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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES i
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING G�
JOHN A. LAMBIE. COUNTY ENGINEER. ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST 1
CROSS ST. L
NUMBER - FIXTURE OR ITEM EACH FEE I "
'OWNER
WATER CLOSET $1.25 MAIL
HATH TUB 1,25 ADDRESS ^i L
CITY c TEL. NO.
SHOWER 1.25
LAVATORY 1,25 CONTRA A
SINE 1,25 ADDRESS
DISHWASHER 1.25 CITY TEL. N -,.-Be�
LAUNDRY TUB I,gS CONTRACT T STATE
REGISTRA7 N NO. ��/, COUNTY ❑
CLOTHES WASHER 1.25 D 'DII�N�+_ 5 BY
WATER HEATER 1.50 (JT/
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL '
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .00 INSPECTION!RECORD d
�. .�' 1, fir' 3
CAu
Z
APPROVALS DATE—, INSPECTOR'B'S�iATU RE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE J e GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT ANO AGREE TO COMPLY GAS'VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER �p��t►
PLUMBING. _
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANOIOR PLUMBING F IXTU RE S
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST,,
CALIFORNIA OR THAT I T "EGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE,D SC ED RESIDENTIAL PROPERTY"/ J/ UTILITY CO. NOTIFIED •.,�
SIGNATURE /�As1 i �1 / f.ILf e l
OF PERMITTE "A'.Voe
v�
FINAL
VALIDATIQN--",,ROBERT N. WOOD F
CK M.a., CC45�. )SUPERVISING MECHANICAL ENG R
Liao 4,. 5 0 0 2 AN 16 5 D 3.50-
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oB..n loss APPLICATION FOR PLUMBING PERMIT
' es
DIVISION OF BUILDING AND SAFETY
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS 2
CASSATT D. GRIFFIN, SUPT OF BUILDING � �+ `
LOCALITY
ESK4,)PPLICANT TO &ILL IN NEAREST
CROSS ST.
OWNER I/ DISTRICT NO. UP I CIE I READY FOR INSPECTION
MAIL
ADDRESS
OOE !! INDUSTRIAL
CITY TEL. NO. WASTEAPPROVAL
PLUM &0�52 INSPECTION RECORD
ADDRESS
CITYzaZ
STEL. NO.
i
LICENSE O� •, J B/�
NUMBER TYPE OF FIXTURE OR ITEM FEE]^
WATER CLOSET (TOILET) @ -$1.00 $ D
BATH TUB .@ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ 51.00
WATER HEATER @ $1.00
GAS SYSTEM @ .$1.00
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT S 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE eL GAS VENT 7/ \
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER �! 1 A
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY `
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES ' ✓J�✓/,i�.�z�4..-.�1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST ,
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1THE 'LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED t
DESCRIBED RESIDENTIAL OP Y,
SIGNATURE ��,,,,
OF PERM ITTEE
FINAL )'VO.~Z,O ;! JA ,.;1-
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CH. M. 9. CASH
`�D9 6 2 4 At1G?7 - 3 2.0:0
75A5n it 5-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX. CHIEF ENGINEER
FOR.APPLICANT TO FILL IN DISTRICT_NO. GROUP ZONE PERMIT NO.
t'�" `�— / —7 (�v
PLUMBE RECEI VED BY READY FOR DATEISSUED
FIRST INSPECTION //�4
ADDRESS y/�JfrT-�}vr� /"1/
`�, !1 TEL. N ADOREIN (JV4,G'
CITY
LICENSE I O.I aI/ I M 04
G�367 tV LOCALITYL�'I.
EXPIRES
10
NEAREST
PERMIT FEES caoss sr.
NUM6ER TYPE OF FIXTURE OR ITEM FEE OWNER ��f�W✓ �,�..r v
MAIL 'WATER CLOSET (TOILET) C 0.50 5 MAIL ESS /'� /�
BATHTUB O.50 CITY _ J TEL. N -X—/ 0
SHOWER C 0.501_ I HE o/ ACKNOWLF,'D GE THAT I HAVE READ'THIS
LAVATORY (WASH BASIN) n O.50 APPLICAII N ANI, STAB" " HAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY VS1'fH ALL COUNTY ORDINANCES AND
KITCHEN SINK t@ 0.50 STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.501 ANGELES COUNTY LI NSE -0 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL RO ERTY DESCftIB ABO E.
GAS SYSTEM—OUTLETS Qa 0.501 SIGNATURE OF �
I WATER HEATER @ 0.50 PERMITTEE
J SLOP SINK c 0.501 INSPECTION RECORD
I FLOOR SINK @ 0.501
FLOOR DRAIN (a 0.501
DISHWASHER Q 0.501
DRINKING FOUNTAIN
URINAL
HOUSESEWER @ 0.50) Q
Z
MISCELLANEOUS /;(/ it U
Y " nI v o
E
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.001 CESSPOOL
SEPTIC TANK' SEPTIC TANK
1 DRAIN ( ) PIT ( 1.Do SEWER
PERMIT 1.00 GAS TEST /I
TOTAL FEE
UTILITY CO. NOTIFIED / 1�
6
FINAL �f
sdAeeT n B-SO - APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY . Ste`
COUNTY OF LOS ANGELES
WILLIAM . FOX. CHIEF ENGINEER
F APPLICANT TOAF LL IN DISTRICT DI O. GROUP ZONE PERMIT NO.
