HomeMy Public PortalAbout5005 HELEO AVE_Plumbing__ .76A667.CEAB, ;0.6
. APPLICATION` FOR 'PLUMBIN.G PERMIT -
COUNTY' OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER _
BUILDINGtSAFETYAND AFETY DIVISION Buanrnc O 0 S
JOHN A. TY ENGINEER. ADDRESWILLIAMT OF BUILDINGLOCALITY
FOR FILL-IN - - NEAREST' CROSSST.NUMBER FIXEACH FEEOWNER L (/�WATER CL $1.25 O MAILBATH.7TUB1125 ADDRESS
- CITY TEL'. NO.
SHOWER 1.25.
ool
LAVATORY 1125. -[1 CONTRACT
/ ADDRESS
SINK 1.25.
DISHWASHER '.1.25.. - CITY TEL. N `� Q. ' -
LAUNDRY TUB j;yg' CONTIIACiOR'S STATE- ❑
REGISTAAiION'NO. COUNTY ❑
CLOTHES WASHER ;1:25 " DISTRICT NO.QQ GROUP ZONE P OCBY
WATER HEATER X1.50
1.50 INDUS
WASTE APPROVAL GAS SYSTEMOUTLETS O
E APPROVAL-
OUTLETBOVER PER SYSTEM .00 q-I INSPECTION
RECORD, A � /I u
jo
z
APPROVALS DATE INSPEC"TON'S SrcjMn&C
PERMIT' $� .2. ,OO UNDER SLAB,WORK' R/el '
ROUGH.PLUMBINGW
• TOTAL FEE. � I -
S GAS PIPING ' � V •/
I HEREBY ACKNOWLEDGE THAT 1•HAVE- READ'THIS APPLICATION GAS VENT
AND-STATE THAT-THE 'ABOVE 15 CORRECT AND AGREEITO COMPLY
WITH ALL COUNTY ORDINANCES AND 'STATE LAWS REGULATING HOT WATER HEATER /
PLUMBING. ..
1 HEREBY',CERIIFY' THAT 1 AM PROPERLY REGISTERED AND/OR - PLUMBING FIXT U RES,_' / '
'LICENSED AS REQUIRED ISY CLOS ANGELES COUNTY AND,STATE OF /,.
-CALIFORNIA.OR THAT I AM THEI,CEGAL OWNER'.OF,ANO"INTEND TO GAS TEST _r ,.
RESIDE IN:THE'ABOVE'-DESCRIBED RESIOENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE,
- OF',PERMITTE FINAL afNv
ALIDATIO_ N ROBERT A. WOOD
cK_ M.o.•' cA.H3 SUPERVISING MECHANICAL ENG'.R
0.0'6,UG' JUL2 ' �.
LtCo b V- 1 S.Q.
fRKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I here ffrm that I have a certificate of consent to self 76A667A
inswP, or o certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) Clty Of Temple Cit
or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES Y BUILDING AND SAFETY
Policy No. 201916 Company SCIF 02481
Certified copy d
is hereby furnished.. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy is filed with the county building inspec- ADDRESS 5005 No. HeleD AVE.
lion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date 4-1 -86 Appliq,mronng-ral Tectal 1 . WATER CLOSET Tem le Cit
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS" BATHTUB CROSS ST. Encinita
COMPENSATION INSURANCE OWNER
(This section need not be completed if the work involved by SHOWER Robert C. Lutes
the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL
I certify that in the performance of the work for which this ADDRESS same
permit is issued, I shall not employ any person in any manner '}r CITY TEL N0.286-3814
so as to become subject to the Workers'Compensation Laws. DIS HER
CONTRACTcdeneral Installation CO.
Date Applicant CLOTHES MT ER
NOTICE TO APPLICANT: If, after making this Certificate of — ADDRESS 6558 West Blvd.
Exemption, you should become subject to the Workers' SWIMMING ,ECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL NO.
LAWN SPRINKLER M OS Angeles 753-2541
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. 1 WATER HEATER .O 6.00 LICENSE NO. S 3 CLASS C36
LICENSED CONTRACTORS DECLARATION DISTRICT NO. FR ESSED BY
I hereby affirm shot I am licensed under provisions of Chapter 9 GAS SYSTEM Jj4TS c�L/
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �" >
and Professions Code,and my license is in full force and effect. 5 PER SYSTEML VALID TION O
FINA
License Number 151839 Lic. Class C36 DATE i V
FINAL 11. 91..3. r m
W. O. Provin 4-55 {jP
Contractor Date BY y 0 ® 1 an,.,.i ' W
❑ I am exempt under Sec. O Q23-8
J y
N
B.BP.C. for this reason Plan check fee ► Z
Date: PLUMBING PERMIT ISSUING FEE$ 10 .50
Signature
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that 1 am exempt from the Contractor's License Address
Law for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No.
❑ I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section Poo.
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.).
i
Lender's Name
Lender's Address
I certify thol I have read this application and state that the '►
above information is correct. I agree to comply with all County
ordinances and Slate laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above- en 'oned p p rty for inspection purposes
ZC57 SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Per tree Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS iP-L-0508-00087400.131
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDDING AADDDgESS-
TR: 13329 LT: 5 BL: .001 UN: .002 50050 LAV_
::�2
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CA-917803825
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA
8590-023-025 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY
21 HOSE BIBB(S) 2.00 FIX 32.40
TENANT: 27 PRESS REG DEVICE(S) 1.00 DEV 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
47 WATER HEATER(S) 1.00 WTH 16.20 08/14/00 UT 02/11/01
63 WATER PIPING BR/FIX 10.00 FIX 67.50
OWNER: TEL. NO: TOTAL FEES 160.05 FINAL DATE FINAL BY: COD
LUTES ROBERT C;JUDITH A TRS (626) 286-3814- ? /
5005 HELEO AV -/S`f
TEMP 917803825 DESCRIPTION OF WORK
REPIPING, MAIN LINE AND WATER HEATE
APPLICANT: TEL. NO:
HENRIK PLUMBING (323) 258-5858-
4062 VERDUGO RD. SPECIAL CONDITIONS:
LOS ANGELES, CA
Pt4GELES CO
CONTRACTOR: TEL. NO: OS �/�/ APPROVALS DATE INSPECTOR SIGNATURE
HENRIK PLUMBING (323) 258-5858-
4062 VERDUGO ROAD LIC. NO UNDER SLAB WORK
LOS ANGELES 91006 741020 C36
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLUMBING
LIC. N0: 1111111
GAS PIPING
I�1� ��� ���1�//n GAS VENT
11 it O L�� �1II VI II (DRO'11\\ 8) HOT WATER HEATER
�/� L� 1J l/ lJ l!LLII U PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
Service Tha
GRAY WATER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR263 ROUTE TO: BS0508