HomeMy Public PortalAbout6452 LIVIA AVE_Plumbing__ P.B.173.41 25M APPLICATION FOR PERMIT
-DEPARTMENT OF BUILDING AND SAFETY _ ��������
COUNTY OF LOS ANGELES
WM. J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO.
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ROUGH sr-,
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PLUMBING FIXTURES COMPLETE -
R _ Y READY FOR DATE ISSUED
HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION
GAS MISCELLANEOUS
APPLICANT FILL Ily HEAVILY OUTLINED PORTION ONLY
6' JOB
G NAME ADDRESS
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ADDRESS I / LOCALITY
NEAREST
-I CITY /YJ TEL. CROSS ST.
IL
COUNTY
CERT.No. EXPIR IC• NAME
MAIL
LOCATION OF SEPTIC TANS, OR CESS_OOL 3 ADDRESS
NORTH 0
• CITY TEL.No.
IAM THE LEGAL POSSESSOR OF THE ABOVE- LOS
ANGELES COUNTY CERTIFICAT OF ,IJ ALIFICATION
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PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
_ - ABOVE. -
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3 i OWNER
CORRECTIONS
SOUTH J
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DESCRIPTION OF WORK Z
BATH TUB FURNACE a
HOWER DISHWASH,ER-
___a,.LAVATORY - REFRIGERATOR _
KITCHEN SINK WATER SOFTENER' - -
FLOOR SINK SAND TRAP
SLOP SINK FLOOR DRAIN _
WASH TRAY URINAL APPROVALS }
WATER CLOSET DRINKING FOUNTAIN DATE,�-1cy�. INSPECTOR'S
_WATER,HEATER - DENTAL LAVATORY ROUGH PLUMBING
METE Rc GAB SODA FOUNTAIN GAS PIPING -
/ OUTL
GAS VENT
CESSPOOL
TOTAL NUMBER OF FIXTURES Q0 SEPTIC TANK
CESSPOOL SEPTIC TANKF SEWER
$ UTILITY CO. NOTIFIED r
TOTAL FEE 1_6 = FINAL
D B S-17 25M SETS 12-45 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBmw
Wm: J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO GROUP 1 '4_�
ZONE PERMIT NO.
ROUGH FIXTURES COMPLETE �.P� 77
HEATER CESSPOOL I I SEPTIC TANK 6RfEIV SN READY FOR DA EISSUED
FIR8T1 PECTIONGAS MISCELLANEOUS � I `�
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
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NAM !o ��//
ADDRESS iJ )
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ADDRESS �(� r / _ LOCALITY ,4
NEAREST �D
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CITY Ate__14 j`��TEL.No. CROSS IT. l /
COUNTY
• CERT No. EXPIRESm I NAME v
LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL
3 ADDRESS _
NORTH O
CITY PEL No
I AM THE LEGAL POSSESSOR OF THE ABOVE LOS
• ANGELES COUNTY CERTIFICAT OF Q0kLIFICATION i
PLUMBER i
I AM THE LEGAL OWNER OF THE PROPERTYDESCRI®HD
ABOVE.
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owN®I
CORRECTIONS
SOUTH
a
DESCRIPTION OF WORK
ATH TUB FURNACE
H
SHOWER DISHWASHER 0
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
LOP BINK FLOOR DRAIN ♦ G.
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN ., DATE INSPECTOR'S NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
METER GAS SODA FOUNTAIN GAS PIPING
OUTL
GAS VENT J +
CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOI SEPTIC TANK ®� SEWER I I
� v
UTILITY CO.NOTIFIED
I TOTAL FEE
C FINAL
- --NORKERS'COMPENSATION DECLARATION AP UCA 11 OON FOR PLp v�� Nr, PERMIT
'rhereby affirm that I have a certificate of consent to self 76A667A USI PERMIT �s 3
irisu(e,,ora ertificate of Workers'Compensation Insurance, CE 817'(REV 10/81)
or a certifiecTcopy thereof (Sec 3800, Lab C ) OUNTY OF S ANGELE,§ BUILDING AND SAFETY
Policy No- 4.,e
y ¢
❑ Certified copy i nished as
❑ FOR APPLIC TO IN(PRINT R TYPE) BUILDING /
Certified copy the county building inspec- ADDRESStion deparimeNUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date WATER CLOSET NEAREST ZV
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST
COMPENSATION INSURANCEOWNER
(This section need not be completed if the work involved by SHOWER
the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL
ADDRESS
1 certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK' CITY �� TEL
so as to become subject tothe W2-lid,
rsmpensation Laws DISHWASHER
CONTRACTOR
Date Applicant t CLOTHES WASHER )+ a
ADDRESS
NOTICE TO APPLICANT If, after making this Certificate of v
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY EL NO
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC
deemed revoked WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �JJ (Vf�O >_
and Professions Code,and my license is in full force and effect 15 PER SYSTEM FINAL ALIDATION 0'
DATE O
License Number �2 � Lic Class ✓ V
FINAL
Contractor Date BY O
❑ 1 am exempt under Sec tU
B &P C for this reason H
Plan check fee ' ® �
42 f�7
�) r
to PLUMBING PERMIT ISSUING FEE$ w
Signature
TOTAL FEE
Plan check applicant 0 b 7,
SINGLE FAMILY #!
HOME OWNER-BUILDER DECLARATION Name i 0
1 hereby affirm that I am exempt from the Contractor's License 21 7
Address
Law for the following reason (Section 7031 5, Business and
Professions Code) City Tel No
❑ 1, as owner of the property, will do the*;W
structure is not intende r e fo
7044, BusineWaI4
� fe
S L ct AGENCY
I m hat t ere 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 DP
ordinances and State jaws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-menti: property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permitt&e Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0109120026
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING .
TR: 12504 LT: 16 6452 LIVIA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801329
ASSESSOR NEAREST CROSS STREET:
5382-018-004 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY
13 DISHWASHERS) 1.00 FIX 16.20
TOTAL FEES 43.95 0 S .
09/12/01 UT 03/11/02
OWNER: TEL. NO: FINAL DATE FI AL CODE:
LUND PAUL A;SHARON C (818) 285-6738- �� v
6452 LIVIA AV
TEMP 917801329 DESCRIPTION
DISHWASHER INSTALLATION
APPLICANT: . NO:
D ANH SERVICES (818) 343-4009-
6029 1/2 RESEDA BLVD SPECIAL CONDITIONS:
TARZANA CA 91356
CONTRACTOR: TEL. NO: �®a G� APPROVALS DATE INSPECTOR SIGNATURE
D AND H SERVICE (818) 343-4009-
6029 1/2 RESEDA BL LIC. NO UNDER SLB WORK
TARZANA CA 91356 704779 C36
WATER SERVICE
A/ PLASTIIC Y/N METAL Y/N
ARCHITECT R G L. /
ROUGH PLUMBING
GAS PIPING
GAS VENT
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GAS TEST
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GRAY WATER SYSTEM
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REPORT ID: DPR263 ROUTE TO: BS0508
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