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HomeMy Public PortalAbout6243 IVAR AVE_Plumbing__ 8179) -a/77 FOR PLUMBING pC Ravi OT BUILDING AND SAFETY DIVISION FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDIN ®R.Al +'� NUMBER. FIXTURE OR ITEM @ FEE ADDRESS (+r�3 WATER CLOSET LOCALITY ` i.Cr Ci -r NEAREST ' BATH TUB CROSS ST. SHOWER OWNER ��` e Vv S LAVATORY MAIL l ADDRESS SINK CITY TEL.NO.'ZS'6 2 DISHWASHER CONTRACTOR CLOTHES WASHER ADDRESS 26 Q L e ✓;{ SWIMMING POOL RECEPTOR /� CITY rV*l&-Lr TEL.NO.?1� 6 8 6 ri LAWN SPRINKLER SYSTEM STATE Z � LIC. e Z-® WATER HEATER LICENSE NO. J CLASS GAS SYSTEM OUTLETS 3 DISTRICT NO OUP E ROCE ED BY ss33 / OUTLETS OVER . e O 5 PER SYSTEM I INDUSTRIAL WASTE APPROVAL CD INSPECTION RECORD W G G E C@7 p J Cn � Z Plan check fee PLUMBING PERMIT ISSUING FEE$ ®d TOTAL FEE zo Plan check applicant APPROVALS DATE INSPECTOR'S SIGNATURE Nome UNDER SLAB WORK Address ROUGH PLUMBING City Tel.No. GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT THAT THE ABOVE IS 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 AS PLUMBING FIXTURES REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST (� ^ © 5 r7 .��j/,lG/ LEGAL OWNER OF.AND INTEND TO RESIDE IN THE ABO DE ENTIAL -. PROPERTY. UTILITY CO.NOTIFIED, SIGNATURE OF PE RMITTEE FINAL 7 �L PLAN CHECK V UDgtION CK. M.O. ' cnsyy. PERMIT VA 1, TION Q. M.0. CASH d 'WORKERS' COMPENSATION DECLARATION �n I hereby affirm that I have a certificate of consent to self 76A667A �o� 0�������OuV �O0� 0���� 0���� ��� �� insure, or.a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) Temple City or a certified copy thereof'(Sec. 3800, Lab. C.)' COUNTY OF.LOS ANGELES BUhLDING AND SAFETY Policy No.tIC5173500company Select Iris. Co. Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the count building inspec- ADDRESS 6243 No. 'Ivar St tion depdrtinent: Geo a '� Plbg, NUMBER FIXTURE OR ITEM � FEE ' z LOCALITY Tem le, Cit Date 3-28-$5 Applicant WATER Garibaldi '& Rosemead CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER ' (This section need not be completed if the'work involved by SHOWER J. Barrio the permit is for one hundred dollars($100)or less.) LAVATORY MAIL I certify that in the performance of the work for which this ADDRESS 624 NO. Ivan Sto permit is issued, I shall not employ any person in any manner SINK CITY; Temple City TEL. N0.286-71i3 so as to become subject to.the Workers Compensation Laws. DISHWASHER CONTRACTOR George. Brazil Plb. & Heating Date Applicant CLOTHES WASHER ADDRESS 17420 SO a Broadway NOTICE TO APPLICANT: If, after- making this Certificate of y Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY Gardena, 90248 TEL. N05�5-0404 with comply with such provisions or this permit shall 6e - STATE LICENS , deemed revoked. ] WATER HEATER relocate 6 00. E NO. 4416'8 CLLICASS C 6 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR CESSED BY 'Ibz I hereby.affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3.of the Business OUTLETS OVER (f and Professions Code,and my license is in full force and effect. 5.PER SYSTEM 3' FINAL VALI TION DATE O License Number 441678. Lica Class C 36 k; Plumbing3-2$-85 FIA Contractor Date tb ❑ 1 am exempt under Sec. � B.BP.C. for this reason 21 8 08 A Plan check fee ## o ­ .o o:0 5 Dare: ' PLUMBING PERMIT ISSUING FEE$ 10,50 0 0 5 O Signature TOTAL FEE Plan' 16 0 0 0'0.1 65006 check applicant SINGLE FAMILY ' HOME OWNER-BUILDER DECLARATION Name 0405"85 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 iso 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 of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WOtFQtS'COMPENSATION DECLARATION he affirm that I'have a certificate of consent to self 76AEI67A ������ 0����� ®� PLUMBING �� ��� insure, or a certificate of Workers' Corripensotion Insurance, CE 817 (REV.8(86) or a certified copy thereof ` �r � 3800, Lab. C ) • �� SQ cTA7e �C)JUA COUNTY OF LOS'ANGELES' DEPT OF PUBLIC ,WORKS Po 'cy No. Cam