HomeMy Public PortalAbout5414 HILTON AVE_Plumbing__ 7GA669 098 IT 7-51 APPLICATION FOR PERMIT
IIEPA -COUNTY
OF BUILDING 'AND SAFETY
O
UNTY F LOS ANGELES
WILLIAM J. FOX. CHIEF ENGINEER
FOR APPLICANT TO FILL IN CI ��, G PERMIT O.
✓ / 7 `�
PLUMBER (�' `y. ; �_Qji RECEIVED BY READY FOR DATE.{SSUED
C ` ,^ L1ti FIRST INSPECTION
ADDRESS G"I e �h0 CyY/G4— �(/
DD RU'LDIN
L AD
/ I Or
CITY L-L.a TEND. - �//� •
CESS
OUNTY LOCALITY ri C I��!PLc i
NSE NO. EXPIRES
NEAREST �
PERMIT FEES cRpas ST. y
NUMBER TTP[OF FIXTURE OR ITEM FEE OWNER $ L�i1J l.iO1✓a / 1
a� MAIL
Y'-
WATER CLOSET(TOILET) 0 0.50 § p(7 ADDRESS d ✓ / �.,, ✓iD'
BATH TUB @ 0.50 C}
CITY 04LTEL. NO. L" j
SHOWER Q 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) 0 0.50 QO E ABOVE IS CORRECT
ANDLICATION AND AGREE TO COMPATE A LY WITH ALL H COUNTY ORDINANCES
KITCHEN BINK ® 0.50 AND STATE LAWS REGULATING PLUMBIND.
'I CERTIFY THAT I POSSESS THE ABOVE VALID LOB
LAUNDRY TUB OR TRAY a 0.5D ANGELES COUNTY LICENSE, OR 1 AM T LEGAL OWNER
GAB SYSTEM UTLETB @ 0.50 •—.0 SI THE RESIDENTIAL pjtpP Y DES
IBED ABOVE.
E� SIGNATURE OF mf
WATER HEATER a 0.50 y (� pERMITT[F ��
SLOP SINK o.sD INSPECTION RECORD
'--�- FLOOR BINK 0.90 a
-� FLOOR DRAIN U.50 y/'`)
(DISHWASHER ® 0.50 �,W � ��aff l-/�r/k/AJ � wq,/ ^✓
DRINKING FOUNTAIN ® 0.50 4A'L!I pe Lro �4%! fV/
URINAL Q 0.50
Q
HOUSE SEWER a 0.90 �y Zai"'(_;. _Z
MISCELLANEOUS
rP ..w
L ,A-z
APPROVALS
m5 E INSPECTOR'9 NAME
ROUGH PLUMBING / . .6"�•�Z
V
DAB PIPING
GAB VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT .
1.00 t SAH TEST e� .+ hPh'-I.,
UTILITY CO. NOTIFIED
TOTAL FEE
$
Q
,/ FINAL
WORKER'S COMPENSATION DECLARATION 20.0026 DPW 9/69 APPLICATION FOR PLUMBING PERMIT ll
A
I hereby affirm that 1-have a certificate-of Consent6A667
to self insure,� �,.
or a certificate of Worker's Compensation Insurance, or a Certifibd
copy thereof(Sec.3800 Lab. C.)
Policy No. 10-048960%ompany CNA Insuran Co. COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
❑ Certified copy is hereby furnished.® BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 54 14 Hilton
Certified copy is f7NSATION
the county building inspection
department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Temple City
Dale 9-5-90antOwen Bros Plumbing, Tic. , WATER CLOSET NEAREST
CERTIFICATEMPTION FROM WORKERS' 5�,(PCROSS ST.
COM INSURANCE BATH TUB :�J ASSESSOR
(This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.) 7 OWNER PAT MURRAY
I certify that in the performance of the work,for which this permit LAVATORY
is issuetl. I shall not employ any person in any manner so as'toSINK ADDRESS 3603 N. Rio Hondo MAIL
become subject to the Workers' Co a $a� aws.
