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HomeMy Public PortalAbout6037-6039 GOLDEN WEST AVE_Plumbing__ • I 76 A 667—CE B17 B/68 APPLICATION FOR PLU BING PE IT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION ADD DRENG SS 6039 Golden Fest JOHN A. LAMBIE, COUNTY ENGINEER COLEMAN W JENKINS. SUP T OF BUILDING LOCALITY Tem le City., California FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST Woodruff CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE �� WATER CLOSET 1 50 OWNER Mr, Bowen MAIL BATH TUB 1 50 ADDRESS p �7 SHOWER 1.50 CITY Same TEL. NO. 286-9 LAVATORY' 1 SO CONTRACTOR Paicif c Institers, Inc.. SINK 1.50 ADDRESS 10920 • Grand Avenue DISHWASHER 1.50 CITY Temple Ciqp CalifEL- NO. la 42-7070 CLOTHES WASHER 1 50 STATE NO 211596 CLIC LASS 0 ' SWIMMING POOL RECEPTOR 1 50 DISTRICT NO. mm 7'j- P ZONE PR CESSED BY a LAWN SPRINKLER SYSTEM 2.00 5-, Dg - r U WATER HEATER 1 50 1 0 INDUSTRIAL Z WASTE APPROVAL o GAS SYSTEM OUTLETS 1 SO INSPECTION RECORD w OUTLETS OVER .3G c- 5 PER SYSTEM Z Plan check fee 25% of above. See reverse PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE 3 ,5o APPROVALS DATE INSPECTOR 5 SIGNATURE Plan check applicant UNDER SLAB WORK Name I ROUGH PLUMBING Address GAS PIPING GAS VENT Ci ty Tel No HOT WATER HEATER EBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ATE THAT THE ABOVE IS CORRECT AND AGREE TO PLY PLUMBING FIXTURES LL COUNTY ORDINANCES AND STATE LAWS AT G GAS TEST G EBY CERTIFY THAT I AM PROPERLY REGI R N /OR UTILITY CO NOTIFIED D AS REQUIRED BY L ANGELES COON AND STA OF NIA OR THAT I AM LE OWNER F AND INTE D TO IN,THE ABOVE DE I IDENTIA R PERTY FINAL URE JACK R. ALLEN, SUPERVISIN HANICAL ENG'R RMITTEE PERMIT VALIDATION CK M O CASH PLAN CHECK VALIDATIONCK M o CASH Vie_ 0 5 a 3 5a D.B.S.17'28M SETS 12.44 .-_'APPLICATION-FOR PERMIT DEPARTMENT OF BUILDING-AND SAFETY•.• -I I - {; COUNTY OF LOS ANGELES' PLUMBINGWM.J. FOX.'CHIEF ENGINEER` T, _ ■, 1 'NAT,URE OF-INSTALL"ATION ° -DISTRICT_NO.,.' GROUP : ZOr 9R 1 : ROU`?I,. FIXTUREf COMPLITQ t v "' �(l -L � ATlR CESSPOOL -[SEPTIC TANK Q CE V B - READY FOR DATE ISSUED. 14-ATE AS MISCELLANEOUS APPLICANT•FILLIN HEAVILY OUTLINED:PORTION-ONEY- - JOB• NAME �� - ' -ADDRESS • a w - m ADDRESS 'LOCALITY ' (L NEAREST ° '1 CITY No: CROSS ST. � COUNTY - CERT:No: — l tr- EXPIRES 0 v '••a NAME • ' ' LOCATION-:OF SEPTIC'TANKf OR CESSPOOL 'z- ' ,MAIL ' • ADDRESS -Q r NORTH - I' ' h CITY TEL.No. .z 1 AM .THE LqOL 'POSSE88 R` OFT HE %1BOVH LOS ' I { ANGELES COUN CERTIFICAT F ALIF AT N. +, t I . - PLUMetUt 1 AM THE LEGAL OWNER OF THH PROPERTY DESCRIBED ABOVE. s 3 v ,•i - - OWNER - - CORRECTIONS T' �k r SOUTH ` DESCRIPTION:OF-WORK _ d ATH TUB`T. --' URNACH HOWER ; Y, ^ISHWASHER ` 0 AVATORY- REFRIGERATOR . ITCNEN OINK WATER SOFTEN SR IsLOOR SINK --SAND TRAF { aLOP BINK FLOOR DRAIN - <3 }. -WASH TRAY URINAL - AP PR .'° _WATER CLOSET, DRINKING FOUNTAIN• Y - irrt- `DATE' IN PKCTOR'8 NAM[' WATER HEATER —DENTAL LAVATORY / - _ ROU<iH.PLUIMBINd• r ' Y - METER s GAS,. RODA FOUNTAIN ' r OUTL" GAS,PIPING' GAS VENT" : CESSPOOL - TOTAL�NUMBER OF FIXTURES - Vim+'' SEPTIC TANK,- ' CESSPOOI SEPTIC TANK' SEWER S' TOTAL' FEE UTILITY CO.NOTIFIIrD � - I - FINAL 71iA667A �• CE 817(REV 6/78)' APPLICATION ;FOR PLUMBING' PERMIT , COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN•(PRINT OR TYPE) BUILDING ADDRESS 6039 Golden West NUMBER FIXTURE OR ITEM ® FEE WATER CLOSET �J LOCALITY Temple City , O NEAREST BATH TUB - Ov' CROSS ST SHOWER OWNER Nick Gomez MAI LAVATORY ADDRESS 11915 Eberle Street SINK D CITY Cerritos TEL N0924-4580 DISHWASHER 20 CONTRACTOR Inc CLOTHES WASHER ADDRESS 4265 N. Baldwin Ave. SWIMMING POOL RECEPTOR CITY El Monte, TEL NO 443-0078 LAWNSPRINKLER SYSTEM STATE 231 741 LIC C36-20 WATER HEATER LICENSE NO CLASS GAS SYSTEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT u �S HOT WATER HEATER PLUMBING FIXTURES 6pQ��9 GAS TEST / Plan check fee UTILITYCO NOTIFIED PLUMBING PERMIT ISSUING FEE$ uvv., /? TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDATION Nome Address 67 Y6 F City Tel No . A76a01A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE . # o O O O O 5 •THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES ' AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION - 2o c /, 9 0 O , I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 4 ' REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE 