HomeMy Public PortalAbout9061 HERMOSA DR_Plumbing__ TBABBT •CE^BIT 10-82
APPLICATION FOR PLU BING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER p
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, BUP'T DF BULLDING y
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER /Y
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
SHOWER1.25 CITY TEL. NO.
LAVATORY 125 CONTRACTOR �L K.,Q ., LC
SINK j,25 ADDRESS S�G/Z Y✓
DISHWASHER las CITY L"t-/(p �TEEL. NO.CONTRACTOWS
STATE
LAUNDRY TUB 1a5 REGISTRATION NO. /G.d ?I& COUNTY COUNTY p
CLOTHES WASHER 1,25 DISTRICT NO. GROUP ZONE PRO 5 D BY
WATER HEATER 1.50 "T
50 INDUSTRIAL y
GAS SYSTEM OUTLETS 1. WASTE APPROVAL C
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD V
O
H
V
W
a
N
Z
APPROVALS DATE INSPECTOR5 SIGNATURE `
PERMIT $ ` 00 UNDER"SLAB WORK
i ROUGH PLUMBING
TOTAL FEE
GAS PIPING
XEREBY ACKNOWLEDGE CI HAVE HEAD THIS APPLICATION
ANO IS STATE TMgT THE ABOVE 15 CORRECT AND AGREE TO PLY GAS VENT
WITH ALL COUNTY ORDINANCES AN STAT LAWS RE ATING
PLUMBING. HOT WATER HEATER
1 HEREBY CERTIFY AN ER REGIS T AND/OR PLUMBING FIXTURES
LICENSED AS REOUI LOS AI L COUNTY STATE OF
CALIFORNIA OR T THE ER OF, D INTEND TO GAS TEST
RESIDE IN, THEA SCRIBE SI IAL R ERTY. UTIL TY COIN OTFED
SIGNATUR
OF PER FINAL 111 Vw
�V�LI��,
DATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENG'R
- LAGo9 6 1 5G-, huG30 . _5 D- 3.25- v
t
WORKERS'COI have a TION DECLARATION CK
APPLICATION FOR PLUMBING .PERMIT
I hereby affirm that I have a' certificate of consent to self crc en (z-ao)
insure, or a certificate of Workers'Compensation Insurance,or / -
a certified copy thereof(Sec. 3800,Lab. C.)
COUNTY OF LOS ANGELES �/ BUILDING AND SAFETY
Policy No. Company -
Certified copy is here11 by furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING FEE ADDRESS /,�rQ`tq// �+ ,/L'fG�/ /j.- �J��MO SA
Certified copy E filed with the county building inspection NUMBER FIXTURE OR ITEM - OO q
-department. .
WATER CLOSET 0",-,22/6.- - - - - -- - - - LOCALITY- �" G
Date Applicant NEAREST
BATHTUB _ CROSS ST. -� E
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
/3 ti/ _3 to. JlrJ7//E,G
MAIL -
(This section need not be completed if the work involved LAVATORY. - ADDRESS L' E E�/'�lO�j'/,1' �/ d
by the permit is for one hundred dollars ($100) or less.) SINK
CITY EiY/�C'� �+/r TEL. NO..2,,7_ U
I certify that in the performance of the work-for which this DISHWASHER
permit'is issued. I shall not employ any person in any manner CON TRACTOR,4r.Qj,G' �i7E �iN� Gam' O
so as to become subject to thqe Workers'fompensation Laws. CLOTHES WASHER ADDRESS y F
Date��u.-yJ'Applicantf/r/�� YE Zn-ra - _ S// Gt T3EdE:¢G /SLev W
SWIMMING POOL RECEPTOR' CL
NOTICE TO APPLICANT: If, after making this Certificate of CITY /� / 6 TEL.NO. N
Exemption, you should become subject to the, Workers' LAWN SPRINKLER SYSTEM. STATE. / LIC. '/ z
Compensation provisions of the Labor Code, you must forth- LICENSE NO. 3��� / CLASS G '.r
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY
LICENSED CONTRACTORS DECLARATION - OUTLETS OVER - t5da
I hereby affirm that I am licensed under provisions of Chapter 5'PER SYSTEM
9 (commencing with Section 7000) of Division 3 of the Busi- - FINAL/ q VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect.
p'/ C FINAL /
License Number 3J 7// 7 Lic.Class G S BY
Contractor / •e- - Data
I am exempt from the licensing requirements as I am a Plan Check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE
acting in my professional' capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address 3s G(J• �Cr/G�< ,
License Law for the following reason (Section.7031.5, Busi- City -/]E./�O :Tel.
ness and Professions.Code): - 32 1.6 A
❑ I, as owner of the property, am exclusively contracting -
with licensed contractors to construct the projects ° s o o v
(Section 7044, Business and Professions Code). -
CONSTRUCTION LENDING AGENCY - Q e!°, G 0.0
I hereby affirm that there is a construction lending agency .° ° ° 1 0. 00 X0
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 SEE REVERSE FOR EXPLANATORY LANGUAGE -'
ordinances and State laws regulating Plumbing, and hereby -
authorize representatives of this County to enter upon the
above-me r ed proper y or'mspection purposes. _ -
. 2 G -3'u
TSi nature of Permittee Data
'COUNTY OF LOS ANGELES TEMPLE CITY 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1002220003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
)LEGAL ID: FEES PAIDBUILDING ADDRESS: 1
ITR: 5904 LT: 332 1 - 9061 HERMOSA DR I
I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ) TEMP CA 917801917
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOMA
( -
5384-015-030 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 'LOCALITY: TEMPLE CITY, CI
I11 CLOTHESWASHER(S) 1.00 FIX 16.20
TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
TOTAL FEES 60.15 102/22/10 SR 02/22/11
TOWNER: TEL. N0: JFINAL DATE FINAL BY: CODE:
IVINTHER WILLIAM H (928) 938-0540- // ���
19061 HERMOSA DR I'/�I/I�-!I
ITEMP 917801917 (DESCRIPTION OF WORK
IPLUMHING FOR KITCHEN REMODEL NEW 2" DARIN @ WASH MACHINE,
ISET FINISH PLUMBING FIXTURES
(APPLICANT: TEL NO: )
0WENS (626) 285-7725- I I
5924 N. RENO AVE. ISPECIAL CONDITIONS
1 :
TEMPLE CITY CA 91780
I I I
CONTRACTOR: TEL. NO: ))APPROVALS DATE INSPECTOR SIGNATURE
IRON OWENS (626) 285-7725-
15924 N. RENO AVENUE LIC. NO (UNDER SLAB WORK )
ITEMPLE CITY, CA 91780 276346 1 _
IWATER SERVICE
)PLASTIC YIN METAL YIN
(ARCHITECT OR ENGINEER; TEL. NO: ^
ROUGH PLUMBING v
LIC. N0:
IGAS PIPING
I I I
III )GAS VENT
HOT WATER HEATER
PLImm IMG FIXTURES
I I
I ILAWN SPRINKLERS
I II )GAS TEST I II I
(UTILITY COMPANY NOTIFIEDI I I
III CWV
GRAY WATER SYSTEM
I
I III I I III
I I I I I
I I I I I I
I I I I VIII III
I I II II I I
REPORT ID: DPR263 ROUTE TO: BS0508
I I I I I I
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