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HomeMy Public PortalAbout9926 LA ROSA DR_Plumbing__ e VBS17 APPLICATION FOR PLUMBING PERMIT 1 OBS IT DIVISION OF BUILDING AND SAFETY Deportment of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS CASSATT O,GRIFFIN, SUPT OF BUILDING LOCALITY J:QR APPLICANT TO 'FILL IN NEAREST AV CROSS ST. OWNER `� DISTRICT GRO Z NE IaaAQY FOa 1nsPEciwn MAIL � � I� ! ADDRESS (./(—L/jC/— ��V// CITY C INDUSTRIAL TEL. NO. WASTE APPROVAL PLUMBER �+s�� �Gc ,• (h� INSPECTION RECORD ADDRE..SST)_O� �. + l ) `ROI 1 1 .1�! -F Ga Sz- CITYJTEL. LICENSE NO.� NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 / BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCHEN SINK @ $1.00 ,,/ YJ DISHWASHER _ @ $1.00 4-2--2"(/-3-A� l Ail / 6Pll AfE 1- 7 -1-ItA LAUNDRY TUB OR TRAY @ $1.00 (,rfj,f •T�IRF n/Y ��YR 'ITR• CLOTHES WASHER @ $1.00 WATER HEATER @ SI.00 GAS SYSTEM _ @ $1.00 APPROVALS DATE INSP= G. TURE UNDER.Fa(tgJ�WORK (['!/^� - PERMIT $ 1 00 ROUGH PLUMBING 18 TOTAL FEE GAS PIPING GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY HOT WATER HEATER WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM T LEGAL OWNEROF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDEN PROP 1TY� �' c �� SIGNATUREOF PERM TTE ` FINAL JOHN A. LAMBIE. COUNTY ENGINEER ALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR CK. 0,0 CASH 51 ;68- SEP 2)4 5 A 11 .00 1R 4"A WORKERS'COMPENSATION DECLARATION ]a A6a7A 1 hereby affirm that I have a certificate of consent to self =E $17 (a-aa) APPLICATION FOR PLUMBING PERMIT insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 384Lab. COUNTY OF LOS ANGELES F., BUILDING AND SAFETY Policy No. Company V� 'xE (2471-4Certified copy is hereby furFOR APPLICANT TO FILL IN (PRINT OR TYPE) 1 ILDINGt_ p ADDRESS ��\✓^— c `� Cer)i fiel copy is filed with he o my u di in ection NUMBER FIXTURE OR ITEM • FEE - r nt WATER CLOSET LOCALITY Date Applicant NEAREST '�j �(� (� /� BATH TUB CROSS ST. t_Jl CERTIFICATE EXEMPTION FROM WORKERS' ll'' COMPENSATION INSURANCE SHOWER 'OWNER LAVATORY MAIL (This section need not be completed if the work involved ADDRESS by the .permit is for one hundred dollars ($100) or less.) (e� _ /2 1 SINK lJ� CITY-- TEL. NO. V 9 O I certify that in the performance of the work for which this DISHWASHER 0 permit is issued, I shall not employ any person in any manner CONTRACTOR so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS , O Date Applicant 1- SWIMMING POOL RECEPTOR n U NOTICE TO APPLICANT: If, after making this Certificate of CITY iPE� TEL. NO. L— LU Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE /1/10,/(� LIC. U3 Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO.oOO o /6 CLASS Z with comply with such provisions or this permit shall be — deemed revoked. DISTRICT NO. C SED BY GAS SYSTEM OUTLETS /�, p, ,Q� rp LICENSED CONTRACTORS DECLARATION OUTLETS OVER I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Busi- FINAL frt� q FINAL ness and Professions Code, and my license is in full force and S VSn�� 0© DATE ^�� —(�U` VA 3 LIDAT N effect. FINAL License Number« ` .Class ` By �r Contractor _ 1 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE 13 Lie.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031.5, Busi- City Tel.No. ` 3 2 5 7 A ness and Professions Code): - El 1, as owner of the property, am exclusively contracting # 5 with licensed contractors to construct the project (Section 7044, Business and Professions Code). 2 n a 1 3 0 0 CONSTRUCTION LENDING AGENCY e o 0 1 3005 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.). .( Z 0 1 —80 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 State laws regulating Plumbing, and hereby authorize representatives of this County to ente upon he above-me imrFTI!rTope for inspectio p rpose Signature of Permittee Da COUNTY OF LOS ANGELES TEMPLE CITY k 0508 PLDMBING PERMIT - DEPARTMENT OF PUBLIC WORKS 9901 LAS TUNAS PL 0508 0701240003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITS: 9481 LT: 20 ON: .003 1 1 9926 LA ROSA DR I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917803922 I ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: AGNES 18589-023-006 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl 147 WATER HEATER(S) 11.00 WTH 16.20 1 I TENANT: I TOTAL FEES 43.95 TISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 101/24/07 JK 07/23/07 I I TOWNER: TEL NO: (FINAL DP.TE `�/, L1 ■BY: CODE: SAGAMI ANDREW J;ROBERT J (626) 286-9249- 1 1 19926 LA ROSA DR. ITEMP 917807406 - IDESCRIPTION OF WORK IWATER HEATER CHANGE OUT IAP PLICANT: TEL. NO: IRICHARD LA PAGE 1760) 219-0909- I 1SPECIAL CONDITIONS: II II 1 1 I 1 I (CONTRACTOR: TEL NO: .(APPROVALS DATE INSPECTOR SIGNATURE ALL PRO PLUMBING CORP (909) 615-3330- 112023 ARROW RTE LIC. NO (UNDER SLAB WORK IRANCHO CUCAMONGA CA 91730 778137 C36 I T (WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: II I I I _ IIROUGH PLUMBING LIC. NO: T (GAS PIPING GAS VENT IHOT WATER HEATER . (PLUMBING FIXTURES (LAWN SPRINKLERS I (GAS TEST pTI LI TY COMPANY NOTIFIED( I i ICWVI I I GRAY WATER SYSTEM I I I I II II 1 I I I I I I I I I I I I I I I II I II 11 I I I I I REPORT ID: DPR263 ROUTE TO: BS0508