DISWASHER CITY Rosemead CA TEL.NO.443-1
579
NOTICE TO APPLICANT: U, after making this ertificate of CLOTHES WASHER CONTRACTOR OWEN BROS PLUMBING, INC.
Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS 4265 N. Baldwin Ave.
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITY TEL.N0.
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER El Monte CA 443-0078 IL
(commencing with Section 7000) of Division 3 of the Business and STATE LIC. O
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. 23 1—74 1 CLASS C36-20-, 16 U
OUTLETS OVER7 DISTRICT NO. S PR gESSEO BY Cc
5 PER SYSTEM O /y7 �
,cense Number 231-741 Lia Class C36-20- 16
FINAL y, VALIDATION a
DATE
on
tractor Owen bros Plumboate 9-5-90 W
❑ I am exempt under Sea FINAL Z
BV
BAP.C.for this reason i
Dete
Plan check fee ,
PLUMBING PERMIT ISSUING FEE$
Signature
❑ T 94-1
OTAL FEE
SINGLE FAMILY
Plan check applicant c
� .
HOME OWNER-BUILDER DECLARATION Name r�
I hereby affirm that I am exempt from the Contractor's License Law _ _ - Flt:I .%
for the following reason (Section 7031.5, Business and Professions Address 75.5 l-
Cade):
❑ City Tel. No.
1,as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, Business TA & 35 - 50
!:HEC
and Professions Code). ,
CHECK
-�c�..ic
1.',. ce!
CONSTRUCTION LENDING AGENCY _
I hereby affirm that there is a construction lending agency for the f,N2NuE ,1!
performance of the work for which this permit is issued (Sec. 3097.
Civ.C.)
. i lfli lI_I—I 1[h!I i t'it�'1 7/1
'?" l
Lender's Name `170—1 f HI 9:14
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
representatives of this County to enter upon the above=mentioned
property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1306100016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 17387 LT: 13 5414 HILTON AV
I IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803122
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
18588-029-005 101 PERMIT ISSUANCE FEE 2').80 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI
113 DISHWASHER(S) 1.00 FIX 16.20
(TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 11SSUED ON: PROCESSED BY: PLAN BY:
TOTAL FEES 60.20 106/10/13 SR
OWNER: TEL. N0: FI £I,///���DATE FINAL BY: CODE:
PARKS, RONALD/JUDITH (626) 826-3594- " -1 A� �(^C�
15414 HILTON AV -q - �J
ITEMP 917803122 (DESCRIPTION OF WORK
REPLACE DISHWASHER AND KITCHEN SINK
(APPLICANT: TEL. N0:
ICASTRO, RICK (714) 980-0349-
122632 GOLDEN SPRINGS I (SPECIAL CONDITIONS:
DIAMOND BAR CA 91765
I
CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
(ALLIED RESTORATION SERVICES (714) 980-0349- 1 1
122632 GOLDEN SPRINGS DRIVE LIC- NO I (UNDER SLAB WORK
DIAMOND BAR CA 91765 908870 1 1 11
IWATER SERVICE
IPLASTIC Y/N METAL Y/N
IARCHITECT OR ENGINEER: TEL. NO:
I EARL AMMERMAN (951) 352-3588- 1 (ROUGH PLUMBING 1
19980 INDIANA ST #3 LIC. NO: 1 1 1
IRIVERSIOE CA 92503 NONE I IGAS PIPING
I I I I�I I
IGAS VENT
1 11
I IHOT WATER HEATER
1 1
I IPLUMBING FIXTURES
11
LAWN SPRINKLERS
GAS TEST
I I I
I I (UTILITY COMPANY NOTIFIED( I
I I
CWV
I 1GRAY WATER SYSTEM 1 I I
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1REPORT ID: DPR263 ROUTE T0: 850508 1 1 1 1
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