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Home My Public Portal About5921 HART AVE_Plumbing__ 76A667 171 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. I GROUP ZONE PERMIT NO. PLUMBER RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION ADDRESS UILDING CITY TEL. NO. ADDRESS COUNTY LOCALITY LICENSE NO. EXPIRES NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET (TOILET) t@ O.50 I$ 1 ADDRESS BATH TUB O.50 I I CITY TEL. NO. SHOWER 0.50 I I 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS 1 LAVATORY (WASH BASIN) 0.50 I I APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK n 0.501 STATE LAWS REGULATING PLUMBING. 1 I CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS E LAUNDRY TUB OR TRAY O.50 I ANGLES COUNTY LIC-NSE. OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS @ O.SO I SIGNATURE OF WATER HEATER CB 0.501 1 PERMITTEE SLOP SINK O.SO I� INSPECTION RECORD I FLOOR SINK n 0.50 I _ _ FLOOR DRAIN @ 0.50 DISHWASHER ( 0.501 - 1 DRINKING FOUNTAIN (0) 0.501 URINAL Ca 0.501 1 J I HOUSE SEWER 0.501 1- z MISCELLANEOUS I I _ a I O 1 I 1 1 1 APPROVALS DATE INSPECTOR'S NAME 1 ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 I 1 CESSFOOL _ I SEPTIC TANK: I I SEPTIC TANK DRAIN ( ) PIT ( ) Q 1.001 I _ SEWER I _ PERMIT . . . I 1.00 _GAS TEST UTILITY CO. NOTIFIED TOTAL FEE: 5 FINAL I I 76A667 ,17-.5-49® APPLICATION FOR PERMIT ,DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP I NE PERMIT NO. 'p'g7T(� �j j��'(V (� PLUMBER M. e 1'�OTTI1"V MJ1'RA��.X0. / R ECEIY�p Y READY FOR DATE ISSUED FIRST INSPECTION / ADDRESS 123 No. Clove -1r Ave. CITY ADDRESS �_K �s A&'-VA6oiTEMPLE ( g g9CALLF COUNTY LOCALITY .� LICENSE NO. EXPIRES p - NEAREST PERMIT FEES CROSS ST. LNUM11CR TYPE OF FIXTURE OR ITEM FEE OWNER 0 e MAIL WATER CLOSET (TOILET) @ 0.50 $ I ADDRESS BATH TUB @ 0.50 I l� CITY TEL. NO. SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK @ 0.50 - STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LICENSE, OR 1 AM THF, LEGAL OWNER OF T EE{�p-ESIDENTI PROPERTY,K DES £D"ABOVE.,. GAS SYSTEM OUTLETS @ O.50 , SIG NATU OF WATER HEATER @ 0.50 I ;4NP - ITTE � SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN .@ 0.50 DISHWASHER @ 0.501 DRINKING FOUNTAIN @ 0.501 \.X f��GP�► _ G/i /G�.. URINAL @ 0.501 -j 'HOUSE SEWER @ 0.501 `!! QZ_ - MISCELLANEOUS I� � 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL @ 1.00 I CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.001 SEWER PERMIT . 1.00 GAS TEST $ � UTILITY CO. NOTIFIED TOTAL FEE FINAL i D.B.S.17 2SM SETS 10-47 APPLICATION FO 6DtC�4DM IT DEPARTMENT OF BUILDING AND SAFETY �8 PERMIT H COUNTY OF LOS ANGELES PLUMBING WM.J. FOX, CHIEF ENGINEER c�NATURE•OF INSTALLATION DISTRICT NO. o OUP ZONE P NO. ROUGH FIXTURES COMPLETE �� A/ /1-39-3 HEATER CESSPOOL I—I SEPTIC TANK RECEIVED BY READY FOR, -,.,DATRASSUED Y/ "/ FIRST INSPECTION GAS- MISCELLANEOUS APPLICANT FILL ItINI�I�HEAVILY OUTLINED PORTION ONLY JOB ++s� �l-* C NAME 11 f 1(�S_II�IG q1.111 ADDRESS 2/6� O / R d n/ ADDRESS 715 EAST B"(APiki � LOCALITY CITY P.0.BOX 67 SAWNEAREST r,�IEL, Cho CROSS ST. COUNTY _rCERT.No. EXPIRE&' �^�' C NAME LOCATION OF SEPTIC TANK, OR CESSPOOL z MAIL ': ADDRESS NORTH O CITY TEL.No I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE—,CF p ALIFICAT.ION. rf�'PLUMD I AM THE LEGAL OWNER OF E P.,.FjOPERTYDE:SCRIBED ABOVE. �.'�` 6�f� D OWNfiR CORRECTIONS I SOUTH J DESCRIPTION OF ®YORK z -BATH TUB FURNACE HOWER DISHWASHER / E3 LAVATORY REFRIGERATOR ITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP GLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN SATE INSPMCTOR'S NAMe WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER-4GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT / CESSPOOL I (- TOTAL NUMBER OF Fi]4TLLREB �� SEPTIC TANK I I �c•C$VRMEPTICTANK sQ SEWER Qft I I $ TOTAL FEE UTILITY CO.NOTIFIED I , I-, 1'2 FINAL WORKERS'COMPENSATION DECLARATION n fo�fo�fl C� iTPON FOR 17f1 fl flll/1 0 PNG 1�2f�111 T' I hereby affirm that I have a certificate of consent to self 76A667A /r�11�Ih L� !tel ll u V FOR lf"L�luJ11VU I1V lf�LS IJ�lJVII ll insure, or a certificate of Workers' CE 817(REV. 10/81) or a certified copy thereof (Sec. 38COUNTY OF LOS ANGELES BUI G AND SAFETY Policy No.—Company=. ' Certified copy is hereby furnishe 9 Certified copy is filed with the county building inspec- FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGADDRESS 4tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date 1a d Applicant WATER CLOSET NEAREST .CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL / ADDRESS 7 I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY �G TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER - �v0 CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of f ?e Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the.Labor Code, you must forth- CITY TEL. NO.I/W ^7� LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE UC. deemed revoked. WATER HEATER LICENSE NO. 12Z CLASS �- 3 LICENSED CONTRACTORS DECLARATION DISTRICT NO. 