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HomeMy Public PortalAbout5303 LOMA AVE_Plumbing__ 76AG67 (CE-817) - 1/75 APPLICATION FOR PLUMBING PERMIT {� COUNTY OF LOS ANGELES LJ DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO ADDRESS � � HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST CROSS ST L NUMBER FIXTURE OR ITEM @ FEE /� 2 0 OWNER N So 13FiQ Ts WATER CLOSET o MAIL BATH TUB 2. 0 ADDRESSJf'Cl SHOWER 2 p CITY TEL. NO C LAVATORY 2 0 CONTRACTOR SINK 210 ADDRESS DISHWASHER 2 1 0 CITY EL NO. CLOTHES WASHER 2 0 STATE LIC LICENSE NO CLASS SWIMMING POOL RECEPTOR 2.40 DISTRICT NO GROUP ZONE PROCESSED BY LAWN SPRINKLER SYSTEM 2 p Q � WATER HEATER 2 0 INDUSTRIAL WASTE APPROVAL pr GAS SYSTEM OUTLETS 2 0 INSPECTION RECORD U s OUTLETS OVER 0 O 5 PER SYSTEM H U W N a Plan check fee See Reverse r F PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE APPROVALS DATE INSPECTOR S SIGNATURE Plan Check applicant UNDER SLAB WORK k Name ROUGH PLUMBING Address GAS PIPING City Tel NO GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ •THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES , WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT F AM PROPERLY REGISTERED AND/OR 1 UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF / CALI FORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENT 1111A AOPERJrP:i'� A FINAL SIGNATUREUC, rv�� r OF PERMITTEE �/ PERMIT VALIDATIONM,O. CASH PLAN CHECK VALIDATION CK M.O. CASH 5.0 3-JUN 2 5 U 4.7 5 e�16 76A667 (CE-817) - 5/73_ APPLICATION R -PLUMBING'- PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION " MAKE CHECKS PAYABLE TO ADIDRESS �} Q 17(:--z- -L7,n� � '1 r HARVEY T. BRANDT, COUNTY ENGINEER, LOC'ALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST © t CROSS ST NUMBER 'FIXTURE OR ITEM @ FEE _ WATER CLOSET 1.75 •75 t`��' i •�t O OWNER b MAIL BATH TUB 1,75 ` 7 ADDRESS �n SHOWER 1.75 CITY"t6Ty\,j ITEC NO' '7 >]`� LAVATORY 1.75 CONTRACTOR SINK 1.75 ! ADDRESS DISHWASHER 1.75 CITY TEL NO CLOTHES WASHER 1.75 ` STATE LI,C LICENSE NO r CLASS SWIMMING POOL RECEPTOR 1.75 DISTRICT 'GR ZON P O ESSE Y LAWN SPRINKLER SYSTEM ' 1.75 OC/ V WATER HEATER 1.75 ?� INDUSTRIAL WASTE APPROVAL GAS SYSTEM. OUTLETS 1,:75 7� INSPECTION RECORD OUTLETS OVER 30 - 5 PER SYSTEM • � r O Cn Plan check fee See Reverse PLUMBING PERMIT'ISSUING FEE $ 3 00 TOTAL FEE /„S APPROVALS DATE SPECTOR S SIGNATURE Plan check appllcanf UNDER SLAB WORK Name ROUGH PLUMBING t / x4x4w�? Address r GAS PIPING City Tel NO, GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS,APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ' PLUMBING - GAS.TEST _ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR TH:1A HE LEGAL OWNER OF, AND INTEND TO RESIDE IN THE ABOBED R SIDENTIAL PROPERTY FINAL - SIGNATURE . r • j/!�/' ,� Gl OF PER MITTE ///��' `� PERMIT VA D TION cK M.o CASH PLAN CHECK VALIDATION CK Ni 0 CAS 5. 5•�,1UN 1.7 �, .1 5.2 5 DO-S 7GA667 17 5-49® APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN�/�v DISTRICT NO. GROUP ZONE PERMIT NO. PLUMBER �j �� `.(9 RECEIVED BYREADY FOR, DATE ISSb!ED FIRST INSPECTION (/'� ADDRESS S 16 ' " 1'-3— pyv�i- aS ADDRESS BUILDING CITY TEL NO. I, COUNTY / '^ LOCALITY sr/h e, u •.