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HomeMy Public PortalAbout6051 GOLDEN WEST AVE_Plumbing__ DBS-17 10.55 APPLICATION FOR PLUMBING PERMIT 1 DBS-17 DIVISION OF BUILDING AND SAFETY Department of County Engineer County of Los Angeles BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS Q CASSATT D GRIFFIN SUPT OF BUILDING / G� ..,j LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST OWNER DISTRICT NO. GROUP ZONE READY FOR INSPECTION MAIL ADDRESS / INDUSTRIAL CITY / TEL NO WASTE APPROVAL PLUMBER ,�S'.r�j �yTpa��� INSPECTION RECORD ADDRESS �i CITY 0111 TEL NO.+� v1 3 j3 LICENSE NO - / 1/z J J ^� NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ BATH TUB @ $1.00 -17 /a�i��P/Pyab SHOWER @ $1.00 �U//�/A — � LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1 00 TO/°,D^P4?IAI DISHWASHER @ $1 00 LAUNDRY TUB OR TRAY @ $1 00 o /�"''K`!� �� F//,q4 1"r-e WIV CLOTHES WASHER @ $1 00 WATER HEATER @ $1 00 GAS SYSTEM@ $1 00 !T Q tD ZA7—fR -7-00f Y APPROVALS � — DATE INSPECTOR'S SIGNATURE UNDER SLA WORK //'' p�' PERMIT $ 1 ,00 ROUGH PLU BING-ry 3-Ia� 66e - ^ GAS PIPING TOTAL FEE v GAS VENT - 0S '_ I HEREBY ACKNOWLEDGE THAT-1 HAVE READ THIS APPLICATION HOT WATER HEATER ,�- Q" 1f AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ ,p WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING FIXT RES -1(2 1, PLUMBING I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED PND/OR GAS TEST -/k LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA'OR THAT I AM THE LEG L OWNER OF THE BOVE UTILITY CO NOTIF)ED ��5-,5r DESCRIBED RESIDENTIAL PR Y. IGNATUR SOF PERMIT FINAL WMA MRI—i ion JOHN'A. LAMBIE, COUNTY GINEER VALIDATION ROBERT A WOOD, CHIEF PLBG INSPECTOR CR. N.0 CASH `_SCO 5 8 9 4 MBAR, s3 3 9.C) 76A667 (CE-817)-4/72 r i APPLICATION FOR .PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER 'BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO ADDRESS Jl d / HARVEY T. BRANDT, COUNTY ENGINEER LOCALIT - FOR APPLICANT TO FILL IN (PRINT OR TYPE I NEAREST CROSS ST �(�J NUMBER FIXTURE OR ITEM @ FEE OWNER � WATER CLOSET 1.75 MAIL BATH TUB 1.75 ADDRESS SHOWER 1,75 CITY TEL NO. LAVATORY 1,75 CONTRACTOj � `/ w SINK 1.75 ADDRESS / �Vv'""�� ' DISHWASHER 1,75 � CLOTHES WASHER 1,75 STATE LIC - /� fGj SWIMMING POOL RECEPTOR 1,75 LICENSE CLASS DISTRICT NO G�P I ZONEI PROCESSED BY LAWN SPRINKLER SYSTEM 1,75 1 . r © r, WATER HEATER 1.75 INDUSTRIAL D.- WASTE APPROVAL o- O GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD 6i OUTLETS OVER 30 O 5 PER SYSTEM t3 C7 W N Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel No GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING GAS TEST IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED 4 LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF CALI FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INT N9 TO 7 RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PER TY FINAL SIGNATURE OF PERMITTE �-�- ' r PERMIT VALIDATI0� ., M o CASH PLAN CHECK VALIDATION CK M o CASH 0 '5 9N OCT 3 5 D 4.75 WORKERS' COMPENSATION DECLARATION ,APPLICATION FOR PLUMBING PERMIT t,I Hera!(y firrr;rthat I have o•certificate of consent to self 76A667A insu-e, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a,certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS°ANGELES _ -BUILDING AND,SAFETY ' Policy No Company ❑ Certified copy is hereby furnished 1 FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING' O�) C` vi Q ' Certified copy is filed with the county building mspec_ ADDRESS 13+ A NUMBER FIXTURE OR ITEM FEE LOCALITY 1 G �! ton department il ` @° Date ppIicant WATER CLOSET lr/ NEAREST ) CERTIFICATE OF EXEMPTION FROM-WORKERS' BATHTUB CROSS-ST U COMPENSATION INSURANCEL OWNER W (This section need not be completed if the work,involved by , SHOWER CJ the permit is for one hundred dollars ($100)or less.) MAIL LAVATORY Ej ADDRESS . I certify that in the performance of the work for which this - ° permit is issued, I shall not employ an person in an manner SINK CITY 1 TEL tJ P P Y YP Y ��Wv 1.