HomeMy Public PortalAbout10211 GREEN ST_Plumbing__ 76 A.667 - CE 817, 7-69
APPLICATION FOR PLUMBING PER -IST
COUNTY OF LOS ANGELES
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DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION ADDRESS Q 1 l ty �+`1 c�� S°T
JOHN A. LAMBIE, COUNTY ENGINEER
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN (PR NT OR TYPE) NEAREST
CROSS ST n %,,,/
NUMBER FIXTURE OR ITEM [EAH FEE OWNER • 'r, V,+
r WATER CLOSET 0 0 MAIL ,r
BATH TUB 0 ADDRESS3 �SHOWER 0 ( IJ O CITY /C-""4,1, �'�f TEL.
LAVATORY1.50 CONTRACTOR x�
1.50 f �p� ADDRESS
DISHWASHE 1.50 CITY TEL. NO.
CLOTHES WI4SHER ; 1.50 y Q STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. G P ZONE PROFESS D BY
LAWN SPRINKLER SYSTEM 2.00 .�1
WATER HEATER 1.50 ' �y INDUSTRIAL ttt
WASTE APPROVAL O
GAS SYSTEM ), OUTLETS 1.50 INSPECTION RECORD U
OUTLETS OVER O75(
5 PER SYSTEM .30AZI /f 17b
W
D.
W.
d 2� Z
Plan check fee 25% of above. See reverse.
PLUMBING PERMIT ISSUING FEE $ 2 00
TOTAL FEE APPROVALS DATE IN CTOR'S G TURE
Plan check applicant UNDER SLAB WORK
Name O t- 1 rROUGH PLUMBING
Address r Q A i �J f' GAS PIPING
GAS VENT
City °— L';.r, Tel. No. 'Y r
HOT WATER HEATER
LI BY ACK OWLEDGE TN I HAVE READ THIS APPLICATION
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
LL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST //G.EBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
NIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO
N,THE ABOVE DESCRIBED RESTIAL PROPERTY. FINAL
URE JACK R. ALLEN, SUPERVISIN ECHANICALENG'R.
RMITTEE -
PERMIT VALIDATION�. M.O. CASH
PLAN CHECK VALIDATION CK. M.O. CASH
t f�6 6 6 5c-- W 2 2 5 o 1 ..DON
alk�
76A667 (CE-817)-4/72
d APPLICATION FOR PLUMBING PERMIT {J
COUNTY OF LOS ANGELES IJ
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
,HAKE CHECKS PAYABLE TO: ADLID
DRESS D otj '
HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY & ,
FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST
CROSS ST. /" 7
NUMBER FIXTURE OR ITEM @ FEE
OWNER
WATER CLOSET 1.75
MAIL
BATH TUB 1.75 ADDRESS s%
SHOWER 1,75 f CITY L TEL. NO.
LAVATORY 1.75 ZS CONTRACTOR i• A�
SINK 1.75 ADDRESS Q f �7
DISHWASHER 1,75 CITY 77
e TEL. NO
CLOTHES WASHER 1.75 STATE LIC
SWIMMING POOL RECEPTOR 1,75 LICENSE NO. , CLASS
DISTRICT NO. GROUP (�
V
` E OCESSED BY
LAWN SPRINKLER SYSTEM 1.75 �{' Q ( �/
WATER HEATER 1.75 INDUSTRIAL D�
WASTE APPROVALCD
0-
GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD V
OUTLETS OVER 30 O
5 PER SYSTEM
t3
V
W
a
N
Z
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $ 3 00
TOTAL FEE
APPROVALS D T 115 PECTOR A IGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO. GAS VENT �.
HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES E
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ,
PLUMBING. GAS TEST �!
I HEREBY CERTIFY THA I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICENSED AS REQUIRED B OS ANGELES COUNTY AND ST TE OF
CALIFORNIA OR THAT I AM E LEG L OWNER OF, AND I ND TO
RESIDE IN THE ABOVE DES ED R DENTI PRO PERT FINAL
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATI CK. M.O. CASH
PLAN CHECK VA TION CK. M.O. CASH
1 1r,. 0 393-73 APR5 D 1 1 .7 5
WORKERS'COMPENSATION DECLARATION APPGAT I CJ N FOR P LU(All B N G PENT
I hereby affirm that I have a certlfJtgte of consent to self 7&%WA
lnsbro, or a certificate of Workers'Compo tion Insurance, U817(REV.--0/81)
or aSertlfied copy thereof (Sec. 3800,to COUNTY OF LOS ANGELES )3l1 ING AND SA
P�ollcy No.------.Company
Certlfled copy Is hereby furnished.
