HomeMy Public PortalAbout9235 KENNERLY ST_Plumbing__ 76A6�7 OBS 17 11-SO APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY '
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
DISTRICT-NO.
FOR APPLICANT TO FILL IN -r
PLUMBER ep! �' -" ' R El / BY READY FOR DATE ISSUED
a - FIRST INSPECTION �Y
i-l6 !� ,.>�,/.rJ - mss'
ADDRESS y /�Jffj �
_CITY TEL. No"�'- • BUILDING
ADDRESS /
Azsr 1%r
COUNTY J
LOCALITY
LICENSE NO. / EXPIRES /�G
NEAREST
PERMIT FEES CROSS
OWNER
NUMBER TYPE OF FIXTURE OR ITEM FEE
!
MAIL 4 .9I
WATER CLOSET(TOILET) � 0.50 »i ADDRESS�i
BATH TUB 0.50 CITY TEL. No. ' 7?40X*�)
SHOWER @ 0.50 ! 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 ! APPLICATION AND STATE THAT THE ABOVE IS CORRECT
j AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 ,i AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL P OPE D SCRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50
SIGNATURE OFe
WATER HEATER @ 0.50 PERMITTEE
SLOP SINK @ O.so -INSPECTION RECORD
FLOOR BINK - @ 0.50
FLOOR DRAIN @ 0.50
DISHWASHER @ 0.50
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 .J
Q
HOUSE SEWER @ 0.50 Z
MIS EL NEOUS O
C
O
APPROVALS
DATE INSPECTOR'S NAME
' ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1;00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT I 1.0O GAS TEST �,�,�
UTILITY CO.NOTIFIED A,
TOTAL FEE S C,( .�a a' 7..—
// FINAL �' 7
WORKER'S COMPENSATION DECLARATION 76A667A 6DPW9/89 APPLICATION N FOR_;PLUMBING PERMITS
76A66 '
I herebyaffirQ`that I have a certificate of consent to self insure,
,or a'certificate of,Worker's Compensation Insurance, or a certified :
copy ttrereof(Sec.3800 Lab C.)
COUNTY OF�LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.'OF PUBLIC WORKS DIV.
Policy No Company
❑ Certified copy is hereby furnished. l ,
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING' N n�
El- Certified copy is filed with'the county budding inspection I ADDRESS ,tet
llj
department. ENUMBER FIXTURE'OR ITEM p FEE LOCAL"
r, r
Date' Appll C• WATER CLOSET ,55 NEAREST - -
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST
BATH TUBCOMPENSATION INSURANCE ASSESSOR' G(This-section need not be completed if the work involved by theSHOWER MAP BOOK /PAGE PARCEL
permit Is for one hundred dollars($100)or less.)' LAVATORY OWNER1-
I certify that in the performance of the work,for which this permit
is issued, I shall not employ any person in an manner so as to MAIL. Gf _
Y � SINK _ ADDRESS;vT/. Z3
become subject to the Workers' Compensation Laws is 1 L
DISWASHER CITY �I'yt - t �,r EL NO �SA�S�~J•
Date Applicant CLOTHES WASHER w w
CONTRACTOR
NOTICE TO APPLICANT. If, after'making this Certificate of
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must.forthwith comply with such ADDRESS
provisions.or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
` }
LICENSED CONTRACTORS DECLCITY TEL NO:ARATION x �
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER 4.
(commencing with.'Section 7000 of Division 3 of the Business and STATE LIC
( 9 ) LICENSE NO CLASS
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS r (�'
OUTLETS OVER DISTRICT,NO. PROCESSED BY Q
5 PER SYSTEM Q
License Number Lc,Class / - v
FINAL VALIDATION W
/ • - DATE �� .C. �'`) - "a
Contractor Date
❑ SecFINAL. C Z
am exempt under BY. 1:.
A rr a
B&P.C.for this reason t"CC
- / ToT
Date:• Plan check fee r ,. ...., . . M7 •213.90
Signature
PLUMBING PERMIT ISSUING FEE$ 02��' - i ITEMS
TOTAL,FEE f V'
❑ ` TOTAL 213.90
Plan check-abplicant � �V/ �1`.
SINGLE FAMILY rti�Cf,. 0
HOME OWNER-BUILDER DECLARATION Name r• -•C u- r,t�
I hereby affirm that I am exempt from the Contractor's License Law y' C SE .00
fort following reason (Section 7031.5, Business and Professions Address "
) ` CIt _ _ Tel. No. .'. � ����t�t���t i{ 66 GG
I,as owner of the property,will do the work and the structure y `, OOIN—n I', •r 7� ��7 •
is not intended or offered for sale (Section 7044, Business r _ .._ .._.. t� 44 _- AM A.0C
and Professions Code). 1 t1t t 7 V•:
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 ti ;
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 ofPrIA Coul to enter upon the above-mentioned
pro e for.msp tion ur es �%//� SEE REVERSE FOR EXPLANATORY LANGUAGE
Z--
SInatu ofPermittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 _ PLUMBING PERMIT _
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0908120005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE. (626) 285-0488 EXT:
ILEGAL ID- FEES PAID BUILDING ADDRESS: 1
ITR 16475 LT.: 116 I 1 9235 KENNERLY ST I
I - IFEE DESCRIPTION: - QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803728 -
(ASSESSOR INFORMATION NUMBER: I ' -. '� .r . ' I NEAREST CROSS STREET: LOWER AZUSA
NCE FEE
18590-010-016 101 PERMIT ISSUANCE 27.75 I THOMAS PAGE: 596 GRID: .JS LOCALITY: TEMPLE CITY, ClC
I 147 WATER HEATER(S) 1.00 WTH 16.20 I I
(TENANT: 164 WATER PIPNG <=•1 1/2 8.00 LIN 129.60 IISSUED ON: . PROCESSED BY- PLAN BY: EXPIRES ON 1
TOTAL FEES 173.55- 108/12/09 SR 08/-12/10 1
(OWNER: TEL. NO: 1 IF AL.DA .FIN Y. CODE: I
IQUAN, NELSON - (323) 401-5743-
19235 KENNERLY ST I� s�•'
ITEMP 917803728 1 1DESCRIPTI I OF- WORK 1 '
COPPER'-REPIPE TO 8 EXISTING FIXTURES AND NEW WATER HEATER
(APPLICANT: TEL NO: - -
IBROOKS (800) 649-7511- I
11371 TITAN WAY _ SPECIAL CONDITIONS:
IBREA; CA 92821 I 1 1
I I I
I I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE a1
ICAL-COAST REPIPING INC. (800) 649-7511- 1 1 -
11371 TITAN WAY LIC. NO I1UNDER SLAB WORK I I
BREA CA 92821' 636649 C36 *1 I . 11 I
IWATER SERVICE I I. 1
IPLASTIC Y/N METAL Y/N I
1ARCHITECT OR ENGINEER: TEL. NO: I -
- I IROUGH PLUMBING
1 LIC. NO: I
IGAS PIPING. 1� I
I I I I I I
. (GAS VENT I
I ' LI I
IHOT WATER HEATER I
I IPLUMBING"FIXTURES I I
I I I I I I
I 1LAWN SPRINKLERS I I I
1 I IGAS TEST I I I
I 1 11 1
I (UTILITY COMPANY NOTIFIEDI I I
CWV
I I - . • I I I I
• IGRAY WATER SYSTEM 1 I I
I I I I I I
I I I I I I
I* ADDITIONAL DATA ON FILE I
i IREPORT ID: DPR263 ROUTE TO: BSO508 I I
I I