—jCy L 7 so as to become subject to'the Workers'Compensation Laws DISHWASHER CONTRACTOR yA c o Date' Applicant CLOTHES WASHER ADDRESS 5�� l L NOTICE TO APPLICANT If; after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you-should become subject to the Workers' CITY �• Ck TEL NOS 8 006, Compensation provisions of the Labor Code, you must forth- LAWN`SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE �� LIC deemed revoked WATER HEATER LICENSE NO CLASS 91 LICENSED CONTRACTORS DECLARATION DISTRICT NO PR CESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS �t (commencing with Section 7000) of Division 3 of th6441 / e BOsiness OUTLETS OVER (f �i and'Professions Code;and my license is in full force and effect 5 PER SYSTEM FINAL //� / VAI.I TION °' DATE V /�/1`J So Li_cerise Number Lic Class FIN C9 Contractor Date BY ❑ I am exempt under Sec ;2 2,1 Q 3 A d B'&P C-for this reason __ - Plan check fee ► # �.� 5 Date PLUMBING PERMIT ISSUING FEE$ 1 ,'_0 'I'- o'2 a 5 0 Signature , TOTAL FEE ° o 0 0 2 5 0 v Plan check applicant ` SINGLE FAMILY - - 4,23_$5 , HOME OWNER-BUILDER DECLARATION Name 0 I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031 5, Business and Professions Code) _ City Tel No ❑ j, as owner of the property, will do the-work and the _ structure is not intended or offered for sale (Section ► 7044, Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a-constructioh lending agency for the performance of the work for which this permit is issued (Sec 3097, Gv 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 jaws regulating_Plumbing,,and hereby 3, authorize representatives of this County to enter upon the above-mentioned property for inspection purposes - (,�,1� �� SEE REVERSE FOR EXPLANATORY LANGUAGE `� Signature of Permittee vDate J COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0907280006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID I FEES PAID I BUILDING ADDRESS ITR 6561 LT 90 UN 002 I 1 6051 GOLDEN WEST AV I IFEE DESCRIPTION QUANTITY UOM- AMOUNT I TEMP CA 917801755 1 (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET LAS TUNAS 15385-019-003 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 597 GRID A2 LOCALITY TEMPLE CITY, Cl 145 WATER CLOSET/URINAL 1 00 FIX 16 20 1 1 ITENANT I _ TOTAL FEES 43 95 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON: 1 107/28/09 SR 07/28/10 1 (OWNER TEL NO- 1 I NAL D E FI BY CODE 1 IWILSON CYNTHIA M (310) 264-8121- I 16051 GOLDEN WEST AV 1 I I ITEMP 917801755 1 lhtSCRIPTfON OF WORK I 1 1 IREMOVE/REPLACE GAS WATER HEATER SAME LOCATION I I I I 1APPLICANT TEL NO I I I ILIZ BRIDGES (425) 636-7084- I I I (SPECIAL CONDITIONS I I I I ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE IFAST WATER HEATER CO (800) 454-8955- I 112601 132 AVE NE LIC NO 1 (UNDER SLAB WORK 1 1 KIRKLAND WA 98034 877489 C36 II I I I 1 IWATER SERVICE I I I (PLASTIC Y/N METAL Y/N I I 1 (ARCHITECT OR ENGINEER TEL NO I I I IROUGH PLUMBING I I LIC NO 1GAS PIPING II I I I I I I I I IGAS VENT I I I IHOT WATER HEATER 1 I I (PLUMBING FIXTURES 1 I I I I i I I I ILAWN SPRINKLERS 1 I I I I I I I GAS ,TEST I I I I I I I (UTILITY COMPANY NOTIFIEDI I I I ICWV I I I 1GRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID DPR263 ROUTE TO BS0508 _