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76X667-CE4817 6-65
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES 71
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING6 •. j
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS �jt A rl V c
COLEMAN W. JENKINS. SUPT OF BUILDING LOCALITY t I L t
FOR APPLICANT TO FILL IN NEAREST p (�
CROSS ST. CAD - --l-L (L�Q
NUMBER FIXTURE OR ITEM EACH FEE L
OWNER /`�L'Z.,A;e 6R
WATER CLOSET ) 31.25 MAIL /
Bmv-zuB Urn)a/ 1.25 / a� ADDRESS 3 'D
C
uy
SSR E 1.25 J/" CITY b r � TEL. NO. �: -3
3 LAVATORY 1.25 �� CONTRACTOR r
f SINK 1.25 a5 ADDRESS77 cb l
DISHWASHER 1.25 CITY till Lc t ` TEL. NO. Lf-d 0.7
SATELAUNDRY TUB 1.25 / p�_5 LICENSE NO. �' LIC, ' (,` CLASS G �'
CLOTHES WASHER 1.25 DISTRICT NO. GROUPZQNE PROCESSED BY
/ WATER HEATER 1.50 6C f/^�-- Z
GAS SYSTEM OUTLETS 1.50G INDUSTRIAL a
WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U
0
F-
U
W
CL
cn
Z
APPROVALS DATE INSPECTOR' SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
/
TOTAL FEE ��� ROUGH PLUMBING.
i
GAS PIPING
I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING.
I HEREBY CERTIFY THA 6K-_49_GISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REBED Y LOS ANGELES COUNTY -A", TATE OF
CALIFORNIA THAT I AM THE LEGAL OWNER OF,AND IN TO GAS TEST
RESIDE I HE ABOVE DESCRI D UTILITY CO. NOTIFIED
SIGNATU
OF PERMITTEE
FINAL
CALIDATION
CK. M.O. CASH
L., 4477 AUG 31 5 D 17.50-
WORKERS'COMPENSATION DECLARATION APPLICATION
PPLIC/�TION FOR PLUMBING
PERMIT
I hereby,.�affirm that I have a certificate of.'consent to self in- 76A66�A PW a/87 M \e/`1 8\ll ® e �J11WI1 irQ7 PERMIT
�Lw 6r a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86)
certified copy thereof (Sec. 3800, Lab. C.
Policy No. oZ Compo COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING +�/O
Certified copy is filed with the county'building'inspection NUMBER FIXTURE OR ITEM ADDRESS (�
department. @ FEE LOCALITY
Date ._4d Applicant , ,�i WATER CLOSET(TOILET) ,70 oZ O NEAREST dr
�/ BATH TUB CROSS ST. "
CERTIFICATE OF EXEMPTION FROM WOR S' (`
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY p29 O ADDRESS Adr_ _ It:.c..tJ
I certify that in the performance of the work for which this per- J! SINK
mit is issued, I shall not employ any person in any manner so o CITY TEL. NO./ _'
as to become subject to the Workers'Compensation Laws. DISHWASHER _ Co
CONTRACTOR Of
Date Applicant CLOTHES WASHER /A
NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS 30 L:—�C�es �'
emption,you should become subject to the Workers'Compen- SWIMMING POOL'RECEPTOR �
sation provisions ofithe Labor Code,you must forthwith comp- CITY TEL. N0.�6�
P Y P LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC. �i
ed.' / WATER HEATER �® LICENSE NO. , CLASS Ol
LICENSED CONTRACTORS DECLARATION DISTRICT NO. CESSED BY
I hereby affirm•that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �� ✓rte t��
d Professions Code, and my license is in full force andfef- 5 PER SYSTEM FINAL Y¢ VALIDATION a
fe
License Numbe
�oZ rs Lic. Class `' `' DATE
FINAL W
Contractor -ss p BY
❑ r� O
I am exemp under Sec. W
B.&P..C. for this reason ® U)
Plan check fee �
Date: PLUMBING PERMIT ISSUING FEE$ �� Q
_ Signature
TOTAL FEE cg
' SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant `�
I hereby affirm that I am exempt from the Contractor's License Name
Law for the following reason (Section 7031.5, Business and
Professions Code): Address
I, as owner' of the property, will do the work and the City Tel. No. ,-
structure is not intended or offered far sale(Section 7044, i i E1 i
Business and Professions Code). ® °' -'i
IUiHIL , 30
CONSTRUCTION LENDING AGENCY
40
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued ':i `)f''3= 4111_'
(Sec. 3097, Civ. C.).
