SINK 1.75 ADDRESS 501 DISHWASHER 1.75 CITY Ful lerton TEL. NO. CLOTHES WASHER 1.75 STATE LIC LICENSE NO. 265094 CLASS C-20 SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP NE OCE83ED BY LAWN SPRINKLER SYSTEM 1.7E v' WATER HEATER 1.75 WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD ouTLET9 OVER SO 8 PER SYSTEM 7 Plan check fee S/• R•v.rr/ PLUMBING PERMIT ISSUING FEE 8 3 00 TOTAL FEE APPROVALS DATE IHS P[c TOR a SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. No. GAS VENT I HERESY ACK MOW L[DSE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STAT[ THAT TH[ ABOVE IS CORRECT AND AIR[[ TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS RE41ULATING GAS TEST PLUMBIN4. I HERESY CERTIFY THAT I AM PROPERLY R[SISTERED AND/OR UTILITY-CO. NOTIFIED LICENSED AS REOUI RED BY LO■ AX SELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDE TIAL PROPERTY. FJNAL S10 NA TU RE OR PERMITTEE / ./' PERMIT VALIDATION CN'S M.O. CASH PLAN CHECK VALIDATION CK. M.0. CASH U !('„ 3 2 1 373 SEP 14 5 A d�4.7 5_A OOUIfTY OF LOS ANGELES APMCATIOA FOR PE 3M Department of County Engineer DIVISION OF BUILDING & SAFETY PLUMBING WILLIAM J. FOX, Causty Eiplmew FOR APPLICANT TO FILL IN DISTR= NO. GROUP i IONE PERMIT NO./ PL BCR 2-Ae��C-A RK113EIVED AlrYREADY FDR DAT[ IUQUKD FIRST INePEUT10N r _t ADDRKMS I .J U BUILDING DITY TEL. N DDREIIN - OOU LICLNSK _ LOCALITY N CAR E32rT PE$N[IT FEES CROSS ST. NUN�c� Tri-[Or Frxruw=on ITEM FEE OWNER MAIL ATER OLOBET(TOILET) 0 0.60 to O ADDRESS ATH TUB 0.50CITY TEL NO. SHOWER O 0.60 I HEREBY ACK4OWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) 0 [LBO D APPLICATION AND STATE THAT THE ABOVE 10 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ITCH[N LINK Q 33,833 AND STATE LAWS REDULATINO PLUMBING. I CERTIFE Y THAT 1 POSSESS THE ABOVVALID LOW LAUNDRY TUB OR TRAY O 0.513ANGELES COUNTY LIC[NGE, OR 1 AM THE EGAL OWNER OF THE REGIDENTIAL PROPERTY DEBCR AB� GAN SYST[ OUTLETS f 0.30 '010 yy� /p s+- WATER H[AT[R 0.60 ■IONATURE OF ERMITTEE � 4, may"• �f�`�� SLOP BINK a 0.60 PECTION RECORD FLOOR BINK 0 O.SO v FLOOR DRAIN 0 D.BO DloI-WASHER 0 D.BO DRINKING FOUNTAIN 0 0.BO URINAL 0 0.513 J HOUSE NEWER CL a MIOCELLANEOUS O APPROVALS DAT[ INfi-mTOR-■ NAM[ ROUGH PLUMBING MAIC PIPING .�✓" GAB VENT �• CEIIBPOOL 1,033 OESGPOOL SEPTIC TANKS BEPTID TANK DRAIN ( ) PIT ( ) 1.DO SEWER PERMIT 1.00 GAS TENT UTILITY 00.NOTIFIIED rINAL TOTAL FEES �Q rwur DBS#1r 10/62 z WQRKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING P E RM I T I hereby affirm that I have a certificate of consent to self 76A667A Insure, of a certificate of Workers'Compensation Insurancb„ CE 817(REV. 10/81) or a cert copy thereof 3800 C,) COUNTY OF LOS ANGELES BUILDING AND SAFETY cy No mpany Certlfled copy Is hereby fumished. FOR APPLICANT 70 FILL IN(PRINT OR TYPE) BUILDING Cerllfied copy Is filed with the county bullding Inspec- ',�� tion department. NUMBER FlXTUREORffEM O FEESW Gn LOCalliS Date App IIgant. t(�� l�LV' WAS awl NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURAiJCE. SHOWEROWNER (This section need not be completed If the work Involved by the penbit Its for one hundred dolls t ($100)or to".) LAVATORY