� LICENSE NO. 1 EXPIRES 6 NEAREST PERMIT FEES CROSS ST. OWNER J-1 _D OQJ� NUMBER TYPE OF FIXTURE OR ITEM FEE MAIL WATER CLOSET (TOILET) @ O 50 $ ADDRESS e BATH TUB O 50 CITY TEL NO. AN 4 s'd SHOWER O s0 1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) Q O s0 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN SINK Q 0.50 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ O s0 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER -OF THE RESIDENTIAL PROPERTY D SCRIBED ABOVE. GAS SYSTEM OUTLETS Q O 50 SIGNATURE OF WATER HEATER Q O s0 PERMITTEE SLOP SINK Q o so INSPECTION RECORD FLOOR SINK @ O 50 FLOOR DRAIN @ 0.50 DISHWASHER @ O 5o DRINKING FOUNTAIN IQ O 50 URINAL Q O s0 �J HOUSE SEWER @ O 50 Q z_ MISCELLANEOUS UI 0 l APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING I I GAS VENT CESSPOOL @ 100 CESSPOOL SEPTIC TANK- SEPTIC TANK I DRAIN ( ) PIT ( ) Q 1 00 SEWER PERMIT . . I 1.00 GAS TEST ) UTILITY CO. NOTIFIED �s-o TOTAL FEE $ FINAL � T' 2-47 APPLICATION FOR PERMIT D 85.17 25M�"'r DErENT OF BUILDING AND SAFETY'• OUNTY OF LOS ANGELES PLUMBING WM.J. FOX,CHIEF ENGINEER �j NATURE OF INSTALLATION DISTRI NO. GROUP Z,9,NE P RMIT NO. ROUGH FIXTURES COMPLETE HEATER CESSPOOL 1-1 SEPTIC TANK RECEIVlal EDY READY FOR' DAT ISSUED FIRST INSPECTION AS MISCELLANEOUS i APPLICANT F LL IN HEAVILY OUTLINED P�ORTIOC�N,ONLY JOB d, NAME A..� f-7L ADDRESS P)Olfq CA m ADDRESS LOCALITY m ( NEAREST CITY TEL.No. CROSS ST. 6 CERT.No�'-36-,r97317 EXPIRES K NAME LOCATION OF SEPTIC TANK, OR CESSPOOL = MAIL 3 ADDRESS NORTH, O , CITY .A .NO. 1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CE �UALI�ATON. , PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS V SOUTH J DESCRIPTION OF WORK i ATH TUB (� FURNACE 6 SHOWER DISHWASHER Q --LAVATORY v REFRIGERATOR ITCHEN SINK'r WATER SOFTENER FLOOR BINK SANDTRAP SLOP SINK aLOOR DRAIN WASH TRAY URINAL APPROVALS _WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'*NAME WATER HEATER *ENTAL LAVATORY ROUGH PLUMBING � METER_aGAB SODA FOUNTAIN OUTL OAS PIPING GAS VENT CESSPOOL I TOTAL NUMBER OF FIXTURES SEPTIC TANK I I CESSPOOL SEPTIC TANK ' SEWER I S UTILITY CO.NOTIFIED ( I TOTAL FEE FINAL D.6 S.17 25M SETS 2-47 ' 1 ' APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY, Y- - ' COUNTY OF-LOS ANGELES WM. J. FOX, CHIEF ENGINEER PLUMBING NATURE OF INSTALLATION DISTRI GRO�ZONE PERMIT NO. ROUGH FIXTURES COMPLETE _ HEATER CESSPOOL 1-1 SEPTIC TANK RECEIVED BY READY FOR DAT ISSUED FIRST INSPECTION / AS MISCELLANEOUSIIIpIIEI r APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY Joe E NAME i'// :�� ADDRESS m ADDRESS G LOCALI n n NEAREST JCI y Og J EL.NO. CROSS ST. �A . 6 COUNTY fy CERT.NO. EXPIRES K NAME J /`Y LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAILC� O ' 3 ADDRESS NORTH O CITY TEL.No. IAM THE .LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QU�A/LJI�FIICATTIIO�N. q PLUMBiR 1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. OWNER CORRECTIONS SOUTH ' J DESCRIPTION OF WORK z z_ ATH TUB FURNACE 6 I ' I m SHOWER DISHWASHER p _IAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET RINKING FOUNTAIN DATE INSP[CTOR'S NAMK WATER HEATER DENTAL LAVATORY I ROUGH PLUMBING METER GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK I CESSPOO7SEPTICTANK SEWER S / UTILITY CO.NOTIFIED I A I TOTAL FEE (/ �/� WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 b`9 PLUMBING 16 APPLICATION FOR