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HomeMy Public PortalAbout6027 IVAR AVE_Plumbing__ 4'76A667 - CE8i7 5/70 APPLICATION FOR PLU BWG _ RMIT . COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING. SS JOHN A. LAMBIE. COUNTY-ENGINEER COLEMAN W. JENKINS SUPT OF BUILDING' LOCALITY FOR APPLICANT TO FILL IN (PR NT OR TYPE) a NEAREST CROSS Sr. /G I01/ NUMBER FIXTURE OR ITEM EACH' FEE OWNER ' WATER CLOSET 1.50 .'MAIL BATHTUB 1.50 ADDRESS- SHOWER 1.50 DDRESS'SHOWER1.50 CITY '� ��.�_�. %7�. L. NO. LAVATORY 1.50 CONTRACTOR ��if �, Q,z V S SINK 1.50 ADDRESS DISHWASHER 1.50 _ CITY >"0511- � 7 TEL. NO. CLOTHES WASHER 1.50STATE 2 /ry''- _ CLIC LASS LICENSE NO. !� SWIMMING POOL RECEPTOR 1.50 - - - - DISTRICT NO GROUP �ZNE < PRO SED BY LAWN SPRINKLER SYSTEM 2.00 S'c� WATER HEATER 1.50 °. INDUSTRIAL - WASTE APPROVAL GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD OUTLETS OVER ,30 5 PER SYSTEM N Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 9 2y 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant - UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING' GAS VENT City, Tel. No. HOT WATER HEATER 1 HEREBY,_ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION- AND STATE THAT THE ABOVE IS-CORRECT AND AGREE TO COMPLY „,� PLUMBING FIXTURES WITH ALL' COUNTY-ORDINANCES. AND STATE LAWS REGULATING GAS TEST PLUMBING. ' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF _ CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO d� y RESIDE IN,THE ABOVE SetfRIB7EBIDENTIAL PROP Y. FINAL ��/� SIGNATURE .TACK R. ALLEN, SU PER V.ISING ANICAL ENG-R. OF PERMITTEE - -.,,�,_, - - PEfltMIT VALIDATflOIV CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH f2 3 5 D 4,7 5 . WORKERS' COMPENSATION DECLARATION AP P UCAYDON POP P LUlIVLIIRING PERAUT affirm that I have a certificate of consent to self 76A667A - - insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY , Policy No.; Company ❑ Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGADDRESS r 61 Certified copy-is filed with the county building inspec- �% o� tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET f 1 Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE OWNER - ' (This section need not be completed if the work involved by SHOWER MAIL /! the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued,,)shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to.the Workers' m emotion Laws. DISHWASHER `A/) CONTRACTOR Date 1 A Iicant • CLOTHES WASHER NOTICE TO APPLICANT: f after making this Certificate o/' ADbRESS > 12� Exemption, you. should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the LaborCITY TEL. NO �� Code, you must forth- SPRINKLER SYSTEM -�/� � ' LAWN with comply with such provisions or this permit shall be .STA E LIC. / �/ deemed revoked. WATER HEATER LICENSE NO.. CLASS[/ (— LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED Y I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS S (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER `� t >_ and,Professions Code;and my license is in full force and effect. 5 PER SYSTEM FINALa- DATEf / J^ VALID ION O License Number Lic. Class �+�' l' BY A f,4 Contractor Dote � LAI I am exempt under Sec. 1- � 1, 03,9A B.&P.C. for this reason Plan-check fee D # 0 0 0 0 0 5 " Date: PLUMBING PERMIT ISSUING FEE$ Signature � -1 6.5 0 ' TOTAL FEE 6 Plan check applicant o165p0' SINGLE-FAMILY HOME OWNER-BUILDER DECLARATION . Name .:( 1.08:84 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 D 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 a ov me Toned pry for./ pection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGESignature of Permittee Date WORKERS'COMPENSATION DECLARATION QppUCAMN FOR PLUMENG NG PERMY •' L I her'sby affirm that I have a'certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Seca 3800, L b. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N��5:4�.C.mpany ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the cou y building inspec- ADDRESS �.2 tion de tment. ° NUMBER FIXTURE OR ITEM a' FEE p LOCALITY Date Applicantw1k WATER CLOSET NEAREST CERTIFICATE OF EXEMPTIO FROM WO RS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY' TEL. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACT R Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS D>0 n Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO /1y . LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. _ deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NQ, �OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS S U (commencing with Section 7000) of Division 3 of the.Business OU7 TS OVER > . and Professions Code,and my license is in full force and effect. 5 P SYSTEM FINAL _ DATE !/ LIDATION License Number j• Lir. Class 19 FINAL O Contractor Date BY a' El LU I am exempt under Se A z B.&P.C. for this reason Plan check fee Dom, #x,3050'o 0 0 © o Date: PLUMBING PERMIT ISSUING FEE$ JV 1 - 3Q50 o 0 3 Q 5 0 Signature , TOTAL FEE :3 Plan check applicant o o'P 3 Q 5 0 v SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name d ( 0.0 2-8 5 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 D 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 D above information is correct. I agree to comply with all County ordinances a d State laws regulating Plumbing, and hereby authorizer resentatives of this County to enter upon the above-me coned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Si n o Per 't a Da e COUNTY OF LOS ANGELES TEMPLE CITY # 0508 tPCUMB'I'NG P. T DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL-0508 06Qb'1;90053i�- BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDI.NG_ADDRESS: TR: 5904 LT: 119 Q'6-02riVAR AVS,-. FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP`"CA 91-7801522 ASSESSOR INFORMATION NUMBER: ' NEAREST CROSS STREET: LONGDEN 5386-011-067 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 21 HOSE BIBB(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 25 LAVATORIES/SINKS 2.00 FIX 32.40 06/19/00 UT 12/ /00 45 WATER CLOSET/URINAL 1.00 FIX 16.20 OWNER: TEL. NO: 47 WATER HEATER(S) 1.00 WTH 16.20 FINAL DATE FINAL BT CODE: YASSINE SAM H;FATMEH N 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 6027 IVAR AV TOTAL FEES 141.15 TEMP 917801522 DESCRIPTION OF WORK PLUMBING FOR REMODELING AND RELOCATE WATER HEATER APPLICANT: TEL. NO: KATSOF, ARON (626) 564-9323- 975 E. GREEN ST. SPECIAL CONDITIONS: PASADENA Cc CONTRACTOR: TEL. NO: � APPROVALS DATE INSPECTOR SIGNATURE JASON PARADA LIC. NO UNDER SLAB WORK NONE WATER PLASTIC Y/NMETAL Y/N ARCHITECT OR ENGINEER: TEL. NO: AIKD ARCHITECTS (626) 564-9323 ROUGH PLUMBING 975 E. GREEN ST. #205 LIC. NO:� "Z PASADENA, CA 91006 C20713 GAS 1111,1I PIPING GAS VENT F ;I p L C \111\11/0 R 8 HOT WATER HEATER 1J V U PLUMBING FIXTURES D 0 ,iIl��e LAWN SPRINKLERS (f O ❑ GAS TEST A C--� � �p�r�c� UTILITY COMPANY NO IFIED El �tl0 CWV e?vjce GRAY WATER SYSTEM Lot REPORT ID: DPR263 ROUTE TO: BS0508