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Home My Public Portal About6258 HART AVE_Plumbing__ 76A667 (CE-817)-4/72 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION MAKE CHECKS PAYABLE TO: BUILDING ADDRESS ._ HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST /' s�, CROSS ST. / - /�✓ii NUMBER FIXTURE OR ITEM @ FEE OWNER WATER CLOSET 1.75 MAI L BATH TUB 1.75 ADDRESS (QD.Sq 4o5-- SHOWER 1,75 CITYTEL. NO.a �- LAVATORY 1.75 CONTRACTOR SINK 1.75 ADDRESS DISHWASHER 1.75 CITY 001w TEL. N0. UUP' " CLOTHES WASHER 1.75 STATE LIC LICENSE NO. CLASS -� SWIMMING POOL RECEPTOR 1.75 1 #,I DISTRICT NO. GROUP ZONE PROCESSED BY LAWN SPRINKLER SYSTEM 1.75 Ff ! _ WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL a- GAS SYSTEM OUTLETS 1.75 S INSPECTION RECORD V OUTLETS OVER / _ �/ I\' p� 5 PER SYSTEM .30 /�-7-7 tip /i A T J�1/0 .0 L CD 1-- � C7 j 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 PIPINGP��a9 City Tel. No. GAS VENT r1l I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES A �� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING �F,p PLUMBING. GAS TEST I HEREBY CERTIFY THAT LOAM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REOUI RED BY LOS ANGELES COUNTY AND STATE OF �� y CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DE RIBEDR ESIDENTIAL PROPERTY. FINAL 'J� J'4 SIGNA TU RE 9\�� ,f OF PERMITTEE t7CueA_- CK. 'M, PERMIT VALIDATION o. CASH PLAN CHECK VALIDATION CK. M.O. CASH 9 6 71PMAR 7 5.'1) 605.0 A98 . 76 A 6.67 RC E-817)-4/72 - APPLICATION ICOR PLUMBING BING P R U E M 1T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ,HAKE CHECKS PAYABLE TO: ADDRESS HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY 1 FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST. OWNER WATER CLOSET 1.75MAIL BATH TUB 1.75 ADDRESS SHOWER 1,75 L� CITY TEL. NO. 3 LAVATORY 1,75 `J CONTRACTOR IS , SINK 1,75 ADDRESS /) UIS eVM DISHWASHER 1.75 CITY TEL. N0. CLOTHES WASHER 1.75 STATE LIC SWIMMING POOL RECEPTOR 1.75 LICENSE NO. CLASS e,3 6j DISTRICT NO. GROUP E FR CESSED BY LAWN SPRINKLER SYSTEM 1,75 C �I SCJ WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL a GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD """ v OUTLETS OVER 30 5 PER SYSTEM O F-- C.) W a N Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE -APPROVALS PATE I PECT SIGNATURE Plan check applicant UNDER SLAB WORK ?i Name ROUGH PLUMBING z 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I THE L AL OWNER OF, A NTEND TO RESIDE IN THE ABOVE DE C BED SIDEN J�4L PROP T FINAL SIGNATURE / OF PERMITTEE PERMIT VALI TION � CC1, t.'n.o. cnsH PLAN CHECK VA ATION CK. M.O. CASH 0908: 3 MAY 5 D • 11 .75- L fii.r'} WORKERS'COMPENSATION DECLARATION I APP UCQIM N F® °� p° LUMp oUVG PER I hereby,offirrn 't�at I have a certificate of consent to self 76A667A. insure; or o certificate of Workers'Compensation Insurance; OE 817 (REV.8/86) or a certifi co t r ec. 3800, a . C.) + COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Polido ompany ' ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN.