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Home My Public Portal About4979 LOMA AVE_Plumbing__ 76A667-CE#817 6-65 APPLiCATION FOR PLUMS G PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. ° NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS CITY TEL. NO. 1/ IT e SHOWER 1.25 LAVATORY 1.25 CONTRACT SINK 1.25 ADDRESS DISHWASHER 1.25 CITY L N STATE L C LAUNDRY TUB 1.25 LICENSE NO CLASS CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE P=ESSBY WATER HEATER 1.50 GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a WASTE APPROVAL O OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U 0 H U W O_ N Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING 1 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 THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES ° LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST r CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERMITTEE FINAL DATION CK M O CASH Llo 9 9 4 1 1 FEB 2 3 5 0 3.5- 0- 76A667 OBS 17 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN ISTRO O P Ns— ::;7-- 1 . MI N . PLUMBER /( ,♦ RECEIJE BY FIRSTNSPECTION Y FOR DA IET SBUED ADDRESS .10 //,� AZ CITY TEL No. ADORE �+ ,t�� COUA COUNTY LOCALITY < / 7 LICENSE NO. EXPIRES NEAREST, ♦.e �ry ' PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEEOWNER /tl MAIL WATER CLOSET(TOILET) @ 0.50 $ ADDRESS BATH TUB 0.50 CITY TEL, NO. SHOWER @ 0.50 ..� 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS , LAVATORY (WASH BASIN) O.SOV APPLICATION AND STATE THAT THE ABOVE 19 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 ,� AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT I ,THE ABOVE VALID LOS ' LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER GAS SYSTEM A!� OUTLETS @ 13.5o r lb OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. WATER HEATER @ O.SO �-Z� SIGNATURE DF PERMITTEE "-'d SLOP SINK @ 0.513 INSPECTION RECORD FLOOR SINK (A 13.50 FLOOR DRAIN 0.513 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL 0.50 a HOUSE SEWER @ 0.50 ? MISCELLANEOUS L7 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING A GAS VENT ! W CESSPOOL @ 1,00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) C 1.00 SEWER ♦ iGLsr+•fvw' �i'��C.7/��' PERMIT I 1.00 GAS TEST / UTILITY CO.NOTIFIED 9y+'' I"Irsv TOTAL FEE 160 FINAL v- �. A � WORKERS' COMPENSATION DECLARATION � APP CATPON FOR PLS MMNQ PE RMPT i, 20-0026 DPW 4/87 Il, II�J L�) [� �I'Irerekiy�dffirm•ihat I have a certificate of corisent to self me 76A667A - •• + ' - _ _ _ , • . sure,ora certificate of Workers'Compensation Insurance;ora, CE 17(REV'8%86) - ceft fled copy thereof (Sec 3800,-Lab C ): Y, - + Ai -- a 4 - 4'' _ �� COUNTY OF-LOS ANGELES DEPT OF PUBLIC WORKS Policy,No Company Certified"copy rs hereby furnished'' s FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with•the'county building inspection ADDRESS department ' NUMBER FIXTURE OR ITEM FEE / _17LOCALITY I � CST Y v, WATER CLOSET(TOILET) Q Date- Acca ni NEAREST CERTIFICATE OF EXEMPTION'FROM WORKERS' '- BATH TUB CROSS ST COMPENSATION INSURANCE` -' '• SHOWER.` • ' OWNER' (This section need not'be completed if'the work involved'by ` Lisp MAIL the permit is for one hundred dollars ($100)or less.)' r LAVATORY� p ADDRESS 5441,_ _ I,ceitify that in the performance bf the woWfor'which this,per- mit is issued, I shall not employ any'pers n it any manner so r CITY TEL NO as to become subject to`the Worke?s' mpe sa b Laws DISHWASHER CONTRACTOR ' Date 1 Applicant oel_ CLOTHES WASHER ADDRESS y NOTICE TO APPLICANT If, after:mciking,t"is Certificate of Ex- SWIMMING POOL RECEPTOR empt 0, you-should become subject"to the Workers'Coinpen- CITY TEL NO sation provisions of the-Labor Code,you must forthwith•com'p- - LAWN,SPRINKLER SYSTEM ' ly with such provisions or this permit shall be deemed,revok;, STATE LIC - ed• WATER HEATER '/`, LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO t PROCESSED BY ' I hereby affirm-that I am licensed under provisions of Chapter t. GAS SYSTEM- OUTLETS ?,(Commencing with Section 7000)'of Division 3 of,the Business ' OUTLETS OVER d and Professions Code, and my license ,s in full force and ef- 5 PER SYSTEM FINAL / VALIDATION feet ¢, A� 1, DATE'Al �Z.Z._�2;• License Number Lic ClassiOF rte✓ V FINAL Contractor Date BY Q ElI am exerrpt�under Sec u } W B 8P. C for this reasonN Plan check fee' - - Date. PLUMBING PERMIT ISSUING FEE $ 3 Signature_ ,; - .