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Home My Public Portal About5434 LOMA AVE_Plumbing__ 76A667 -CE817-5/70 APPLICATION KATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER TNE DING BUILDING AND SAFETY DNLSION ADDRESS JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUP T OF BUILDING ALITY P '� FOR APPLICANT TO FILL IN(PR NT OR TYPE) RESTSS ST. /IiC.W NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET OWNER GJ ,/s� �J MAIL BATH TUB 1.50 ADDRESS ��33 J /) ' SHOWER 1.50 CI7Y7' 6_5 !? � TEL. NO. o� � LAVATORY 1 50 CONTRACTOR SINK 1 50 ADDRESS m S 15.0te DISHWASHER 1.50 CITY TEL. NO. CLOTHES WASHER 1 50 STATE LIC LICENSE NO CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NO. GROUPY ZONEESSED BY LAWN SPRINKLER SYSTEM 2 00 $7 'S-0 _L / q-i�r s WATER HEATER 1.50 INDUSTRIASTE AL AOVAL �.•- GAS SYSTEM OUTLETS .1.50 $ 7-� INSPECTION RECORD OUTLETS OVER 5 PER SYSTEM 30 CL U) Z Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 3 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. 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 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED .LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO - RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY FINAL SIGNATURE �� JACK R. ALLEN, SUPERVCHANICAL ENG'R OF PERMITTEE PERMIT VALIDATIOISC M O CASH PLAN CHECK VALIDATION CK M o CASH 4 4o-3u�,t 7 � 4,75N 76 A 667 CE 817 8/68 y ®d�zi� c t7 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVLSION BUILDING [� /�Q�f, JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS J X13 •• • L 4q COLEMAN W. JENKINS SUP T OF BUILDING LOCALITY V FOR APPLICANT TO FILL IN(PR NT OR TYPE) NEAREST CROSS ST. p q e NUMBER FIXTURE OR ITEM ,EACH FEE ry✓ WATER CLOSET 176 OWNER- J-0 LO 0 eA 44 � /� MAIL ? ,{� , BATH TUB 1.5 DRESS ��✓ /► L n a SHOWER 1.5) CITY 7Q %, 3 ho CTEL. NO.4 � '�j/ LAVATORY 15 7 CONTRACTOR I �/ SINK is I ADDRESS DISHWASHER 1.5 CITY TEL. NO. CLOTHES WASHER 1 0 STATE LIC LICENSE NO CLASS SWIMMING POOL RECEPTOR 1. 0 DISTRICT NO. GROUP NE CESSED BY a LAWN SPRINKLER SYSTEM 2 0 WATER HEATER 1 50 j 7 INDUSTRIAL WASTE APPROVAL / GAS SYSTEM OUTLETS 1 50 INSPECTION RECORD W OUTLETS OVER a 5 PER SYSTEM 30 Z Plan check fee 2P)o of above. See reverse PLUMBING PERMIT ISSUING FEE 8 00 TOTAL FEE APPROVALS DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel No 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 L S PLUMBING I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR UTILITY CO NOTIFIED _ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 'tTATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND,4INTEND TOS RESIDE IN,THE ABOVE DEI��BC RILED gESIDEAL PROPERTY FINAL SIGNATURE j//�Sj/�1_(6.A/''n/6f ^ JACK R. ALLEN SUPERVISING MECHANICAL G'A OF PERMITTEE PERMIT VALIDATION CK M O CASH PLAN CHECK VALIDATION CK M O CASH E >, 2 2 Q° � '�.1 1 ,1..`75- r - ! WORKERS' COMPENS/,.TION DECLARATION 4-dlJ-PUCAMN FOR PLSU0VvUBNG PERNT f I 1 ereby4affirm that'I have a certificate of consent to self 76A667A insure, or`a certiflfate of Workers' Compensation Insurance, ;;,�-CE 817,(REV 10/81) Lf 6r a certified-copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company ❑ Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING � � �v Certified copy is filed with the county building inspec- tion department NUMBER FIXTURE OR ITEM @ FEE ADDRESS LOCALITY Date Applicant - WATER CLOSET 6 NEAREST � 4,(� CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST`�\��._� `✓�J COMPENSATION INSURANCE ` OWNER Q)^ (This section need not be completed if the work Involved by SHOWER 06 the permit is for one hundred dollars ($100)or less.) ' LAVATORY 6 ADDRESS I certify that in the performance of the work for which this _2 permit is issued, I shall not employ any person in any ma ner SINK CITY rC TEL NO 2 `f so as to become subject to the W kers"Compe