'O i0 O 4, Y.0 O U LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL , PROPERTY `' 1,0'7-79 SIGNATURE OF PERMITTEE DISTRICT NO P CESSElD-BY -; INDUSTRIAL WASTE APPROVAL '7GA667A GE 817(RLV 6/78) •�5 - APPLICATION ,FOR P,LU iVI P ING,.PE RM IT COUNTY OF LOS ANGELESBUILDING AND SAFETY FOR APPLICANT-TO FILL IN(PRINT OR TYPEI BUILDING NUMBER FIXTURE OR ITEM FEE ADDRESS 603 Golden West LOCALITY Temple City WATER CLOSET NEAREST BATH TUB & 3j CROSS ST SHOWER OWNER Nick Gomez ' LAVATORYn MAIL 11915 Eberle Street (! ADDRESS SINK O CITY Cerritos TEL NO 924-4580 DISHWASHER ll CONTRACTOR CLOTHES WASHER v ADDRESS' 4265 N Baldwin Ave. SWIMMING POOL RECEPTOR n CITY El Mon TEL NO 443-00 8 LAWN SPRINKLER SYSTEM JATE LIC WATER HEATER /> LICENSE NO 231 741 CLASS C36-20----- GAS SYSTEM OUTLETS (� APPROVALS DATE INSPECTOR S SIGNATURE OUTLETS OVER UNDER SLAB WORK 5 PER SYSTEM, ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER _ PLUMBING FIXTURES GAS TEST Plan Check fee UTILITY CO NOTIFIED PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Liu /) FINAL [� P PLAN CHECK VALIDATION an check applicant ' x.7;6 4,9 R• Name G�f� f� �-Z # 0 0 0 0 05 Address w 6 7•�',6 407 2 0 049.00 City Tel' No (T I HEREBY ACKNOWLEDGETHATI HAVE READ THIS APPLICATION AND STATE i .O G o.4 9.0 0 C, THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION 10;7,�—7 9 , I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS ' REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE _ - LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY 'SIGN ATURE OF PE RMITTEE /.�2Cf��© T111� �'✓/ ��" bAlil Q� - DISTRICT NO P OC��SED BY / INDUSTRIAL WASTE APPROVAL WORKERS'COMPENSA'I>QON DECLARATION 76A667A I hereby affirm that I have a certificate of consent to self ce eii (z-eo) APPLICATION FOR PL U M B I N G 'P E R M I T • insure, ora certificate of Workers'Compensation Insurance,or _ a certified copy thereof(Sec. 3800,Lab C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.------.Company C / ❑ Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDINGr �-r� NUMBER FIXTURE OR ITEM FEE ADDRESS lye OL`(EU W� 1' �. Certified copy is filed with the county building inspection ' WATER CLOSET department L 0 C A L I T P _ Date Applicant NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' ' COMPENSATION INSURANCE SHOWER OWNER NA(NS - MAIL LAVATORY (This section need not be completed if the work involved ADDRESS i S Cf1-L S7' a o by the permit'is for'one hundred dollars ($100) or less.) SINK CITYTEL NO R�ar-t}5V I certify that in the performance of the.work for which this DISHWASHERcc permit is issued, I shall not employ any person in any manner CONTRACTOR L �e; �s'Z O so as to become subject to the Workers' Compensation Laws CLOTHES WASHER ADDRESS U Date Applicant SWIMMING POOL RECEPTOR LLI CL NOTICE TO APPLICANT If, after making this Certificate of CITY TEL NO. l/ Exemption, you' should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC Z Compensation provisions of the Labor Code, you must forth- LICENSE NO CLASS with. comply with such provisions or'this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS DISTRIICT' NNO�/ PRO ESSEB BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM ­ 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL VALIDATION ness and Professions Code, and my license is in full force and DATE Q { effect. y�` � Lic Class y BY License Number Contractor NiCx�"`eZ Date I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a•registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code) TOTAL FEE Lic,or Reg.No Date Plan check applicant HOME OWNER-BUILDER•DECLARATION Name w I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031"5, Busi- City Tel.No ness and Professions Code) ❑ I, as owner of the property, am exclusively contracting 21 2 R 2 A with licensed contractors to construct the, project (Section 7044,Business and Professions Code) # o 0 0 0 0 5 CONSTRUCTION LENDING AGENCY 2 ° ° 1`G O O I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is ° ° ° O, O 00, issued(Sec 3097,Civ.C). Lender's Name O 7, 1 '6-80 6-8O 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 SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby ' authorize representatives of this County to enter upon the above-mentioned property for inspection purposes ,_�VtA'd( o b Signature of Perinittee Date