ppp I certify that In the performance of the work for which this j permit Is{sawed, I shall not employ any person In arty manner SINK nwl TEL _.. so as to become subject to the Workers Compensatlon Laws, DLS"AS ER 7C7 A,I'-^ Y ' Date -App IIGant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certfficate of ADDRESS Y1 Exemption, you should become subject to the Workers' SWLYMINGf30a RECEPTOR Compensation provisions of the Labor Code, you must forth- CTfY LAWN SPRIh10_H2 SYSTEM with comply with such provisions or this 9.&rmlt shall be STATE CIC I deemed revoked. WATER NEATER LIC&EE NO• CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (coma ncing with Section 7000) of Division 3 of the Buslnesa OUTLETS OVER p and Ftofmslons Code, and my license is In full force and effect. 5 PER SYSTEM FINAL YAL1D/A770N DATE T / V License Number Ic. Cla13_5 HNAL � Contrarto.2 l cite BY Q-} 0 ❑ I am exempt under Sec. J � B.BP.C. for this reason Plah check fee Date: PLUMBING PERMIT ISSUING-FE$ Signature TOTAL fE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractors License Address Law for the foltowlng reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the structure Is not Intended or offered for sale (Section �.6 4 A 7011, Business and Professions Code). CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for 2.0 - 3G50 the-performance of the work for which this permit Is Issued (Sec. 3097, Clv. C.), c C to 3 0. 0 i Lenders Name, ,/�/ � Q'i, 20-8a Lender's Addrass I certify that I have read this application and stale that the ► above Information Is correct.i agree to comply with all County ordinances and Stot&laws regulating Plumbing, and hereby outhorize representatives of this County to enter upon the abovo- entio o for Inspection purposes.. SEE REVERSE FOR EXPLANATORY LANGUAGE Statarperm ttee Date r .COUNTY OF LOS ANGZLZS TOOLE CITY # 0508 PLUMBING PERIQ T DEPARTMENT OF PUBLIC WORKS 9701 LAB TUNAS PL 0508 0506240010 BUILDING AEA SAYXTY / LAND DL'V'U OPIQ.VT TEMPLE CITY CA 91780 PHONE- (616) 285-0488 EXTs ' LEGAL ID: FUSS PAID BUILDING ADDRYSB: TR: 9481 LT: 12 5114 OOLDHN REST AV NYE DESCRIPTION: QUANTITY. UOXI AMOUNT. '1'X07 CA 917803940 A8898SOR INFORMATION NUMBER: NEAREST CROSS STRIXT: 8589-008-014 01 PYRXIT ISSUANCE THY 27.75 THOMAS PAGY1 597 14` LOCILITY: TRIPLE CITY, C 25 LAVATORIES/SIN.B 1.00 BIZ 16.20 T'CIIAANT: 45 RATXt CLOSET/URINAL 1.0-0 FIX 16.20 ISSUED ON: PROCESSED BY: PLAY BY: EXPIRES ON: - TOTAL FRES 60.15 06/24/05 JX 12/21/05 1 OIm1ER: 7m. II0: 1IRA T DATE Y. CODE: SIERRA, YE"T (626) 286-2806- -+ 5124 GOLDEN REST X TEMP 917803940 _ DESCRIPTION O/\ R I�� PLW®Illi FOR YNR BATEROOM APPLICANT: TEL. NO: RAE (818) 448-1355- 5401 RHODES AVE SPECIAL CONDITIONS: VAN IUYS, 91607 CONTRACTOR: TSL. NO: APPROVALS DATE INSPRCTOR SIGNATURE LEGO CONSTRUCTION INC. (818) 448-1355- ' 5852 BURNET AVENUE LIC. NO UNDER SLAB WORK VAN NUTS, CA 91411 794440B . WATER SRHVICH PLASTIC YIN KCTAL TIN ARCHITECT OR HNGINRSR: TEL. NO: ROUGE PLUMBING LIC. NOS GAS PIPING Gm VENT HOT RATER HEATER PLUMBING FIXTURES EARN SPRINlai Q GAS TEST UTILITY COMPANY NOTIFIED CRV . GRAY RATER SYSTEM REPORT IDS DPR263 ROUTE TOs 890508 1 _