sat on L s DISHWASHER —Z2 �� CONTRACTOR \� v G Date Applicant CLOTHES WASHER ADDRESS V NOTICE TO APPLICANT If, after making this Cerh c of L�2-`S V 1 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY e� Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM �w, TEL N0�3?, (j with comply with such provisions or this permit shall be ISTATE32 Q LIC E NO deemed revoked WATER HEATER CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO P ESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS,SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect 5 PER SYSTEM FINAL a DATE License Number Lic Class �q FI0 /� C 7 FIN Contractor V Date ❑ 0 I am exempt under Sec 0 F- B 8P C for this reason Plan check fee , Date PLUMBING PERMIT ISSUING FEE$ Z Signature ;2514.2 A TOTAL FEE Plan check applicant # 000 0 0 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name J V\ 0 C, e' o o 2 8 5 Q I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031 5, Business and Address��j2�S �V ( 0 0 0 2 5 Q cz� Professions Code) Cityyq Tel No ^37j �3 ❑ I, as owner of the property, will do the work and the 0 7.2 8;-8 6 structureis 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 D 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 ab e-mention clpro erty for inspection purposes kq, r SEE REVERSE FOR EXPLANATORY LANGUAGE Sig Vture of Permittee Date WORKERS'COMPENSATION DECLARATION APP �C ` FOR PLUMB G PERMIT 1 hereby affirm that I have a certificate of consent to self 76A667A u 1� A v o uve insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certified copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy N '10S 4r- Company llu Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building in ec- ADDRESS tion epar ment• NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date A lice WATER CLOSET PP NEAREST CERTIFICATE OF EXEMPTION FROM ORKERS' BATH TUB CROSS ST (,C) , COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by SHOWER the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL ADDRESS 1 certify that in the performance of the work for which this /� permit is issued, I shall not employ any person in any manner SINK CITY TEL NO?gc so as to become subject to the Workers Compensation Laws / DISHWASHER -/ CONTRACTOR /i• Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of "-W 5 Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY / TEL NO with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE A� LIC Q deemed revoked WATER HEATER LICENSE NO wi CLASS FJ LICENSED CONTRACTORS DECLARATION DISTRICT, OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 ! GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER } and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL VALIDATION License Numb Lic Class —� DATE �� U FINAL 0 Contract o Date BY � ❑ I am exempt under Sec LU V B 8P C for this reason N Plan check fee z Date PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE )` SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Addres_Ap Law for the following reason (Section 7031 5, Business and C.IJ :9 4 2 7.4 A Professions Code) City Tel No 5 ❑ 1, as owner of the property, will do the work and the i structure is not intended or offered for sale (Section 2iu o 2 8'S 0 7044, Business and Professions Code) ' 50= 000 CONSTRUCTION LENDING AGENCY 1 28v I hereby affirm that there is a construction lending agency for 080 5—8 3 the performance of the work for which this permit is issued (Sec 3097, Civ C ) Lender's Name Lender's that 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 jaws regulating Plumbing, and hereby authonz representatives of this County to enter upon the abo11 ve- entioned pr r inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE gnature o Perm ee D WORKERS'COMPENSATION DECLARATION ^ n 5� FOR nnon p �(�� 0nn �l�n� nl�0 (�(�(n�� d , 6l here affirm that I have a certificate of consent to self APAP CAU N FOR U"L�l�JI1CYULDJ�11 a l!"LSUlLU1% U b f CE 81 7( .