HomeMy Public PortalAbout8628 HALDEMAN ST_Plumbing__ ,76A667-CE817 12/59
APPLICATION FOR-PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AN ,,,,AFETY DIVISION4TCROSSST.
26026
JOHN A. LAM BI COUNTY NGINEER
WILLIAM A. JENSEN. SUPT OF BUILDING
n Gabriel
FOR APPLICANT TO FILL IN rabildi & Burton
NUMBER FIXTURE OR ITEM OWIM Monarc Estates
2 WATER CLOSETMALL
ADDRESS 11518 Zambert
BATH TUB CITY E1 Monte TEL. No. G1 31761
SHOWER
CONTRACTOR Valley Plumbing: Co.
2 LAVATORY
1 SmK ADDRESS 442 W. Fleetwood P1 .
DISHWASHER CITY Glendora TEL. No. Ed 5— J
CONTRACTOR'S �,pr7 STATE El
LAUNDRY TUB REGISTRATION NO. 16084/ COUNTY ❑
71 CLOTHES WASHER DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER Z
1 GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
P.
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10 @ $1.00 PER ITEM
OR FIXTURE $ I 0 0 APPROVALS DATE i ECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK /L
TOTAL FEE I 1JI w. ROUGH PLUMBING !2,16
"111 GAS PIPING i- k
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND'AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES Jq
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE GAS TEST
DESCRIBED RESIDENTIAL PR RTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMIT
AL
®eVALIDATION ROBERT A. WOOD.
ccs/ M.O. CASH SUPERVISING MECHANICAL ENG'R
1 0 2 2 6 2 - IFU g 5 A 12.0 0 �'
r
WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9%89
76A667A
I hereby affirm,that I have a certificate of consent to self insure, APPLICATION FOR PLUMBING-PERMIT�
or a certificFjEe of.Worker's Compensation Insurance, or a certified _
copy,thereof($ec.,3800 Lab:•C) _� f
Policy Not � D/ COUNTY'OF LOS ANGELES ,! DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Company
��Ccertified
-rtified copy is herebfurnishedy ., BUILDING
FOR APPLICANT•TO FILL IN(PRINT OR TYPE) ADDRESS L D�JZlcopy-is filed with^the county'building inspec_tion'
department. NUMBER i FIXTURE OR ITEM @ FEE
'` L,t LOCALITY
Dater_` ( Applicant �/NQ4 Al�4�i�A�/ WATER CLOSET
- � NEAREST �
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. -
• BATH TUB •
COMPENSATION INSURANCE• _ ASSESSOR
(This section need not be completed if the work Involved by the SHOWER MAP BOOK PAGE PARCEL
permit Is for one hundred,dollars($100)or less.). OWNER
.*,4
certify that in the performance of the work for which this permit LAVATORY /��� S�� ��✓
MAIL
is issued, I shall not employ any person in any manner so as to SINK ADDRESS
become subject to the Workers'Compensation'Laws.
_ DISWASHER CITY, L�- /?p•- TEL 'NOa 7
Date Applicant CLOTHES WASHER �` s
NOTICE TO APPLICANT. If, after,making this Certificate of CONTRACTOR .✓
Exemption,you should became subject to,the Workers'Compensation SWIMMING POOL RECEPTOR _ ADDRESS
;provisions of the Labor Code, you,must forthwith comply with such D /�/, _f�A,
provis)ons or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM - -
LICENSED CONTRACTORS DECLARATION CITY�J�AgorrN� TEL NO 7 -7
3-,� a
I hereby affirm that I am licensed
under provisions of Chapter 9" WATER HEATER _ /
(commencing with Section 7000 of Division 3 of the Business and STATE / LIC O
( g ) LICENSE NO. 6` (p T CLASS
GAS SYSTEM OUTLETS U
Professions Code, and my-license is in full force and effect. - �
�/ OUTLETS OVER DISTRICT N0. PROCESSED BY O
License Number V-� V 7� Lia Class, d 5 PER SYSTEM
' FINAL
'o' �� �� ^z�` DATE g„4, + VALIDATION a
Contractor Date ,� - (n
❑ 1 am exempt under Sec. FI AL c ?
B'&P.0 for this reasonZ;�; �Y
Date Plan check fee
PLUMBING PERMIT ISSUING FEE$ '� '�)7
Signature _
r _ TOTAL FEE p Si _ I ITENS r
Plan check applicant TOTAL } 40 65
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name• - ;.ti' - 40.b7.1
I hereby affirm that I am exempt from the Contractor's,License Law - t 1 ``� n
for the following reason (Section 7031.5, Business and Professions Address CHANGE- I I i
Code):
❑
City ,Tel. No 1
I, as owner of the property,will do the work and the structure `� S _
is not intended or offered for sale (Section 7044, Business - 00100-13C101 :r "t,/9]"
and Professions Code).
• �' 3'v
_ r� t ' 01"1"25
'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,
ICiv C)
Lender's Name
Lender's Address f' ,
I certify that I have read this application and state that the above
information is correct I agree to comply with all County ordinances - '
Pol-
and State laws regulating Plumbing, and hereby authorize %
representatives of this County to enter upon the above-mentioned
property for ins ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE n
gna e,of Per flee' Date f
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1403050011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 26026 LT: 5 8628 HALDEMAN ST
I .IFEE DESCRIPTION: QUANTITY: DOM: • AMOUNT: ( SGAB CA 917752637 1
(ASSESSOR INFORMATION NUMBER I - I NEAREST CROSS STREET: 1
15386-007-056 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID. G2 LOCALITY: TEMPLE CITY CAI
1 107 BATHTUBS/SHOWERS 2.00 FIX 32.40 1
TENANT: 125 LAVATORIES/SINKS 3.00 FIX 48.60 11SSUED ON: PROCESSED BY: PLAN BY: I
145 WATER CLOSET/URINAL 2.00 FIX 32.40 103/05/14 SR I
TOTAL FEES 141.20 1 1
OWNER: TEL. NO: (FINAL DATE FI AY: CODE:
WAN, ANTHONY (323) 240-7707- IJ
18628 HALDEMAN ST
ISGAB 917752637 IDE R PTION OF WORK
BATHTUBS/SHOWERS, LAVATORIES, SINK AND WATER CLOSETS
1APPLICANT: TEL. N0-
IDE LA ROSA, GERARDO (213) 305-5535-
1 I
1460 S LA VERNE AVE I ISPECIAL CONDITIONS:
LOS ANGELES CA 90022 1
1 I I
ICONTRACTOR: TEL NO. I (APPROVALS _ DATE INSPECTOR SIGNATURE
IDE LA ROSA CONSTRUCTION (213) 305-5535- 1
460 S LA VERNE AVE LIC NO (UNDER SLAB WORK
LOS ANGELES CA 90022 855010
WATER SERVICE
IPLASTIC Y/N _METAL YIN -
(ARCHITECT OR ENGINEER: TEL NO- I
- IROUGH PLUMBING
LIC. NO:
' (GAS PIPING
_ .. I GAS VENT
I I �
IHOT WATER HEATER
I I I
(PLUMBING FIXTURES
I I I I I I
ILAWN SPRINKLERS
I I I I I I
IGAS TEST
I 11 I
1UTILITY COMPANY NOTIFIEDI I
IC I
(GRAY WATER SYSTEM
I 'v
I I
I I I I I I
' IREPORT ID: DPR263 _, ROUTE TO: BS0508