HomeMy Public PortalAbout6153 IVAR AVE_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS Pl. 0508.0504060008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL FEES PAID BUILDING ADDRESS:
TR: 5904 LT: 21 UN: .002 6153 IVAR AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801524
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN
5386-010-066 01 PERMIT ISSUANCE FEE 27.75. THOMAS PAGE: 596 GRID: H2- LOCALITY: TEMPLE CITY, C
05 BACKFLOW DEVICES) 1.00 DEV 16.20
TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
45 WATER CLOSET/URINAL 1.00 FIX 16.20 04/06/05 JK 10/03/05
47 WATER HEATER(S) 1.00 WTH 16.20
OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 FINAL DATE FINAL BY: CODE:_-
CHEN, JOHNNY/KATHY (626) 291-2228- TOTAL FEES 108.75 _
6153 I VAR AV /-/Z-6 C
TEMP 917801524 DESCRIPTIO OF WORK
PLUMBING FOR NEW BATHROOM AND LAUNDRY ROOM
APPLICANT: TE O:
TAO (626) 458-8307-
317 W. LAS TUNAS SPECIAL CONDITIONS:
SAN GABRIEL
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
ALEX TAO AND ASSOCIATES (626) 458-8302-
317 W. LAS TUNAS DR., #208 LIC. NO UNDER SL B RK
SAN GABRIEL, CA ,91776 7441516
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. 0: _
LIC. N0: ROUGH PLUMBING
"I a�::z
GAS PIPING --
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
C V
_ GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508
WORKERS'COMPENSATION DECLARATION Ap PPUCAp YMN FOR PLUMQ MIG, PERM57
eb}-affirm that I have a certificate of consent to self 76A667A
qFur,
e,"or a c;rtificdte of Workers' Compensation Insurance, CE 817(REV. 10/81)
cer fitd;copy t e (Sec. 3800, lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Polic ompany
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
❑ Certified copy is filed with the county building inspec- ADDRESS ((J
tion dep rtment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY-,r
Pat It 5,. Applicant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS SL
COMPENSATION INSURANCE OWNER
SHOWER
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
'permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.�
so as to become subject to the Workers Compensation Laws, DISHWASHER:
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS VL
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you .should become, subject to the"Workers' SWIMMING POOL RECEPTOR
Compensation provisions of ther Labor Code, you must forth- CITY" TEL. NO. ? f
LAWN SPRINKLER SYSTEM `
with comply with such provisions or this permit shall be STATE �/_ LIC. h
deemed revoked. WATER HEATER LICENSE NO. QCb CLASS o
. LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
,(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER 1
and Professions Code,and my license is in full forceand
effect. 5 PER SYSTEM 00 FINALz V�.LID IOIb 00
DATE
License Numbe c. Class�L' '" ~ 09
q TINA O
Contracfo Te I f BY
LU
❑ I am exempt under Sec. # a gt _ ' ,,_A.
B.&P.C. for this reason
Plan check fee D [ ®:0 1 b 5®.
Date: PLUMBING PERMIT ISSUING FEE$
Signature �O o o',0 1 6,5 0.31 `
TOTAL FEE 09.2485
`Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
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 6 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 hove read this application and state that the D
je
Wned
t. I agree to comply with all County
regulating Plumbing, and hereby
of this to enter upon the
for ' pecti �
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sig toe of Permittee D to