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HomeMy Public PortalAbout5937 IVAR AVE_Plumbing__ 76A667A(CE'8178)- 1 APPLICATION ® 1/76 ® C 9 LI AT'I®ISI 9®0 PLUMBING ■ ERMIT n BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / NUMBER FIXTURE OR ITEM @ FEE ADDRESS 5 3 ? �`�• L9 WATER CLOSET LOCALITY �� ` Cip10 BATH TUB NEAREST CROSS ST. LD L�r-4 SHOWER OWNER— Afh ^tvA LAVATORY ©-v ADDRESS MAIL - s ®X* SINK CITY �L�C�® TEL.NO. DISHWASHER CONTRACTOR CLOTHES WASHER lg� q ADDRESS P Ti SWIMMING POOL RECEPTOR CITY los op TEL.NO. 46 LAWN SPRINKLER SYSTEM STATEO� LIC. WATER HEATER �j LICENSE NO. f� ® CLASS GAS SYSTEM OUTLETS DISTRICT NO. GROUP ZS]N PR SSED BY `� C5 OUTLETS OVER U v T 5 PER SYSTEM INDUSTRIAL 911. WASTE APPROVAL INSPEOION RECORD u 09 p� �J9 Plan check fee PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Name UNDER SLAB WORK r' Address ROUGH PLUMBING p Cl City Tel.No. 9�®' '9� GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED A,y PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM yRE GAS TEST LEGAL OWNER OF.AND INTEND TO E IN BOVE DESCRIBED RESIDE IAL PROPERTY. UTILITY CO.NOTIFIED SIGNA E Af OF PERMITTEE NAL � '�-��� � PLAN CHECK VALIDATION CK. M.O. ASH PERMIT VALI ATIOI� M.O. CASH ©s WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I hare,a certificate of consent to self 76A667A insure, or a certif5cate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified'copy"therebf (Sec. 3800,,Lab. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Sol —S9 ❑ Certified copy is hereby furnished. F1Certified FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- FIXTURE OR ITEM ADDRESS tion department. FEE LOCALITY WATER CLOSET �) L Date Applicant No� NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER(This section need not be completed if the work involved by MAILthe permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS ` V V1 I certify thot.in the performance of the work for which this permit is issued, I shall not employ any person in any n_ er SINK CIT ZW L. NO. so as to become subject to the Workers' mpensai' DISHWASHER � _ / 'n�/ � CONTRACTOR LV Dated vAaplicanI CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, aft making this CerMki, 'if' SWIMMING POOL RECEPTOR Z. Exemption, you should become subject to the o rs' CITY e TEL. NO. Compensation provisions of the Labor Code, you us rth- LAWN SPRINKLER SYSTEM �a J with comply with such provisions or this per it all be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. L �O Z CLASS LICENSED CONTRACTORS DECLARATION DISTRI `r , P50CEOED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDAT N DATE 0 p� License Number Lic. Class Q FIN U. Date BY Contractor ❑ I am exempt under Sec. U B.BP.C. for this reason LU Plan check fee N, Dote: PLUMBING PERMIT ISSUING FEE$ ( Z Signature o TOTAL FEE SINGLE FAMILY Plan check applicant i Itx v HOME OWNER-BUILDER DECLARATION Name 2 I hereby affirm that I 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 , 7044, 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.). 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 reg ating Plumbing, and hereby outhori repres tiv of s County to enter upon the -mention rop r inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature o Permit Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV.8/86) or a certified copy thereof �(S/ec./3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Policy N6/—L1�C6 >>t� Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ,) o I Certifi d copy is filed with the county building insp ADDRESS /�o, [VAR - T, d part X/eni. NUMBER FIXTURE OR ITEM @ FEE LOCALITY C "T Date , V A p p I i. WATER CLOSET NEAREST r ERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Li e4/W 6 .3 A COMPENSATION INSURANCE SHOWER OWNER. I ► �y A (This section need not be completed if the work involved by the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS 04 e I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR �t �� � A t�j Date Applicant CLOTHES WASHER ADDRESS Zttp COD"ff. U� NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR P P Y LAWN SPRINKLER SYSTEM CITY TEL. NO. C� Compensation provisions of the Labor Code, you must forth- � �� ��®�1 1� with comply with such provisions or this permit shall be STATE1 -37 $ Lic. 1Q 1 deemed revoked. WATER HEATER LICENSE NO. ( � LASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. _i PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (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 SYSTEM FINA DAT (�ALIDATION License Number �� Lic. Class / FIN Contractor d4wJ1�-Date `L � B ❑ ZY I am exempt under Sec. B.BP.C. for this reason ® g Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant ;26853A SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name ,# o 0 o o a 5 1 hereby affirm that I am exempt from the Contractor's License Address o o 5 Law for.the following reason (Section 7031.5,.Business and Professions Code): City Tel. No. o o o 1 &5 O ❑ I, as owner of the property,. will do the work and the structure is not intended or offered.for sale (Section ® [� 4?-8 7 7044, 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.). 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 representatives o4 this County to enter upon the o entioned rope or inspection put ses. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee a COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 9912010011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 115 5937 IVAR AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801520 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HERMOSA 5386-011-059 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 ' LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 TENANT: 25 LAVATORIES/SINKS 2.00 FIX 32.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 12/01/99 UT 05/29/00 TOTAL FEES 108.75 OWNER: TEL. NO: FINAL DATE FI L Y: CODE: TANDYA MADE;MAYLIE (818) 286-1654- 5937 IVAR AV TEMP 917801520 DESCRIPTION OF WORK PLUMBING FOR REMODELING USING REHAB APPLICANT: TEL. NO: HUNT INTERIORS, INC. (626) 285-8439- 1100 S. SAN GABRIEL ___-_ SPECIAL CONDITIONS: SAN GABRIEL, CA (CC) CONTRACTOR: TEL. NO: ®� ����� APPROVALS DATE INSPECTOR SIGNATURE HUNT INTERIORS, INC. (626) 285-8439- 1100 S. SAN GABRIEL BLVD. LIC. NO UNDER SLAB WORK SAN GABRIEL, CA 91776 656524B WATER SERVICE PLASTIC Y/N METAL Y/N ARCHI?ECT OR ENGINEER: ?EL. N0: , _�. . LIC. N / ROUGH PLUMBING V'� �2 �'I 111 l;ll GAS VENTNG UGAS UL'ogL C W 0 S HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS O O 'f. GAS TEST UTILITY COMPANY NOTIFIED ( CWV GRAY WATER SY TEM REPORT ID: DPR263 ROUTE TO: BS0508