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Home My Public Portal About9642 LA ROSA DR_Plumbing__ APPLICATION FOR PLUMBING PE MIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION DRESS tf 1157c JOHN A. LAMBIE, COUNTY ENGINEERWILLIAM A. JENSEN. SUPT OF BUILDING LOCALITYFOR APPLICANT TO FILL IN NEAREST CROSS ST. INUMBER FIXTURE OR ITEM EACH FEEOWNER- WATER CLOSET 71.25 MAIL / �Ko+' XBATH TUB 1.25 ADD 55 (O 7+ c/ dSHOWER 1 25CITY fiEK.� TEL. NO.2LAVATORY 1.25 CONTRACTOR SINK 1.25DISHWASHER 1.25 CITY EL. NO. LAUNDRY TUB 1.25 CONTRACTOR'S REGISTRATION NO. CLOTHES WASHER 1.25 DISTRICT NO. 77- 1 ROUP ZONE P - E68ED BV WATER HEATER 1.50 �Q �_ GAS SYSTEM OUTLETS 1,50 INDUSTRIAL y WASTE APPROVAL OUTLETS OVER 5 PER SYSTEM .00 INSPECTION RECORD V o' FO U w a N Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK / ROUGH PLUMBING TOTAL FEE GAB PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER \ PLV MBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES n ry �,/ LICENSED AB RED I RED 8Y LO GELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 A LE AL OWNER OF.AHD TEND TO RESIDE IN! THE ABO O C R.=-L///SIOENTI PROP Rt UTILITY CO. NOTIFIED SIGNATURE tl// OF PERMITTEE ^'G� n FINAL F VALIDATIO13/-) ROBERT A. WOOD CK. M.0. /C:: / SUPERVISING MECHANICAL ENG'R L:Go 8 2 9 4 FEB 5 5 D 3.50- WORKERS' I have aSATI°N DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, a:irm that have a certificate of consent to self in- 76A667 DPW 4/90 sok,or a certificate of Workers'Compensation Insurance,or a 76A667A - certified copy thereof (Sec. 3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES . DEPT:.OF PUBLIC WORKS ❑ Certified copy is hereby furnished. ❑ Certified co is filed with the count building p FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /� /)) /^ n copy� y gins inspection ADDRESS (! TL � ///� ' department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY �YY 06/v y 611 Date Applicant WATER CLOSET(TOILET) NEAREST !!c�//�� V / CERTIFICATE OF EXEMPTION FROM WORKERS' r BATH TUB O CROSS ST. ��•4- COMPENSATION INSURANCE SHOWER OWNER C"V41A GV� (This section need not be completed If the work involved by MAIL /, /7 !/1 n n /i,�( /J the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS / O// 4A 1424 7 I certify that in the performance of the work for which this per- SINK CITY mit is issued, I shall not employ any person in any manner so 7�tK TEL. NO. / as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER gDDRE55 NOTICE TO APPLICANT: If, after making this Certificate of Ex. SWIMMING POOL RECEPTOR emption, you should become subject to the Workers'Comport- CITY TEL.NO. sotion provisions of the Labor Code, you must forthwith comp. LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR Y I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS S ,gyp/ 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER CJO and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL / �/ALI ATION fect. HOSE BIB DATE L1J`-��'-Q� y License Number Lic. Class QL ACCT.` FINAL Contractor Date BY 3303 59.`0 1 am exempt under Sec. a 1 ITEMS U B.BP.C. for this reason59 . 50 W Plan check fee , TOTAL y Dote:- PLUMBING PERMIT ISSUING FEE$ 02 O CHECYc 59.50 i Signature TOTAL FEE C CHANGE .00 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name 0000-0001 3/21/96 Law for the following reason (Section 7031.5, Business and Professions Code): Address 5442 1 AM 10:17 L� l as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7N , 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 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 abov -m ntioned property for inspection purposes. °21- y6 SEE REVERSE FOR EXPLANATORY LANGUAGE .�g re f Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0411080016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRES - TR: 14467 LT: 76 BL: .001 9642 LA ROSA DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803860 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: CAMILLIA 8589-017-023 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C 47 WATER HEATER($) 1.00 NTH 16.20 _ TENANT: 92 NO PERMIT OWNER-BLDR 128.50 DOL 128.50 ISSUED 0PROCESSED BY: PAN BY: EXPIRES . TOTAL FEES 172.45 11/08/04 JK 05/07/05 OWNER: TEL. NO: FINAL DATE FINAL BY: CtlDE: LUCIANO ALEX;LYDIA G (626) 287-0205- 9642 LA ROS.A, OR U�'� �� __ _ TEMP 917803860 SCRIPT ON OF WOR REPLACE WATER HEATER APPLICANT: TEL. NO: SAME AS OWNER - _ SPECIAL CONDITIONS: '- CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO UNDER SUB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT ORENGINEER: TEL. N0: - ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PL BF-ING- I RSI fO ES LAWN SPRINKLERS S TEST UTILITY COMPANY NOTIFIEU CWV GRAY WATER SYSTEM I i I REPORT ID: DPR263 ROUTE TO: BS0508 _ I