HomeMy Public PortalAbout9922 LA ROSA DR_Plumbing__ -76A66+ U6519 11-50 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY �'
COUNTY OF LOS ANGELES ta6
WILLIAM J. FOX, CHIEF ENOINEER
FOR APPLICANT TO FILL IN '
PLUMBER Plumbers RECEIVED BY READY FOR DATE ISSUED
�f
FIRST INSPECTION
ADDRESS 82 East Broadrni
of BUILDING
CITY TEL No. 10385 ADDRESS Temple City Avenue
COUNTCOUNTY LOCALITY 1 e1 ple W�ty
Y NO. E%FIRES 6 A2
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER Grover Piaul@ "
MAIL
WATER CLOSET(TOILET) @ O.SO ® A0 ADDRESS
BATH TUB ® 0.50 O CITY TEL. No.
SHOWER @ O.SO 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN)_ 0 D.SO O APPLICATION AND STATE,THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK (0 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE•ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL-PROPERTY DESCRIBED ABOVE.
GAS SYSTEM CUTLETS 0 0.501
..,a�}��/p /� /•
SIGNATURE GF% jf / I% Jl�
WATER HEATER @ 0.50 PEIRMITTE
SLOP BINK a 0.50 INSPECTION RECORD
FLOOR SINK 0 0.50
FLOOR DRAIN 0.50
DISHWASHER ® 0.50
DRINKING FOUNTAIN 6 0.50
URINAL O.So
HOUSE SEWER ® 0.90 U
MISCELLANEOUS )1 J
IL
APPROVALS
DATE IN9P// OR'B NAM[
ROUGH PLUMBING / /-2.
SAO PIPING
GAS VENT
CESSPOOL 1:00 CESSPOOL
SEPTIC TANK:
SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 EWER r
PERMIT 1.00 GAB TEST
UTILITY CO.NOTIFIED U'
TOTAL FEE $ S_ nn FINAL 1/0 s
,I
ION
iriiiRS'`haveN5AT1°" DE"ARATent -002
APPLICATION FOR PLUMBING PERMIT
9 rfrt at I have a certificate of consent to self in- + 76A661 DPW 4/87
rfificate of Workers'Compensation Insurance,ora 76A661A
P CE 817 IREV. 8/86)
k _f cgpp thereof (Sec. 3800, Lab..C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy,Mo." "Company
Certified copy is hereby furnished. .
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 6..,
Certified copy is filed with the county building inspection ADDRESS 1
department. NUMBER FIXTURE OR ITEM @ FEE _ LOCALITY
Date Applicant / WATER CLOSET(TOILET) NEAREST '
CERTIFICATE OF EXEMPTION FROM WORKERS' ! BATH TUB J 1 CROSS ST. T ,t
COMPENSATION INSURANCESHOWER rl ,— OWNER (.,/P,yNG G✓/<1 Glt l
(This section need not be completed if the work involved by IF O MAIL u
the permit is for one hundred dollars ($100)or less.) LAVATORY �, ADDRESS 9/ L? �,A /9C+'P U2
I certify that in the performance of the work for which this der-
hi is
er-hiis issued, I shall not employ any person in any manner so f SINK �, CITY M PL E C 1 Ty TEL NO.
\as to become subject to the Workers' Compensation Laws. DISHWASHER
/, CONTRACTOR 6G✓.vE n,_
-Dote –1Y�91 Applicant W e e WflADDRESS
' CLOTHES WASHER
NOTICE TO APPLICANT: If, after t o this Cern koro of Ex- SWIMMING POOL RECEPTOR
empti on, you should become subject to the Workers'Compen- CITY TEL. NO,
sation provisions of the.Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC
ed. WATER HEATER U LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION
I hereby affirm :hot I am licensed under provisions of Chapter GAS SYSTEM OUTLETS D By
r DISTRICT NO. CLOG SEU /// /
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER e
and Professions Code, and m license 1s in full force and el 5 PER SYSTEM
feet, y [FINAL
ATEVALI A ON C
License Number Lic. Class I J O
FINAL
Contractor Date BY O
f
❑ I am exempt under Sec. W
IL
B.BP.C. for this reason Plan check feepop. W
Date: PLUMBING PERMIT ISSUING FEE S J
Signature OTAL FEE
SINGLE FAMILY ty. a
HOME OWNER-BUILDER DECLARATION Plan check applicant Al �t
1 hereby affirm that I am exempt from the Contractor's License Name 373N (Ca Llil
Law for the following reason (Section 7031.5, Business and
I Professions Code): Address 1I IsENIS
RrI, as owner of the property, will do the work and the City Tel. No. TU-At a L-f
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). ► �i-SEltl =''kLl�
CONSTRUCTION LENDING AGENCY C ANNE
I hereby affirm that there is a construction lending agency for -
the performance of the'work for which this permit is issued /^C T
(Sec. 3097, Civ. C.). 0000-13001 .tee 29` 1
Lender's Name b,�'.�i,"'. - L Hyl j:s'•
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 lows regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
\ above-mentioned property for inspection purposes. '
%41...,... �, �� _' 1 y,fy SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign re of Permute Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 C7FUN81_yG_P.ERM IT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS P=0n OOn424Q004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 9481 LT: 19 (9922 L-g-ROSA=DR,
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: T-EMP-EA-977803922'
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BALDWIN
8589-023-005 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20
TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
04/24/00 UT 10/21/00
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
WRIGHT WAYNE A;WANG LUCINDA WEN-HUE (626) 286-6658- PA
�� Fr
9922 LA ROSA DR 7- 21 PA
TEMP 917803922 DESCRIPTION OF WORK
GAS LINE FOR POOL HEATER
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: 5 GEL S (,`o APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO UNDER SLAB WORK
WATER SERVICE
METAL Y/N
ARCHITECT OR ENGINEER: TEL. O: PLAST/
ROUGH PLUMBING
LIC. N0:
1111117 11 GAS PIPING
l�
GAS VENT
Lr U II 11/O� K( �J HOT WATER HEATER /
LS ItJJ V lJ V Ll�l PLUMBING FIXTURES
d 8 x
GAS TEST
❑ � J1�;/ y O � UTILITY COMPANY OTIFIED
o 1 LWV
c Service if n 4L GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508