'I PROC ED BY 411 I hereby affirm that 1 am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS r/ �1 _ (commencing with Section 7000) of Division 3 of the Business oU7LETSOVER JL and Professions Code,and my license is in full force and effect. 15 PER SYSTEM0 FINAI(2 a• r VALI ATION O DATA 4) License Number Lic. Class--r_' � Contractor DateLu I am Vl B.&P.C. for this reason D Plan check fee Date: PLUMBING PERMIT ISSUIN E Signature TOT e 7 8 0.J A SINGLE FAMILY Plan check applicant } o o o 0 o 5 HOME OWNER-BUILDER DECLARATION Name ! a 1 6,50 I'hereby affirm that I am exempt from the Contractor's License o r% 0 1 6.`06 Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. 12,27-83 ❑ .I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section D 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 D 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-meryi�ne property for spection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date t WORKERS'COMPENSATION DECLARATION' 6�11J'lf'L�OCAI �O� N FOR Pa [> U o MO PERMW 7 k fioff,iPm�t ['have a certificate of consent to self 76A667A insure; ore a certifytate of Workers' Compensation Insurance, CE 817(REV. 8/88) - or a certified copy thereof (Sec. 3800,'Lob. C.) COUNTY OF LOS' ANGELES NGEELES DEPT. OF PUBLIC WORKS Policy,No. Company ❑' Certified copy is hereby furnished. h ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ✓ 4- Certified copy is filed with the county building inspec- ADDRESS /l/ fes!" tion department. NUMBER FIXTURE OR ITEM FEE . LOCALITY Date Appligant WATER CLOSET NEAREST. t _ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER / carer (This section need not be completed if the work indolved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY �' ADDRESS ' .I certify that in the performance of the work for which this 1 / permit is issued, I shall not employ any person in any manner SINK CITY M I a f� �,! TEL. NO.��I� �1 so as to become subject to the Workers'Compensation Laws. DISHWASHER /O pP � G 'kaeKX� CONTRACTOR Date A licdnt � CLOTHES•WASHER ADDRESS NOTICE TO APPLICANT: If, after making this,Certificate of SWIMMING POOL RECEPTOR Exemption, •you should become subject to the Workers' Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. [� PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM, OUTLETS (commencing with Section 7000)',of Division 3 of the Business OUTLETS OVER (� and Professions Code,and m license is in full force and effect. 5 PER SYSTEM Y DATE bA,U HI®R9 U License Number Lic. Class FINA O Contractor Date BY V ❑ m I am exempt under Sec. � y B.&P.C. for this reasonD Plan check fee' Date: PLUMBING'PERMIT ISSUING FEE$ Signature 2 8328 A TOTAL FEE S Plan check applicant # 0 6 0 0 0 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I herebyaffirm that I am exempt from the Contractor's License = Law fo .the following,reason(Section 7031.5, Business and Address o 0 0 Ll 0,5 0 v Professions Code): ICity TeL No, .18 ❑ I, as owner of the property, will do,the work and the Q structure is not intended or offered for sale (Section D 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 D ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the a e-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE • Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0207300039 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAI BUILDING ADDRESS: TR: 5904 LT: 330 5921 HART AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801913 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HERMOSA 5384-015-028 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 08/09/02 JK 02/05/03 47 WATER HEATER(S) 1.00 WTH 16.20 OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 FINAL DATE FINAL BY: CODE: TRUONG;VI - TOTAL FEES 108.75 ,,i� off. 5921 HART AV TEMPLE CITY 91780 DESCRIPTION OF WORK PLUMBING FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR IGNATURE SAME AS OWNER LIC. NO �� . ;r�/ �� UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: �� -{ ROUGH PLUMBING � LIC. N0 GAS PIPING 3 -- - - - - -- - GAS VENT ;) ( l!�, HOT WATER HEATER - ,- -- -- J - -- - - PLUMBING FIXTURES LAWN SPRINKLERS GAS TES UTILITY COMPANY NOTIFIED f CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508