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Home My Public Portal About10520 KEY WEST ST_Plumbing__ I �6A887-CE8I7,-1I-57, APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION DRYS OHN A. LAMBIE. County Engineer C SATT D. GRIFFIN, Supt of Building LOCALITY FOR APPLICANT TO FILL IN NEARESSS TT. Fax NUMBER FIXTURE OR ITEM �.-. r OWNER WATER CLOSET MAIL BATH TUB ADDRESS SHOWER CITY Q it TEL. NO g C LAVATORY CONTRAC R SINK ADDRESS DISHWASHER CITY TEL. NO. LAUNDRY TUB CONTRACTOR'S STATE El REGISTRATION NO. COUNTY CLOTHES WASHER DISTRICT GP ZONE READY FOR INSPECTION WATER HEATER GAS SYSTEM INDUSTRIAL WASTE APPROVAL INSPECTION RECORD , r APPROVALS PER ITEM DATE INSPECTOR'S SIGNATURE OR FIXTURE $ UNDER SLAB WORK PERMIT $ 00 ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING _ PLUMBING PLUMBING FIXTURES IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER F THE VE UTILITY CO NOTIFIED DESCRIBED RESIDENTI PROPERTY SIGNATURE OFPERMITTEE FINAL ROBERTA WOOD ®F VALIDATION UPERVISING MECHANICAL ENG R CK M 0 CASH Lj 2'1 2 3 FEB 35 A 3.0 0 � r WORKERS'COMPENSATION DECLARATION APPLICATION FOR PMLUBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 F :� insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No Company Certified copy is hereby furnished ❑ FOR APPLICANT 70 FILL IN(PRINT OR TYPE) BUILDING ` 1/jJ t•/Q sT Sf Certified copy is filed with the county building mC7 spec- ADDRESS J r tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY l•'� Date Applicant WATER CLOSET NEAREST Temole- CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST - COMPENSATION INSURANCE SHOWER OWNERBen�a rA i ii 3ovc] (This section need not be completed if the work Involved by the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS Icertify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITYTCM q �) TEL NO Z so as to become subject to the Workers Compensation Laws DISHWASHERC CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' CITY TEL NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be ATE LIC deemed revoked WATER HEATER ICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT VO ROLES BY I hereby affirm that j am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS e— (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION iv �j �� License Number Lic Class DATE U FINAL Contractor Date BY 0, ❑ I am exempt under Sec B 8P C for this reason Plan check fee �1 Date PLUMBING PERMIT ISSUING FEE$ '7 Signature ' - TOTAL FEE O Plan check applicant Ir SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name �4e �jry) I h O V I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Address -7r K e � Professions Code) City 2 C' Tel No1Yq —9 j, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® I i I A' 3'5° 7044, Business and Professions Code) - - CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for cr'_ 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 jaws regulating Plumbing, and hereby authorize reprelentatives of is Co ty to enter upon the abov�-n ntioned property f r spe ti n purposes ID/ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of P 11mittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0206040031 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: AL FEES PAID G ADDRESS: TR: 11290 LT: 1 BL: .001 UN: .002 10520 KEY WEST ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803462 ASSESSOR INFORMATION UMBE : NEAREST CROSS.STREET: HALIFAX 8585-024-004 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 4.00 FIX 64.80 TENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED B AN B S ON: 13 DISHWASHER(S) 1.00 FIX 16.20 06/04/02 JK 12/01/02 21 HOSE BIBB(S) 4.00 FIX 64.80 OWNER: IFL. NO: 25 LAVA10R1ES/SINKS 7.00 FIX 113.40 FI/NAL DATE _ FINAL`BY: CODE: 2.00 FIX 32 40 10520YKEYOHN WEST ST 45 WATERLLANEOUS CLOSET/URINALR 3.00 FIX 48.60 TEMP 917803462 47 WATER HEATER(S) 1.00 WTH 16.20 DESCRIPTION OF WORK 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 PLUMBING FOR NEW SFR 52 ADDN OUTLETS > 5 2.00 OUT 8.40 APPLICANT: L. 0: TOTAL FEES 424.95 SIEMPRE CONSTRUCTION INC (626) 792-3727- 1827 SAN PASQUAL ST SPECIAL CONDITIONS: PASADENA 91107 CONTRACTOR: TEL. NO: " ' APPROVALS DATE INSPECTOR SIGNATURE SIEMPRE CONSTRUCTION, INC. (626) 792-3727- _ 1827 SAN PASQUAL STREET LIC. NO ` UNDER SLAB WORK PASADENA, CA 91107 805704 B ; 1 6,-y'O Z WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT 0 ENGINEER: N0: �. SUNSHINE DESIGN ASSO (626) 289-6300ROUGH PLUMBING - 301 N. ROSEMONT BLVD. LIC. N0: SAN GABRIEL, CA 91775 NONEGAS PIPING GAS VENT HOT WATER HEATER - -- - - - - FIXTURES G LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508