panY ' Certified copy is herebyfurnished. BUILDING ' ". FOR APPLICANT TO FILL IN(PRINT OR TYPE) Certified copy is filed with the county building.inspec ADDRESS >'. /�✓ do epariment. NUMBER FIXTURE OR ITEM Q FEE LOCALITY ,r DateApplicant/� �0 & r�# T WATER CLOSET . ' = NEAREST . CERTI CATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS 5T. COMPENSATION INSURANCE OWNER07( N� < /`�l (This section need not be completed'if the work involved by SHOWER. the permit is for one hundred dollars-($1D0)or less.) LAVATORY �( MAIL' a I certify that in.the performance of the work for,which this (/ ADDRESS v •SINK CITY / -f TEL.NO. permit•is issued, I shall not employ any person in any.manner f�1 ,� `./,. so as to become subject to,the Workers'Compensation Laws. DISHWASHER CONT RACTOR • ,` . Date APPlicant_ a CLOTHES WASHER ,0 NOTICE TO.APPLICANT: If, after making this Certificate of ADDRESS' V 175 SWIMMING POOL RECEPTOR Exemption, you _should become subject to the'Workers' 3 �T l� CITY LAM TEL. NO. Compensation provisions of the Labor Code, .you must forth-'. •• LAWN SPRINKLER SYSTEM �11 �• with"comply with such,,provisions or this' permit shall be STATE LIC. deemed revoked. WATER HEATER D LICENSE NO. I CLASS . -LICENSED CONTRACTORS DECLARATION' DISTRICT NO. P ESSED BY I hereby affirm that I arri.licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS:OVER and Professions Code,and-my license i in full force and effect. 5 PER SYSTEMFINAL. r O . . DATE VALI �4TION (J. License Number Z Lic. Class cc FIN O Contractor C r6/V1 �ir�bre BY I am exempt under.Sec. •� B.BP.C. for-this reason f!1 Plan check fee �te PLUMBING_PERMIT,ISSUING FEE$ :' �75'Q7•A Signatur TOTAL FEE, l #,0'o .o o'o 55 . Plan check applicant ' "o 0 4 p,5 0 SINGLE FAMILY HOME OWNER-BUILDER-DECLARATION Name I hereby affirm that I aril exempt from the Contractor's'License Address c o ° 4 0.5 0 -Law for.the'following reason (Section 7031 5, Business,cind . i ) City(2—AjzTel, No 2 -'87 Professions Code): � ��—� �� ` 0:7.2 7044, Bus press and Professions Code).do the work and the property,. -structure is':not intendedor offered for sale (Section 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 L'ender's Address I certify,thai'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 represer . es of this .County to enter upon the a ve-. endo ed pro rty for inspecti n purposes. SEE REVERSE FOR EXPLANATORY.LANGUAGE /� Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0309240006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: -LEGAL EES PAID B D G RS : TR: 5904 LT: 27 UN: .002 6243 IVAR AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801526 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5386-010-033 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 T N_A N-f 7 21 HOSE BIBB(S) 2.00 FIX 32.40 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 25 LAVATORIES/SINKS 1.00 FIX 16.20 09/24/03 JK 03/22/04 45 WATER CLOSET/URINAL 1.00 FIX 16.20 OWNER: TEL. NO: 63 WATER PIPING BR/FIX 5.00 FIX 33.75 FINAL DATECODE: CHANG MAY - 64 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 EvE I 6243 IVAR AV TOTAL FEES 158.70 TEMP 917801526 DESCRIPTIONU-WORK REPLACE ALL FIXTURES; COPPER REPIPE HOUSE & MAIN LINE APPLICANT: TEL. NO: SIMON LUY (626) 821-8638- 1327 S SECOND AVE SPECIAL CONDITIONS: ARCADIA 91006 CONTRACTOR: TEL. NO: �; �6 �� APPROVALS DATE INSPECTOR SIGNATURE LUY CONSTRUCTION CO (626) 821-8638- 1829 S SECOND AVENUE LIC. NO r UNDER SLAB WORK ARCADIA, CA 91006 637318 B fi3 WATER SERVICE v� PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: / � ��� I� ROUGH PLUMBING LIC. NO:� GAS PIPING r --- -- - -- --- —-- —� GAS VENT IL C�D 1�7r HOT WATER HEATER --------- -- — --- --- - - -- - PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST -I °-:✓yrs UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BSO5O8 =-"'fit ._ .• �•t+ • - A .. .:;a.:L:.«�vc '1' s I 16 ..4 .674 �.. 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