-ircaure, or'j certificate of Workers' Compensation Insurance, CE 817(REV. 8/86) or a certified copy thereof (Sec 3800, Lab C ) COUNTY'OF LOS ANGELES DEPT. OF•PUBLIC^WORKS. Policy No Company ❑- Certified copy is,hereby furnished _ FOR APPLICANT'TO FILL IN(PRINT OR TYPE) BUILDING ❑ ADDRESS Certified copy,is filed with the county building inspec- tion department NUMBER FIXTUREOR ITEM Q FEE- 4, C t LOCALIT ^ WATER CLOSET Date 'Applicant _ NEAREST `�i0v�A CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB _ CROSS ST QJL j , COMPENSATION INSURANCE OWNEQ��e<-),, � (This section need not be,completed if the work Involved by SHOWER the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ADDRESS .1 certify that in the performance of the work for which,this' m - perit is issued, I shall not;employ any person in an. an SINK CITY TEL NO' 3o as to become subject to the Workers'Compensate Laws DISHWASHER CONTRACTOR Q Date Applicant CLOTHES WASHER ADDRESS`bZ>t 1�7 J%�J 0 NOTICE TO APPLICANT If, after making this C rtifi to of ti Exemption, you should become sublect to the Wo ers' SWIMMING POOL RECEPTOR i Compensation provisions of the Labor Code, you must forth-- LAWN SPRINKLER SYSTEM CITX L.dl _�C� TEL NOT(1 3383 v l with comply with such provisions or this permit shall be STATE ��` Q� LIC / deemed revoked WATER HEATER LICENSE N011%63-2_1 V CLASS ^/ i LICENSED CONTRACTORS DECLARATION DISTRICT V PR D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Divisi6n 3 of the Business OUTLETS OVER and Professions Code;and my license is in full force and effect 5 PER SYSTEM O. FINAL VALID 10� License Number 1 Lic Class y ` DATE FINAL licC Contractor Date Z_` %1_1 BY• ❑ I am exempt under SecL I W W 9L B 8P C for this reason' - Plan check fee, Date PLUMBING PERMIT ISSUING FEE$ D Signature TOTAL FEE 2- ;2 7 12 7 A t Plan check applicant #.o o 0 0 0 5 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name o o 2250 I hereby affirm that I am exempt from the Contractor's License- Law for the following reason (Section 7031 5,-Business and Address o 0 0 2 2 5 0,5 Professions Code)' City Tel No _ O 5 21-$,7 ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section D 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 ) i Lender's Name Lender's Address I certify that I have read this application and state that the D above information is correct I agree to comply with all County ordinances and State 1aws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508- V -PLUMBING PERMIT` DEPARTMENT- OF PUBLIC.WORKS 9071 LAS PUNAS E-0508-9609200006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT:, LEGAL PAID B D.1 G_ D ESS: TR: 7796 LT: 15 5494 LOMA AV FEE DESCRIPTION: QUANTITY: UOM: - AMOUNT: EMP'-CA 9'-7803 03 ASSESSOR INFOR14ATION U NEAREST CROSS STREET: 5388-001-015 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS- 1.00 FIX 16.35 T NT: 25 LAVATORIES/SINKS 2.00 FIX 32.70 ISSUED ON: PROCESSED BY: PLAN B P . 45 WATER CLOSET/URINAL 2.00 FIX 32.70 09/20/96 -' TC - = 09/20/97 47 WATER HEATER(S) 1.00 WTH 16.35 OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.35 FINAL DATE FINAL BY: DE: BECK JEROME;SANDRA T (818) 287-4712 TOTAL FEES 142.20 _ZD 5434 LOMA AV X�7 TEMP 917803003 D€TR-fMON OF WORKI PLUMBING FOR 200 SQ. FT. EXTENTION AND MOVE WATER HEATER APPLICANT: TEL. ALPHA CONS. (909) 627-9632- SPECIAL CONDITIONS: C • CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE ALPHA CONSTRUCTION (909) 627-9632- 6397 TRUMAN LIC. NO (�� UNDER SLAB WORK CHINO, CA 91710 558141 B WATER SERVICE _ PLASTIC Y/N METAL Y/N CHITECT OR ENGINEER: TE ROUGH PLUMBING LIC. NO: /�� G �� L C G 11 O�K S HOT GAS ATER FEMIFN O 0 - 1�1, PLUMBING FIXTURES 0 LAWN SPRINKLERS ED] � GAS TEST UTILITY COMPANY OTIFIED "ems° 9� GRAY WATER SY E REPORT ID: DPR263 ROUTE TO: BS0508