FOR APPLICANT TO R4 IN(PRINT OR TYPE)
Certtfled copy is filed with the county bu nI Inspec- - 4.
`*
ti P department. NUMBER FIXTURE OR ITEM O F� LOCALITY
Date Appll4ant WATE1tCLOSET QST
CERTIFICATE OF EXEMldTI FROM WOOT-RS' BATH TUB CROSS ST
COMPENSATION INSURANCE owr.Jet
bk
(This secl[bn deed not *completed if worImrbhted by sHowETt X
the permit t*for one hundred dollars (=100)or lea.) LAVATORY
I certify that In the peffofm ince of the work for which thisrj
permit Is Issued, I shall not employ any demon In any manner . CITY 9 TEL �7 9�,a,Pa
to as to,become subldct td the Wortcen Compensation Laws. DISfifWASNER
bONTRACTOR
bate A-11cont QOTH£S WASHER
NOTICE TO APPLICANTc If, after making this C6rt1fl4ate of ADDRESS
Exemption, you should become subject to the Workers' SWJMMINO POOL RECEPTOR
Compdruatlon provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM �Y TEL NO Q7
with. Comply with such provisions or this permit shall be STATS i UC
deemed•revoked- WATER HEATER LI NO• r CLASS V
LICENSED CONTRACTORS DECLARATION r D141 PROCEM BY
I hereby affirm that I am Ilcenued Under provlslons of Cater 4 GAS SYSTEM OU7LET5
(commenclrjg with Sectlon.701X0 of Division 3 of the BUslness OVER
and Profession Code,and my license h In full force and effect. S PER SYSTEM FINAL
DATE _ _ yAL1pATION
Lltense Num c• Cl,gsi<4 oe
g NAL , 0`
Contractor Date
QI am exempt
N
B.BP.C. for this reason PIBn che4k fee
flate.�
SlgngturPLUMBING PERMIT ISSUING FEE;
e ,
TOTAL FEE ;� 1 3.32 A
Plan check'gppllcant 0 0 0 0 0 5
SINGLE FAMILY
HOME OWNER.BUILDER DECLARATION Numb I o 0 1 b 5 0
1 hereby affirm thm I am exempt from the Contractors Llcer" "
Law for the following reason (Sectron 7031.5, Business aad Addfep 1 5 5 Q E
Prbfesslon Code): City Tel.No.
0 1, as; owner of the prdperty, will do the work and the 0420783
structure Is not Intended or offered for sgle (Section Opp,
Business'and Profewl-on;Code)
CONSTRUCTION LENDING AGENCY
I herebyafflrrn thdt there-Is a construction lending agency for
the p-erformance of the work for which this permit is Issued
(Sec. 3047, CIv. C.).
Lenders Name
Lender's64dress
I certify that I have read this application and state that the ►
above Infornwtlo Is correct. 1 ogroe to comply with all County
ordinances and State Ibws fegulating Plumbing, and hereby
authorize represe gtives of this County to enter upon the
ajcove entlon rty for Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
roof Permittee Date
COUNTY OF LOS ANGELES ' TEMPLE'CITY 0:0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508'9609200004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488-.EXT:
LEGAL ID: '�EES PAID. BUILDING ADDRESS:
ON FILE 10211 GREEN ST
FEE DESCRIPTION: OPANTITY: LION: N4OLlNT: TEMP CA 917803337
NEAREST CROSS STREET: GLICKMAN
a58. - -0.1 01 PERMIT ISSUANCE PEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY
21 HOSE BIAB(S) 1:00 FIX 16.35
TOTAL FEES 4-4.10 ISSUIED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
09/20/96 TC' 09/20/97OWNER
AMARE�SH-IMELIS;HAILU ELENT (818) 444-6467-
10211 GREEN ST' 2—
TEMP 917803337 DESCRIPTION OF. WORK
NEW HOSE RIBS FOR ADDITION
APPLICANT: TEL. NO-.
SAME AS OWNERTEL, NO"
-
SAME AS OWNER �
LIC. NO !^ra �� d� UATER SERVICE
ARCHITECT OR ENGINEER: TEL. W:. -
�\ PLASTIC Y/N METAL Y/N
LIC. 110: �(/I!// �t i i � 1
GAS PIPING Al�
PUBUCWORKSHOT WALTER HEATER
PLUMBING FIXTURT'g-
-
a
GAS TEST
CWV
f-vi c
REPORT ID: DPR263 ROUTE TO: BS0508