Lender's Name L)`►U.�"i
Lender's-Address E•-ti_'
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 mentioned properT r for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of,Per itte ate
WORKERS'COMPENSATION DECLARATION I APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self '20-0026 DPW 6/87 �j
Insure, or a certificate of Workers'Compensation Insurance, 7GA667A lul
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS
P cY��o.� & 2 7�9tyyompanyo::�'�d eeO
Certified copy is hereby furnished. BUILDING
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS
Certified copy is filed with the county building inspec-
tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date
--�� APPIi4ant WATER CLOSET NEAREST �•
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. p 1 �yQ L00$ .&w.�S
COMPENSATION INSURANCE SHOWER OWNER U�/_,,0 / ,,) ®o e0kol,
(This section need not be completed if the work involved by i MAIL
the permit is for one hundred dbllars($100)or less.) LAVATORY ADDRESS /,6os- 11D• G. S/._
-100-Bo
I certify that in the performance of the work for whichT this D
permit is issued, I shall not employ any person in any manner SINK CITY Y'0S ���� TEL.NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR ,OcS 0 e
Date Applicant ,CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of
Exemption, you should become subject to the Workers' I SWIMMING POOL RECEPTOR CITY -�
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM ss ��i �' TEL. NO. 6r
with comply with such provisions or this permit shall be STATE LIC. /ar
deemed revoked. WATER HEATER LICENSE NO. •as �76 6 CLASS C-?-
LICENSED CONTRACTORS DECLARATION GAS SYSTEM OUTLETS DISTRICT NO. � PROCESSED BY
I hereby affirm-that I am licensed under provisions of Chapter 9 O�
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force a'Zeffect. 5 PER SYSTEM. FINAL VALIDATION C
DATE
License Number 7 5V� 6 6-1.1r. Class C,
// FINAL
ContractorQC"140 /f� to �r:2--92— BY' 11Z
❑ I am exempt under Sec. i W
B.B,P.C. for this reason
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$ 7S_
Signature TOTAL FEE
Plan check applicant &r.r.`s
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address 4".
Law for the following reason (Section 7031.5, Business and L,E113
Professions Code): ; Cit Tel. No.
I, as owner of the property, will do the work and the y ;I"I I (_
13m30
strurture is not intended or offered for sale Section -CHECK 39.K;
7044, Business and Professions Code). "
CHANGE .60
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.). ll l�•s Zi '_�: `_
tl : 1 Aii12 x."23
Lender's Nome
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
above-mentione p ty f nspection purposes.
� SEE REVERSE FOR EXPLANATORY LANGUAGE1-7—J?
u,
7,gnature/ cff fermittee Date
` COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0408020008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 ;.
PHONE: (626) 285-0488 EXT:
E L ID: FEES PA yy BUILDI G ADDRESS:
TR: 6561 LT: 441 BL: .001 I 9810 LAS TUNAS DR
FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA,917802208
ASSESSOR INFORMATION NU.4LIER: i NEAREST CROSS STREET: GOLDEN WEST
8587-027-027 01 PERMIT ISSUANCE FEE 27.75 ff THOMAS PAGE: 597 GRID;_.A3 LOCALITY: TEMPLE CITY, C
25 LAVATORIES/SINKS 6.00 FIX 97.20 f
TENANT: 45 WATER CLOSET/URINAL 3.00 FIX 48.60 ISSUED ON: PROCESSED BY: PL EXPIRES
HEALTHCARE PARTNERS TOTAL FEES 173.55 ` 08/02/04 JK 01/29/05
OWNER: TEL. 0: FINAL DATE —FINAL -BY: ODE:
SNI JR-MING;YU-HUEI (626) 446-9788-
2005 TERRA LN 1-200
ARCD 910078141 DESCRIPTION OF WORK
TENANT IMPROVEMENT - RELOCATE PLUMBING FIXTURES
APPLICANT: T .
WAY (661) 269-0639-
1301 CHELTEN WAY SPECIAL CONDITIONS:
PALMDALE 93551
CONTRACTOR: TEL. NO: APPROVALSDATE INSPECTOR SIGNATURE
R-WAY PLUMBING (661) 267-0639-
1301 CHELTEN WAY LIC. NO UNDER SLAB OR
PALMDALE, CA 93551 472892C36 '
WATER SERVICE
PLASTIC YIN METAL YIN
ARCHITEC OR ENGINEER:- TEL. NO:
ENVISION ARCHITECTURE (310) 839-7515-1 ROUGH PLUMBING
3647 KALSMAN DR., #1 LIC. NO: '
LOS ANGELES, CA 90016 NONE MS'PIPING
:IAS VENT
HOTTA! TE R
PLUMBING FIRo
LAWN SPRINKLERS
GAS ST
UTILITY COMPANY-NOTIFIEff
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508