PLUMBING PERMIT a. - I hereby, affirm that I have a certificate of consent to self in- 76A667A suiek'or a certificate of Workers'Compensation Insurance,or a n certil9d copy thereof (Sec 3800, Lab COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy Ncbill'J �_mpany Q GD/162_ � j� U Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ��02 ��/� C%) ,� 1 Certified copy is filed with the county buildin;inspectio n ADDRESS J / � _P v depa men NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) O•/ / D Date Applicant 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 MAIL %1 /'W//! the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS .J certify that-in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CI /yJ, TEL NO as to become subject to the Workers'Compensation Laws DISHWASHER W CONTRACTOR Date. Applicant CLOTHES WASHER ADDRES NOTICE TO APPLICANT If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY d to&q yT NO /&Z cation-provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC ed WATER HEATER LICENSE NO p? GEA LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY �7 I hereby affirm that I am licensed under provisions of Chapter , GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER' c and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL V1ALID�T.10 LI °`''E fect _ HOSE BIB DATE License Number Lic Class n d FIN / l.li� r� Contractor Date BY / iHLEC.{'t j 'CV 1 am exempt under Sec 1.(7Fi !GE U B &P C for this reasonPlan check fee b' N Date PLUMBING PERMIT ISSUING FEE$ r I ° 131=—fi?I 41 I '1=il, Signature t5S*7` �' [''I'` • t I`: - TOTAL FEE .���__ 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 1, as owner of the property, will do the work and the City Tel No 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 0111. ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- ent ne pe or inspection pu pos SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee ate COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1305150017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS: ITR: 11218 LT 11 BL: 001 UN 002 7 5303 LOMA AV I IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803002 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET- 15388-007-026 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID H4 LOCALITY- TEMPLE CITY CAI 47 WATER HEATER(S) 1 00 WTH 16 20 TENANT I TOTAL FEES 44 00 JISSUED ON PROCESSED BY PLAN BY 105/15/13 SR (OWNER TEL NO IFIDAL 'DATE FINAA BY CODE ICABALLERO PHILIP JR,PATRICIA L 15303 LOMA AV ITEMP 917803002 IDESCRIPTION OF WORK 1 IREMOIIE/REPLACE GAS WATER HEATER 1 1APPLICANT TEL NO IBATIOFF, AMANDA/LUBA (425) 638-7084- I11715 N CREEK PKWY ISPECIAL CONDITIONS IBOTHELL WA 98011 1 1 CONTRACTOR TEL NO- JAPPROVALS DATE INSPECTOR SIGNATURE IFAST WATER HEATER COMPANY (425) 636-7054- 1- 1 111715 NORTH CREEK PKWY S LIC NO (UNDER SLAB WORK I#C-106 931237 1 1I I 1 IBOTHELL WA 98011 ,I (WATER SERVICE I �I IPLA"IIC Y/N METAL Y/N (ARCHITECT OR ENGINEER TEL NO 1 - I I ROU-H PLUMBING LIC NO 1 1__ 11 1 GAS PIPING 1 1 IGAS VENT I I 1 1 IHOT WATER HEATER I 1 1 G I 1 I IPLUMBING FIXTURES LAWN SPRINKLERS I I � IGAS TEST I I I 1 1 (UTILITY COMPANY NOTIFIEDI I I ICwV I I IGRAY WATER SYSTEM I I I I I 1 I I I 1 * ADDITIONAL DATA ON FILE 1 i I I I I I _ IREPORT ID DPR263 ROUTE TO BS0508 I I I_ I