HomeMy Public PortalAbout9118 HERMOSA DR_Plumbing__ 76AG67C (CE-61913) -9/]S
APPLICATION FOR PLUMBING PERMIT
BUILD AND SAFETY DIVISION
FWATER
LICANT TO FILL IN (PRINT OR TV PEI BUILDING
FIXTURE OR ITEM C FEE ADDRESS
CLOSET LOCALITY
NEAREST
UB CROSS ST.
R OWNER
ORY MAIL
ADDRESS
CITY TE . NO.
ASHER CONTRAC
ES WASHER
ADDRESS
ING POOL RECEPTOR
SPRINKLER SYSTEM
ATE LIC p /
HEATER LICENSE NO. 4 CLASSL. fC� y
GAS SYSTEM OUTLETS DISTRICT N I GROUP 3I RO ESS B
OUTLETS OVER --6�
5 PER SYSTEM INDUSTRIAL C
WASTE APPROVAL U
W
d
INSPECTION RECORD H
2
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
Plan check applicant
Name APPROVALS DATE Ivs vGC Toms sIGU ATV Rc
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel. NO. GAS PIPING
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION OAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT NATER HEATER
PLUMBING.
'HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REOU I RED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND (NTE TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL ERTY, UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE % FINAL
PLAN CHECK VALIDATION CK. M.D. cash PERMIT VALIDATION Cx. M.O. CASH
81 2�nCT 2U 5 1) 7_5Q ayb
WORKERS `oMPE"SAT'°" DECLARATION
4APPLICATION -'FOR -.PLUMBIN�G. .PERMIT
I hereby, affnm.tAat have p.cerhficate of consent to self in 6AO6,DPW,4/67 A _ T
sure,or a certificateof Workers'Compensation InsuronsiO, ora CE 817(REV 8/86)' . ' '" • ,: -
certified capy: ereof
th (Sec.'3800 Lab C:):
- - COUNTY OF LOS ANGELES DEPT. OF-PUBLIC-WORKS _
Policy Na. '' Company. - o .
Certified copy Is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
�. Cepor6re M
opy Is filed with the county building inspection _ ADDRESS O
NUMBER FIXTURE OR ITEM .'FEE
- deportment � � @ ' i^ 'LOCALITY
Date - `Applicant - Z WATER CLOSET(TOILET)
NEAREST - to
.. CROSS.ST. - �•
-
CERTIFICATE OF EXEMPTION FROMWORKBATH l/ - -
' -COMPENSATION INSURANCE - OWNER
SHOWER - iv
s(This-section need not be completed Wthe work involved by
the permit is fortune hundred d5lldrs•(5100)or less.) �i LAVATORY - - gDORE55 •—/, ��� I,
-I certify that m'the performance of the work for which this p- SINK' v CITY'' / - TEL: NO: I
mit is Issued, shall not employ any person io any,manner so - O -
as'td became subject to the Workers Com pe nsatidn'Laws. DISHWASHER - -
- _ - CONTRACTSR -
Date Applicant - . - .CLOTHES WASHER -
_ ADDRESS _
NOTICE TO APPLICANT If,:after making this Cerhficcte of E:- SWIMMING POOL RECEPTOR , -
emption;you should become subject toihe,Workers:Compen- CITY - TEL NO
.. .. _ , -
lotion p such
p 6i of fits Labor Code, yau'm use forthwith comp- - - - LAWN`SPR I NK LER'SYSTEM '
ly with such pro'v isions or.this permit shall be deemed revok- 'STATE LIC.
ed. ° - - WATER.HEATER _ LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION - DT
Feieby affirmtth6t om licensed under prpJislons of Chapter.
' GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Dlvisiorr.3bf theBusiness OUTLETS OVER S - "r 'f
and Profess ions_,Code,.and my license is in.full force and ef,- 5 PER SYSTEM' s. FINAL VALIDATION'S - >
,fect. : - ! - DATE 6
License Number• Lic Class - - •'O
FINAL U
2
Contractor Date - BY N ill IV/ O
O, itam eaempl under,Sec'. " Lij
' e 8P c-for this reason • ' ; Plan check fee - • , - z.
Date: t PLUMBING PERMITISSUINGFEE 8'
:'SlgnatuPe,r
SINGLE FAMILY -
p HOME OWNER-BUILDER.DECLARATION Plan check-applicant
,hereby aff1ltn-tFiGil am'exem pt from The Contractors License Nome
Law for the following reason (Section 7031.5, Business and _ •^ - �r`�'r',�r
Professions Code): .^ ' - Address - '- - -
3.3•,07 - 4G:SCt
I; as owner of the property, will do the work and the City Tel. Ni . 1 ITEMS
L stru2tu re-is not intended of offered for'sale(Section 7044
uvness '
y Band Professions Code). , TOTAL - 50
CONSTRUCTION LENDING AGENCY _ - - T 'CHECK ' ' ''40.1!3
1,hereby,offirm.that there,is a construction lending.agency for - _, _ ,.. _ - -_ _
the CHANGEperformance of the work for which this pe,,I issued -
(Sec.3D97, Civ. G').
Lender's Name -••° :i. ?. ._ ] - 0-13001 111 3/19
,. . . . . ��
Lencier's.Address ' . _ - . - - - 6.555 v_1 -AMIG-
'I-certify that I'hove read this application and state that the - -
'above information is correct: I agree to comply with,all County
ordinances and`State'IGws regulating Plumbing,'card hereby ' - r •y '- •
authorize representatives of this County to enter;upon the - -
above menti ed YA ertyfor inspection purposes.
r SEE REVERSE F0R'EXPLANATORY LANGUAGE
. S, a re of Permittee Date,' _ - - ✓- e
COUNTY OF LOS ANGELES TEMPLE CITY #'0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS9701 LAS TUNAS PL 0508 0501190003
BUILDING AND SAFETY / LAND DEVELOPMENT , TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 5905 LT: 85 9118 HERMOSA DR
FEE DESCRIPTION: - QUANTITY: UOM: AMOUNT: _ TEMP CA 917801918
ASSESSOR INFORMATION BER: '-' - NEAREST CROSS STREET: COMA
5387-016-031 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C
25 LAVATORIES/SINKS 1.00 FIX 16.20-
TENANT: 92 NO PERMIT OWNER-BLDR 128.50 DOL 128.50 ISSUED ON: PROCESSED BY: PLAN BY: EXPI ES ON:
TOTAL FEES 172.45 01/19/05 JK 07/18/05
OWNER: TEL. N0: FINAL DAT IBY: CODE:
OSHEN,WNER PATRICIA (626)757-5336-
9118 HERMOSA DR
TEMP 917801918 DESCRIPTION OF WORK
CHANGE KITCHEN SINK.
APPLICANT: L. NO:
SAME AS OWNER
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLUMBING
LIC. NO:
GAS PIPING
GAS VENT
OT WATER HEATER
PLUFB-l-N-GFlTT-dR-rS--
LAWN SPRINKLERS -
GAS TEST
UrILFTY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508