HomeMy Public PortalAbout6143 GOLDEN WEST AVE_Plumbing__ ` N,m that I'have a certificate
of consent tN 76A666DPW9189 APPLICATION FOR PLUMBING PERMIT
" 76A667A
I hereby affirm that I have a certificate of cronsent to'self insure,
or a certificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADDRESS�j i/�7,
❑ Certified copy is filed with the county building inspection
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY'
Date Applicant WATER CLOSET Al 1* NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' JCROSS ST. D
COMPENSATION INSURANCE 1 BATH TUBIIASSESSOR
(This section need not be completed if the work involved by the / SHOWER �/,,�
MAP BOOK 538PAGI�� PARCEL
permit is for one hundred dollars($100)or less.) 2 LAVATORY OWNER /�Wv
I certify that in the performance of the work for which this permit
is issued, I shall not employ any person in any manner so as toSINK MAIL
become subject to the Workers'Compensation Laws. ADDRESS
DISWASHER CITY TEL.NC, .� ,J
Date Applicant CLOTHES WASHER CONTRACTOR !�C/ 6
NOTICE TO APPLICANT: If, after making this Certificate of Ltl�.L�v )
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.NO.
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER I
(commencing with Section 7000) of Division 3 of the Business and STATE LIC.
Professions Code,and my license is in full force and effect. GAS SYSTEM 2 OUTLETS LICENSE NO. CLASS
OUTLETS OVER - -s DISTRICT NO. /
5 PER SYSTEM ' r('
License Number Lic.Class
FINAL/O0
DATE L VALIDATION
/�J
Contractor Date / co
❑ I am exempt under Sec. BY AL —�/ —Y/
BAP.C.for this reason _
Plan check fee
Date: � poll. 3=.•__•� �,.
PLUMBING PERMIT ISSUING FEE$
Signature
❑ TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5, Business and Professions Address "—
Code): p`i., #•;pl
I-� City Tel. No.
T I, 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 construction lending agency for the
performance of the work for which this permit is issued (Sec. 3097,
Civ.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 laws regulating Plumbing, and hereby authorize
representatives of this County to enter upon the above-mentioned
prop r inspec' n pu oses. SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Dat
_ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0710040005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID 1 BUILDING ADDRESS: - 1
1 ON FILE 1 6143 GOLDEN WEST AV
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801756
(ASSESSOR INFORMATION NUMBER: i I NEAREST CROSS STREET: GARIBALDI
15385-020-007 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl
163 WATER PIPING BR/FIX 8.00 FIX 54.00 1
TENANT: I TOTAL FEES 81.75 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
110/091/07 SR 04/01/08
OWNER: TEL. N0: F NALT FIN Y: CODE:
IFURUMOTO IKUO;REGINA (626) 285-4078-
16143 GOLDEN WEST AV I lJ
1TEMP 917801756 1D CRIPTIO OF WORK 1
I I (COPPER REPIPE TO 8 EXISTING FIXTURES UNITS
I
APPLICANT: TEL. NO:
1BROOKS (800) 649-7511- I
11371 TITAN WAY ISPECIAL CONDITIONS:
IBREA, CA 92821
y
I
CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE
ICAL-COAST REPIPING INC. (800) 649-7511- I
11371 TITAN WAY LIC. NO I (UNDER SLAB WORK I I
1BREA CA 92821 636649
I I IWATER SERVICE
I I 1PLASTIC Y/N METAL Y/N
(ARCHITECT OR ENGINEER: TEL. NO:
I - IROUGH PLUMBING 1
LIC. NO: I I
I ( IGAS PIPING
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1GAS VENT
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IHOT WATER HEATER
1PLUMBING FIXTURES
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I 1LAWN SPRINKLERS
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I GAS Ti?ST I
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I I 1UTILI'PY COMPANY NOTIFIEDI I I
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(GRAY WATER SYSTEM I I
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REPORT ID: DPR263 ROUTE TO: BS0508 I I I I
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