HomeMy Public PortalAbout6418 LIVIA AVE_Plumbing__ M%7-=17-I1-57
APPLICATION FOR PLUMBING PERMIT 1 -
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER tG
BUILDING AND SAFETY DIVISION BUILDING /, T y0 �. �� ��A V�
JOHN A. LAMBIE, County Engineer ADDRESS '�
CASSATT,D. GRIFFIN, Supt of Building iN1 r-
T 77,57-
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
HOSS ST. L L
NUMBER FIXTURE OR ITEM
WATER CLOSET '
OWNER
BATH TUB ADDRESS
SHOWER CITY lj (� TEL. NO. 10
LAVATORY* CONTRACTOR
SINK ADDRESS
DISHWASHER CITY TEL. NO.
CONTRACTOR'S STATE ❑
LAUNDRY TUB REGISTRATION NO. COUNTY
CLOTHES WASHERGROU ZONE n READY FOR INSPECTION
DISTRICT O:
WATER HEATER 9 �r
GAS SYSTEM INDUSTRIAL
WASTE APPROVAL
INSPECTION RECORD
APPROVALS
/ @ O$�PERUREEM $ l� V DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 00 ROUGH PLUMBING
TOTAL FEE GAS PIPING — `
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY �7J�J/ n-,�/ryY._�,_1
SIGNATURE (--� �� CS q 12�I�I,XJ
IG ATURETE FINAL
ROBERT A WOOD.
OF DATION SUPERVISING_ MECHANICAL ENG'R
CK M O CASN
UG 2 9-0 8-1 t-tAR 2 5 A 3.0.0 >:
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I ,�-� ,
y WORYER'S COMPENSATION DECLARATION 240026 DPW 9/89
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I hereby affirm that I have a certificate of consent to self insure, 76AG67A -AP�LBCAT�ON FOR PLUMBING PEWT�
or a certAcate'of Worker's Compensation Insurance, or a certrtied
copy thereof(Sec 3800 Lab C),
31803011 Valle �y�w�e COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS I DEPT. OF)PUBLIC WORKS DIV. '
Policy No Company y ri
❑ Certified copy is hereby furnished l FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING y /
Certified copy is bled with the county building inspection ADDRESS 6420 L1V1
department NUMBER FIXTURE OR ITEM ® FEE LOCALITY Temple City
O '
Date 1 wen Bros. Plmb Applicant WATER CLOSET 157 1 NEAREST
CROSS ST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION INSURANCE ASSESSOR ��•p�MAP BOOK PAGE D/� PAR ' n�J P
(This section need not be completed if the work involved by the SHOWER S ..JJdd 7 �C
permit Is for one hundred dollars($100)or less.) LAVATORY OWNER`J 1 /QGf7�0, 7E o
I certify that in the performance of the work for which this permit
MAIL
is issued, I shall not employ any person in any manner so as to SINKADDRESS
become subject to the Workers'.Compensation Laws
t DISWASHER S S CITY TEL 144
Date Applicant I CLOTHES WASHER
NOTICE TO APPLICANT If, after making this Certificate of_ CONTRACTOR Owen Bros. Plumbing, Inc
Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS
provisions of the Labor Code, you must forthwith comply with such 4265 N. Baldwin Ave
provisions,or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION I S CITY TEL d
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER El Monte "$43-0078
-STAT
(commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS ( LICENSE NO '221-741 c6-20-16
Professions Code, and my license is in full force and effect
OUTLETS OVER DISTRICT NO PROCESSED BY T_
r�.� 5 PER SYSTEM
231-741 Od
License Number Lic Class+-•-6-20-16 I G� U
FINAL VALIDATION W
Contractor / Bros. P 9-30-95 DATE CD
ElI am exempt under Sec. BY AL Z
B&P C for this reason
Date
Plan check fee Signature -
PLUMBING PERMIT ISSUING FEE$
El Plan
FEE 5
Plan check applicant r
SINGLE FAMILYIj s$�
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031 5, Business and Professions Address
Code)
- City Tel No
❑ -
I,as owner of the property,will do the work and the structure
is not intended or offered for sale (Section 7044, 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 above-mentioned
pro arty for_s purpo s- SEE REVERSE FOR EXPLANATORY LANGUAGE
natu a of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1012010009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID FEES PAID BUILDING ADDRESS I
ITR 12504 LT. 21 1 6420 LIVIA AV 1
1 IFEE DESCRIPTION QUANTITY. UOM AMOUNT I TEMP CA 917801329 1
ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET LONGDEN 1
15382-018-008 101 PERMIT ISSUANCE FEE 27 80 I THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, Cl
1 126 MISCELLANEOUS FIXTUR 1 00 FIX 16.30 I
ITENANT. I TOTAL FEES 44.10 (ISSUED ON PROCESSED BY- PLAN BY I
12/01/10 SR
(OWNER TEL. NO IFINAL DATE FINAL Y CODE
IMCCLANAHAN, CINDY (626) 826-1060- 1 '^�)
16420 LIVIA AV 1 v
1TEMP 917801329 1DESCRIPTION OF WORK
I
11NSTALL CLEAN OUT 1
(APPLICANT TEL NO 1 1 I
IRESCUE ROOTER (626) 858-9284- 1 I I
1475 E ARROW HWY 1 ISPECIAL CONDITIONS I
1AZUSA, CA 91702 1 1 I
ICONTRACTOR TEL NO I JAPPROVALS1 DATE INSPECTOR SIGNATURE I
IA R S RESCUE ROOTER (626) 858-9284- 1 1 I
1475 E ARROW KWY LIC NO 1 1UNDER SLAB WORK I 1 1
IAZUSA, CA 91702 765155 C36 1 I I 1 I
I 1 IWAThR SERVICE
1 1 1PLASTIC Y/N METAL Y/N 1 1 1
(ARCHITECT OR ENGINEER TEL NO 1 I I I
I - 1 IROUGH PLUMBING I I 1
LIC NO i I_
GAS PIPING
1 i 1GAS VENT 1
I 1 IHOT WATER HEATER 1 1 1
1 I I
I 1 IPLUMBING FIXTURES 1 I 1
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1 I LAWN SPRINKLERS I 1 I
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1 1 IGAS TEST 1 I I
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1 I 1UTILITY COMPANY NOTIFIEDI I I
1 1 ICWV I I I
IGRAY WATER SYSTEM
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REPORT ID DPR263 ROUTE TO. BS0508 I I I 1
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