HomeMy Public PortalAbout9073 HERMOSA DR_Plumbing__ DEPARTMENT OF COUNTY ENGINEER PLUMBING 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
_ Q
WILLIAM J. FOX, COUNTY ENGINEER RBUILDINGDROESS
WR APPLICAN TO FILL IN LOCALITY L' t
BUILDING YD J / NEAREST
ST r '
ADDRESS L"��1DI14 CftOISTRI
�.�. DISTRICT NO. GROUP ZONE PERMIT NO.
LOCALITY cM,oL e Cy L'I"L, ---
NEAREST
CROSS ST. �/�L � � �}`1tECEIVED BY Ready for Inspection DATE ISSUED
OWNER J L'G " =m � �/)j /
"Al L ^^ (( �� �J INDUSTRIAU /
ADDRESS vJ(./ 7 3 C"i lif' lC_P"Lp S/t- WASTE APPROVAL
CITY T t TEL.NO. /y INSPECTION RECORD
PLUMBER `1 f..{,O t i "
ADDRESS //t n 1W,
CITY if TEL.N0. V!/
� E
LICENSE NO. SOUNTY J
(((PERMIT FEES a
z
V1:1rPER TYPE OF FIXTURE OR ITEM FEE 33
WATER CLOSET(TOILET) @ 0.80 $ O
BATHTUB @ 0.80
SHOWER @ 0.80
LAVATORY (WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB ORTRAY @ 0.80.
SLOPSINK @ 0.80
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GASSYSTEM............OUTLETS @ 1.00
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-, GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE, HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED .
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GASTEST
AND STATE OF CALIFORNIA OR THAT�,1 AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RE f0 NTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE P
OF PERMITTEE..._:._ ... ... .. ........._..._..t{ .........__.......... FINAL
76A667 ORS 17 8, V
WORKER'S COMPENSATION DECLARATION 0-0026 76A66A 93a9 APPLICATION FOR PLUMBING PERMIT
1 Hereby Lifiimat thI have a certificate of consent to self insure, � -
or alcedificate of Worker's Compensation Insurance, or a certified
copy thereof(Sec.3800 Lab. C.) i - -
' COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No. Company
❑ Certified copy is hereby furnished.
F-1FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 9 0 ` O �
Certified copy is filed with the county building inspection ADDRESS 1✓
department - NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Dale Applicant j WATER CLOSET �S NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' ♦ BATH TUB bS CROSS ST. '
COMPENSATION INSURANCE I _ ASSESSOR
(This section need not he completed if the work involved by the
SHOWER r MAPBOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) �� 1 OWNER
I certify that in the performance of the work for which this permit LAVATORY - p A
issuMAIL
ed, I shall not employ any person in any manner so as to SINK / ADDRESS r-G,r2MO5Dix
become subject to the Workers' Compensation Laws. - -
DISWASHER CITU`�^n LG �t�, TEL.NO.
� - L,
Oale G J pplicanf ��+ CLOTHES WASHER CONTRACTOR
qq
NOTICE AP AP (CANT: If, after mak' this Certificate of O� oa- 6RL
Ex¢mptidfi,you s uld become subject to the Workers'.Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS /bi.-WA
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.NO. }
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER - 11
(commencing with Section 7000) of Division 3 of the'Business and STATE LIC. 0
/ GAS SYSTEM ! OUTLETS /�. 5� LICENSE NO. CLASS V
Professions Code,and my license is in full force and effect. J DISTRICT NO. O SSED BY OUTLETS OVER Q
5 PER SYSTEM r O ! 0
License Number Lic.Class v
FINAL L.i V I ATION a
DATE
Contractor Date y
❑ FINAL Z
I am exempt.under Sec. BY _
BAP.C.for this reason `_�'hi ;1,.=r_�_
Plan check fee ► •=�
Date:
PLUMBING PERMIT ISSUING FEE$ 24
Signature 5- _„
TOTAL FEE c7 f l!l HL u�-_ '
Plan check applicant i7=•art --_
SINGLE FAMILY ¢
HOMEOWNER-BUILDER DECLARATION Name - =iIMl`l
I hereby affirm that I am exempt from the Contractor's License Law
for
the following reason (Section 7031.5, Business and Professions Address
-;
City Tel. No.
I,as owner of the property, will do the work and thestrucNre n
is not intended or offered for sale (Section 7044, Business 4�_rT) 51'`_r.4
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 ordinances
and State laws regulating Plumbing, and hereby authorize - - -
/epresentatives of this County to enter upon the above-mentioned
v/proper y r ms ecti purpos s. I SEE REVERSE FOR EXPLANATORY LANGUAGE
i
"1,61gnature I e mittee ate _ -
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0909210006
BUILDING AND SAFETY f LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: I FEES PAID BUILDING ADDRESS:
ITR: 5904 LT: 334 1 9073 HERMOSA DR
I FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917801917
IASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET: HART
15384-015-032 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
107 BATHTUBS/SHOWERS 1.00 FIX 16.20 1 I
TENANT: 113 DISHWASHER(S) 1.00 FIX 16.20 JISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I
I 125 LAVATORIES/SINKS 2.00 FIX 32.40 109/21/09 SR 09/21/10 1
1 145 WATER CLOSET/URINAL 1.00 FIX 16.20 1
IOWNER: TEL. NO 147 WATER HEATER(S) 1.00 NTH 16.20 FINAL DATE FINAL BY: CODE:
I THAN, TAM T (626) 602-6118- 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 1\ (���0� G
19073 HERMOSA DR TOTAL FEES 141.15 V/ly �l I{
ITEMP 917801917 D SCRIPTION OF WORK
PLUMBING FOR KITCHEN, BATHROOM REMODEL, GAS LINE AND REPLACE(
(WATER HEATER I
1APPLI CANT: TEL. NO: I I
ISAME AS OWNER - I
I (SPECIAL CONDITIONS:
I I
I I
CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
I SAME AS OWNER - I I I
I LIC. NO I (UNDER SLAB WORK I I I
I I IWATER SERVICE I I I
I _ (PLASTIC Y/N METAL Y/N I I I
ARCHITECT OR ENGINEER: TEL. NO: 1 11 1
IROUGH PLUMBING
LIC. N0: I
GAS PIPING
I (
GAS VENT
I I I
IHOT WATER HEATER
IPL DMHING FIXTURES
ILAWN SPRINKLERS
I
I IGAS TEST I I I
(UTILITY COMPANY NOTIFIED(
Gwv
(GRAY WATER SYSTEM
I I I I 11 I
I I I
I 11 I 11 I 11
I I I I I I
I I I I I I
I I I
I 111 II II I I
(REPORT ID: DPR263 ROUTE TO: HS0508 I I 1 I
I