(PRINT OR TYPE) ADDRESSHart Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM @ FEE t'on depo tment. LOCALITY �7I ///�y//y� WATER CLOSET. RMW Dote ^ y 'Appligon1 ` "� NEAREST CERTIFICATE OF EXEMPTION.FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER -SHOWER (This section;need not be completed if the work involved by MAIL (g the.permit is For one hundred dollars ($100)or less.) LAVATORY ADDRESS jJ I certify that;in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITYMolt W EL. NO.. 3 so as to become-subjec"t'to the Workers'Compensation Laws. DISHWASHERi CONTRACTOR 'hav , Date Applicant CLOTHES WASHER lllvt NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers" SWIMMING POOL RECEPTOR Compensation provisions of the.Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. � Q—A with comply with such provisions or this permit shall be_ STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROLES ED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing.with Section 7000).of Division 3 of the Business OUTLETS OVER and Professions Cod ,and m 1' ase is in'fuII force and effect.' 5 PER SYSTEM FINA DAT bA I®t�V10N License Number Lic. Class ` FIN 0 Contractor Date B i ❑ P t3 I am'exem t under Sec. � B.BP.C. for this reason D • Platt check fee Date: !` _ .PLUMBING PERMIT ISSUING FEE$ V Signature TOTAL FEE S2 ' ';278,1.5A Plan check applicant SINGLE FAMILY #'o 0 0 0 0 5 HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempffrom the Contractor's License Address 1 0 0 1 6.5 0 Low for.the following reason (Section 7031:5', Business and Professions Code): City Tel.'No. •0 0 0 16.5 05 ❑ I, as owner of the property,, will do the work and the structure is not intended or offered for sale (Section o 9.0 1 `8 7 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 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-mentio d property for inspection purposes. e q-1—c5 7- SEE REVERSE FOR EXPLANATORY LANGUAGE I � Signature f Permittee 1•� Date / COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0910050003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: 1 ITR: 5904 LT: 237 1 6258 HART AV I (FEE DESCRIPTION_: QUANTITY: UOM: AMOUNT: ( TEMP CA 917801630 - (ASSESSOR INFORMATION NUMBER: 1 NEAREST CROSS STREET: 1 15384-009-009 101 PERMIT ISSUANCE FEE, 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl 147 WATER HEATER(S) 1.00 WTH 16.20 (TENANT: 151 LOW PRS GAS•5 OUTLET'. 1.00 SYS 16.20 (ISSUED ON: .PROCESSED BY: PLAN BY:- . EXPIRES ON: _ 1 - 163 WATER PIPING BR/FIX 21.00 FIX 141.75' 110/0S/09 SR 10/05/10 - 1 164 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 1 (OWNER: TEL. NO: I. TOTAL FEES 218.10 IFINAL DATE, FI AL BY: CODE: IQUACH JOHN K (626) 456-3060- 1 1 1 16258 HART AV I I 1 ITEMP 917801630 11 ID)ESCRIPTIO14 OF WORK I1 IRE-Pi PE 21 PLUMBING FIXTURES, WATER MAIN, WATER HEATER AND 1 ILINE GAS 1APPLICANT: TEL. NO: j 1 IMASTERSERV, INC. (818) 408-4100- _ 1560 LIBRARY ST. ISPECIAL CONDITIONS: ISAN FERNANDO 91340 1 I I I I I CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE 1 IMASTERSERV INC. (818) 408-4100- 1 1 1 1560 LIBRARY ST LIC. NO (UNDER SLAB WORK I I 1 ISAN FERNANDO, CA 91340 580017 C36 I I 1 1 I IWATER SERVIC I 1 I _ (PLASTIC YIN METAL /N I 1ARCHITECT OR ENGINEER: TEL NO: I - I 1 - (ROUGH PLUMBING �I 1 1 LIC. NO: I I }qr 1 I 1 IGAS PIPING 1 I IGAS VENT I I I I IHOT WATER HEATER j r I I (PLUMBING FIXTURES II I 1 I 1 ILAWN SPRINKLERS I I I 1 I IGAS TEST 1 1 I I I I 1 (UTILITY COMPANY NOTIFIED( 1 11 ICWV I 1 _ IGRAY.WATER SYSTEM I I 1 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 1 1 1 I I I I