14 W
PLUMBER RECEIVED BY REASPECT GATE ISSUED
FIRST INSPECTION
ADDRESS V/
BUILDING
CITY J/� TEL N . _qiCOUNTY G.IV/�/S ADDRESS
LICENSE /�/,r 1 ' EXPIRES �.J� V ! LOCALITY �-
NEAREST
PERMIT FEES crxoss sr.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER
MAIL
WATER CLOSET (TOILET) @ 0.50 S ADDRESS
J
BATHTUB C 0.50 CIT TEL NO ' `
SHOWER C 0.501 1 HE BY ACKNO EDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLI DO AND ST E, HAT THE ABOVE IS CORRECT AND
AGRE TO COMPLY E, ALL COUNTY ORDINANCES AND
KITCHEN SINK 0.501 STATE LAWS REGULATING PLUMBING.
LAUNDRY TUB OR TRAY O.SOI I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
ANGELES COUNTY LICENSE.-E OR I AM THE LEGAL OWNER
@ 1
OF THE RE5ID ENTIAI.FIPRpPTV.SCRIBE
GAS SYSTEM OUTLETS 0.50 ". / Q
�J] SIGNATURE OF
WATER HEATER CSI 0.50 V �/ PERMITTEE
SLOP SINK 0.50 INSPECTION RECORD
FLOOR SINK @ 0.50 'y1
FLOOR DRAIN 3 0.501 ti f
DISHWASHER a 0.50TT
DRINKING FOUNTAIN Q 0.501
IURINAL 0.50 __ -J
HOUSESEWER [Ci 0.501 Q
Z
MISCELLANEOUS U�
O
I
I
11
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL Lol--]
CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) 00SEWER
PERMIT I.Do GAS TEST
UTILITY CO. NOTIFIED
TOTAL FEE $ / �,j!/
FINAL
v
WORKERS'COMPENSATION DECLARATION 7SA657A �-
I hereby affirm that I have acertificateof consent to self CE en (z-es) APPLICATION FO R PLUMBING PERMIT
insure, or a;certificate of Workers'Compensation Insurance,or . .
a ceAlfied copy thereof(Sec. 3800,Lab.C.)
COUNTY-0F LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) , BUILDING
Certified copy E tiled with the county building inspection
NUMBER FIXTURE OR ITEM d FEE ADDRESS
LOCALITY T
department. WATER CLOSET
Date Applicant NEAREST -
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS' p
COMPENSATION INSURANCE SHOWER OWNER T/?JCA- u 1ZFAJ_
MAIL C
(This section need not be completed if the work involved .LAVATORY ADDRESS )��L
by thepermit is for one hundred dollars ($100) or less.) tLJfpp
SINK CITY rc 'G TEL.
I certify that in the performance of the work for which this .DISHWASHERI ,1 U
permit is issued, I-shall not emp y any pe'son In o y manner CONTRACTOR V•••To /y S P4U HRIA16
so as to become subject to the r r ' mpe ion Laws. CLOTHES WASHER yy��
ADDRESS LJ {{�U 1 O
Uate �-Applicant SWIMMING POOL RECEPTOR _ Roy U
NOTICE TO APPLICANT: If a-er making this � ificate of CITY MQAf�CUt TEL. NO.,,y:7S
Exemption, you should b e subject to the Workers' LAWN SPRINKLER SYSTEM C
STATE •'•� /y LIC. `, N
Compensation provisions of t e Labor Code, you must forth- LICENSE NO. / �'1 CLASS C-
with comply with such provisions or this permit shall be .WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY
LICENSED CONTRACTORS DECLARATION OUTLETS OVER LJ G ( GZ
I hereby affirm that 1 am licensed under provisions of Chapter 5 PER SYST
9 (commencing with Section 7000) of Division 3 of the Busi- CFINAL VALIDATION
ness and Professions Code, and my license is in full force and / IrlAe> DATE 3—Z5�.
effect.. n (y
FINAL
-
n 7 1 Z C_ I r
License Number ) Lia Class-7S G.— y'�U FI
Contractor Date 7
I am exempt from the licensing requirements as I am a
Plan check fee
licensed architect or 'a registered professional engineer - PLUMBING PERMIT ISSUING FEE$ S d �G
acting in my professional capacity (Section-7051, Bus-
iness and Professions Code). TOTAL FEE11
J O
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name '
S hereby affirm that I am exempt from the Contractor's Address -
License Law.for the following reason (Section. 7031.5, Busi- Ciry - - Tel.No.