- • - - TOTAL FEE -SINGLE FAMILY + r \ x� HOME OWNER-BUILDER DECLARATION Plan check appltcarit I hereby offiirr that I am exempt'from the Contractor's License Name '< Law for,'1Fe following reason (Section 7031 5, Business and " Professions Code) Address' I, 'as•owner of tFe property, will'do-the work^and the City f Cl Tel No' structure isnot intehded or,offered for sale(Section 7044` 1 j'IFEj 1 Busiries's and Professions Code) y _ °, CONSTRUCTION LENDING AGENCY � I hereby aff,irm•that there is a construction lending agency for _ �.':' r - . !•Frig K _2.1,111 the.performdnce of the work for which this permit•is issued t; t) iC�;1� ,Itll (Sec 3097,•Civ C ) ,• "Lender's Name '.3 1 Lender's Address I certify that I have read,.this application:and state that the " ry j t # H1 ',d: above information is correctI agree to comply with all County t I ordinances and State laws regulating Plumbing, and hereby authze representatives of this County to enter upon the XIb 'vl�orimentio ed/p-,operty for inspection purposes i SEE REVERSE FOR EXPLANATORY LANGUAGE Signa of Permittee `` Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0901060023 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT (LEGAL ID FEES PAID BUILDING ADDRESS ON FILE 4979 LOMA AV IFEE DESCRIPTION QUANTITY. UOM AMOUNT TEMP CA 917803019 - I (ASSESSOR INFORMATION NUMBER I I NEAREST-CROSS STREET 15388-012-008 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY, Cl 1 147 WATER HEATER(S) 1 00 WTH 16 20 I 1 (TENANT. I TOTAL FEES - 43 95 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON 1 I 101/06/09 SR 07/05/09 1 I I I I OWNER TEL NO I (FINAL DAT `pJ, A BY CODE 14979 LN GEORGE q PIR 1 14979 LOMA AV 1 1 ,a N I ITEMP 917803019 1 IDESCRIPTION OF WORK I IREMOVE/REPLACE GAS WATER HEATER 1 (APPLICANT TEL NO I I I (HOME DEPOT (800) 454-8955- I 112601 132ND AVE NE I ISPECIAL CONDITIONS 1 KIRKLAND, WA 98034 I I I I ) I ICONTRACTOR TEL NO- 1 - (APPROVALS DATE INSPECTOR SIGNATURE 1 IHOME DEPOT (800) 454-8995- 1 1 112601 132ND AVE NE LIC NO 1 (UNDER SLAB WORK I 1 IKIRKLAND WA 98034 602331 1 I I IWATER SERVICE I I I --• I PLASTIC YIN METAL YIN I I 1ARCHITECT OR ENGINEER TEL NO I I I I - I (ROUGH PLUMBING I I I LIC NO 1 1 -1-1 1 1 - IGAS PIPING 1 I IGAS VENT I I I I I I I I HOT,WATER HEATER I I I I I I I (PLUMBING FIXTURES I I I I I I I I (LAWN SPRINKLERS 1 I 1 IGAS TEST I I I I (UTILITY COMPANY NOTIFIEDI I I ru IcWv I I I IGRAY WATER SYSTEM I I 1 I I I ( I I I I I i I I I I I I I I I I I I I I I I I I I I I I i I I I I I I I I I I IREPORT ID DPR263 ROUTE TO BS0508 I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0506 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0704130019 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT. (LEGAL ID: I FEES PAID BUILDING ADDRESS- 1 ON FILE I 1 4979 LOMA AV 1 IFEE DESCRIPTION QUANTITY: UOM AMOUNT: ( TEMP CA 917803019 1 (ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET- SERENO 1 15388-012-008 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE 596 GRID H5 LOCALITY: TEMPLE CITY, Cl 1 147 WATER HEATER(S) 1 00 WTH 16 20. 1 (TENANT I TOTAL FEES 43.95 (ISSUED ON PROCESSED BY PLAN BY: EXPIRES ON- 1 1 1 104/13/07 JK 10/10/07 1 1OWNER TEL NO _ 1 (FINAL DABY CODE. 1 1BERGMAN GEORGE C III,GAYLA J (626) 285-4095- 1EXPIR 14979 LOMA AV I (TEMP 917803019 1 (DESCRIPTION OF WORK 1 1 1 (REPLACE HOT WATER HEATER 50 GAL GAS 1 (APPLICANT TEL NO 1 I I 1EINHORN (866) 293-3031- 1 I 1360 MEMORIAL DR. 140 1 (SPECIAL CONDITIONS: 1 CRYSTAL LAKE 60014 1 I I 1 (CONTRACTOR TEL. NO: 1 - 1APPROVALS DATE INSPECTOR SIGNATURE 1 1PLUMB-IN-TIME (866) 293-3031-1041 1 I 1360 MEMORIAL DR #140 LIC NO 1 1UNDER SLAB WORK I I I (CRYSTAL LAKE, IL 60014 C36 868068 -- I I I I 1 1 IWATER SERVICE I I I 1 1 1PLASTIC YIN METAL YIN I I I 1ARCHITECT OR ENGINEER: TEL NO. 1 I I I I 1 _ I (ROUGH PLUMBING I I I LIC. NO 1 I I I I 1 1 IGAS PIPING I I I 1 1 1GAS,VENT I I 1 I 1HOT,WATER HEATER 1 1 I (PLUMBING FIXTURES I I I (LAWN- SPRINKLERS 1 1 1 1 IGAS TEST 1 1 1 1 1 1UTIL]TY COMPANY NOTIFIED( 1 I CWV i 1 1 IGRAY WATER SYSTEM I I 1 1 I r I I I I I I I I I IREPORT ID DPR263 ROUTE TO: BS0508 1 I I I