ness and Professions Code): - - _ ag 3 3 6 6 A-
❑ 1, as owner of the property, am exclusively contracting
with licensed contractors to construct the project # a o o a 5
(Section 7044; Business and Professions Code). -
2 a:• 1 650
CONSTRUCTION LENDING AGENCY
I heretiy affirm that there is a.construction lending agency - ^ • > 1 6 5 0
for the performance of the work for which this permit is
issued(Sec.3097,Civ.C.). Q 3.2 3'--8'2
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and tate.laws regulating Plumbing, and hereby
authorize repres tativ¢ of this County to enter upon the '
abo -me lone prope t for inspection purposes. -
_
tg ature rf ermittee. Date
C�a
COUNTY-OF LOS ANGELES TEMPLE CITY N 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1203280032
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA.91780 ,
PHONE: (626) 285-0468 EXT:
(LEGAL ID: FEES PAIDBUILDING ADDRESS11 :
ITR: 9981 LT: 16 UN: .002 I 9838 LA ROSA DR I
IEEE DESCRIPTION: QUANTITY: DOE: AMOUNT:( TEMP CA 917803920
ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
8589-022-014 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
I 107 BATHTUBS/SHOWERS 3.00 FIX 48.60 1 1
(TENANT: 121 HOSE BIBB(S) 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY:
1 125 LAVATORIES/SINKS 4.00 FIX 64.80 103/28/12 SR
1 145 WATER CLOSET/URINAL 3.00 FIX 48.60 1
1OWNER: TEL. NO: 147 WATER HEATER(S) 1.00 WTH 16.20 _i FI AL%ATE Fdoff I,�BY: CODE:
I WU, ZI DING (626) 487-2884- 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 1 ,/lypl'/1
19898 LA ROSA DR TOTAL FEES_ 238.40
ITEMP 917803920 1 IDES RIPTION OF WORK
PLUMBING FOR KITCHEN, 2 BATHROOMS, WATER HEATER AND GAS LINEI
(APPLICANT: TEL. NO: „I I
ITRINH, BEN (626) 864-2372- ' 1
1813 PONTENOVA AVE SPECIAL CONDITIONS:
HACIENDA HIS 91745 1
I I
CONTRACTOR: TEL. N0:
(APPROVALS DATE INSPECTOR SIGNATURE
WU, ZI JING (626) 487-2884-
19838 LA ROSA DRIVE LIC. NO (UNDER SLAB'WORK
ITEMPLE CITY, CA 91780 NONE 1 1 1
IWATER SERVICE
PLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER: TEL. NO: I ITRINH, BEN (626) 864-2372- 1 IROUGH PLUMBING II 1 1
1813 PONTENOVA AVENUE LIC. NO: 1 1
(HACIENDA HTS, CA 91745 NONE (GAS PIPING
IGAS VENT
IHOT WATER HEATER
I
1 1 (PLUMBING FIXTURES I 1
LAWN SPRINKLERS
I I I
(GAS TEST
(UTILITY COMPANY NOTIFIEDI
Gw
GRAY WATER SYSTEM
I I I
I I I I I I
1 I I I I
I I I I I
IREPORT ID: DPR263 ROUTE TO. BS0508
I I I I I I
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1210150018
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
1LEGAL ID: FEES .PAID BUILDING ADDRESS: 1
TR: 9481 LT: 16 UN: .002 9836 LA ROSA DR
1FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: I TEMP CA 917803920
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
8589-022-014 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
1 107 BATHTUBS/SHOWERS 1.00 FIX 16.20
ITENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 1TSSUED ON: PROCESSED BY: PLAN BY:
1 145 WATER CLOSET/URINAL 1.00 FIX 16.20 110/15/12 SR 1
1 I TOTAL FEES 76.40 1 1
10WNER: TEL 110: 1FIZIA�LDATE Y: CODE:
1WU, ZI JI (626) 487-2884- 1 ,` ���
19898 LA ROSOS H DA
1TEMP 917803920 1 DESCRIPTION OF WORK 1
REPLACE BATHTUB/SHOWER, LAVATORIE AND WATER CLOSET FOR
1REMODEL (E) BATHROOM 1
1APPLICANT: TEL. NO: 1
SAME AS OWNER _
SPECIAL CONDITIONS:
I
� I
1 1
CONTRACTOR; TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE
1SAME AS OWNER -
LIC. NO 1 1UNDER SLAB WORK 1 1
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
1TRINH, BEN (626) 864-2372- 1 1ROUGH PLUMBING 1
813 PONTENOVA AVENUE LIC. NO:
HACIENDA HTS, CA 91745 NONE 1 1GAS PIPING
1GAS VENT
I I I
1HOT WATER HEATER 1 1 1
PLUMBING FIXTURES 1
1
1LAWN SPRINKLERS
ISAR TEST
1 1
1UTILITY COMPANY NOTIFIED 1 1
GWV
-1-1-
GRAY WATER SYSTEM
I I 1 I 1 I
I I I I
I 1REPORT ID: DPR 263 ROUTE T0: 850508