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Home My Public Portal About5634 LOMA AVE_Plumbing__ l 76A657 CBs 17 11-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS"ANGELES PLUMBING AL WILLIAM J. FOX, CHIEF ENGINEER PERMIT NEJ. DISTRICT NO. GROUP ZONE FOR APPLICANT TO FILL IN VAILLCY BOULEVARD PLUMBING CO. s READY FOR DATE ISSUED PLUMBER O RECEIVED BY FIRST INSPECTION -z- _ ISS � ADDRESS 8 300 EAS 1 VALLEY BLVD. CITY ROSEMEAD TEL f1 No. AT. 2-62717 n ADDRESS ell BUILDING LICENSE. NO.COUNTY93M EXPIRES 6-30• / LOCALITY - - - - - NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER 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) @ 0.50 APPLICATION .AND STATE THAT THE,ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES / KITCHEN SINK - @ '0.50 AND STATE LAWS REGULATING PLUMBING. I CERTIFY THAT 1 POSSESS THE ABOVE VALID L09 LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, DR I AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM—L—OUTLETS @ 0.5000, .�SIDNATURE OF WATER HEATER @ 0.50 -PERMITTE r SLOP SINK . @ O.So INSPECTION RECORD FLOOR SINK @ 0.50 - FLOOR DRAIN @ 0.50 DISHWASHER @ 0.60 ( rs 0,�� 'p `3 A7 a DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 -L-�)G' .�7'�� •✓c�T-d�'e J a HOUSE SEWER @ 0.50 G'4 S 'SD-i Z MISCELLANEOUS - � G A .4.Giw, ,,,f 9 _ R O APPROVAM _ DATE INSPECTOR'S NAME ROUGH PLUMBING A APV 7 GAS PIPING �F V GAS VENT CESSPOOL @ 1:00 CESSPOOL SEPTIC TANK: SEPTIC TANK .. DRAIN ( ) PIT ( ) @ 1.00 SEWER %I PERMIT • 1.00 GAS TEST _ UTILITY CO.NOTIFIED TOTAL FEE "dam r LS FINAL 'WORKERS'COMP.FNSATIGN DECLARATION Ap,pLlCATI®N F®R PLU.MBI.NG PER IT �I he ebo,5 f'ifm ,hat I have a certificate of consent to self. - -- 76A667A insure, of,a certificate of'Workers'-'Compensation Insurance, CE 817(REV. 10/81) or a certified'copy thereof (Sec, 3800, Lab. C:) "' "' " ' - COUNTY OF LOS.ANGELES__.' BUILDIf�IG Af�lD SAFETY Policy No " Company 0 Certified copy is hereby furnished. FOR APPLICANT TO,FILL IN(PRINT OR TYPE) BUILDING ❑ Certified cbpy is filed with the county building inspec- ADDRESS ° tion department NUMBER FIXTURE OR,ITEM @ FEE LOCALITY T 4 c WATER CLOSET Date .APPI icant_ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATKTUB... CROSS T COMPENSATION.INSURANCE / V OWNER SHOWER P� "(This'section need_not be completed if the work involved by - - 'the permit is for one hundred dollars ($100)o�less.) LAVATORY_ ADDRESS'- •. O /7 0 I'certify that in the performance of the work for which this - -perm it is issued, I shalL.not em to erson'in an manner SINK - CITY a �'/� TEL. NOv Q§ P P Y 9 R Y.,`,.. L / so as_to:become sub eetto the Wor r 'Co pensatioo Law . H " DISHWASER CONTRACTOR' L CLOTHES WASHER Date f,- Applicant _ ADDRESS NOTICE JO APPLICANT:. If, after making,this Certificate of Exemption, you should become subject to he Workers' _. SWIMMING POOL RECEPTOR _. Compensation provisions•of'ihe Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY'.-- _. _ .. _. TEL. NO. with,comply with such .provisions or this permit'shall be STATE LIC. - deemed revoked.. WATER HEATER LICENSE O. CLA S LICENSED CONTRACTORS DECLARATION' ^'DIST T NO: ' SSED,BY ". . _ ... L hereby affirm that t am licensed GAS SYSTEM OUTLETS under provisions of.Chapter 9 _._ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and ProfessionsCode;and my license is in full force-and effect: 5 PER SYSTEM' "' FINAL DATE License Number Lic. Class ' FINAL O I Contractor. ' -Date FU. ❑, I`am exempt under Sec. _. B.&P.C. for this reasonOUW., Plan check fee . .. __. Date. N. „ PLUMBING.PERMIT ISSUING.FEE$ Z Signature G 61 2.-6 A ell C_ TOTAL FEE # o.aa 5 . Plan check applicant SINGLE FAMILY _ HOME OWNER-BUILDER DECLARATION% Name roc -Tvsv - I hereby.affirm.that I am exempt from the Contractor's Licenseo 0 0'2 Law for the following reason (Section 7031.5, Business and Address-' 3 , " '- °/�►j A"' 51� rofions Code.); City L (� -7 Tel. No. v ! _ 1 .2 1 7 Y':8 6 , 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.). e _ ....._.... . . ._. ..:.,. _..._...._ _ ......... . _ .,..... . Lender's Name Lender's Address _ jb fy that I have read this application and.state that the information is correct. I agree to comply with all County nces and Statelaws regulating Plumbing, and hereby rize representatives of this County to enter u on the-mentioned roperty for in pection purposes. rp - -SEE REVERSE-FOR EXPLANATORY LANGUAGE , Signature of Ferminee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0310160003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 16134 LT: 19 5634 LOMA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802450 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: BIDWELL 5387-019-015 01 PERMIT ISSUANCE FEE 27.75 THOMAS� PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 13 DISHWASHER(S) 1.00 FIX 16.20 10/21/03 JK 04/18/04 25 LAVATORIES/SINKS 2.00 FIX 32.40 OWNER: TEL. NO: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 FINAL DATE FI Y: CODE: AHN; PETER 47 WATER HEATER(S) 1.00 WTH 16.20 5634 LOMA STREET 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 TEMPLE CITY 91780 TOTAL FEES 157.35 DESCRIPTION OF WORK PLUMBING FOR ADDI ON & RELOCATE WASHER & DRYER TO GARAGE APPLICANT: TEL. NO: KEVIN C YANG (626) 672-5098- 9138 OLEMA ST SPECIAL CONDITIONS: TEMPLE CITY 91780 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE KEVIN CHIA-JEN YANG (626) 286-2096- 9138 OLEMA ST LIC. NO UNDER SLAB WORK TEMPLE CITY CA 91780 807384 HIC }} *'� \ / WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: //// ROUGH PLUMBING �1/ tL LIC. NO: GAS PIPING Ir—---------- -- ------- r—---- I GAS VENT co I�� ✓j Gr :� �� 'J I.�� HOT WATER HEATER ;l PLUMBING FIXTURES 81 LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV e5'vice—Ina i� GRAY WATER SYSTEM * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: BS0508 ' f r WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 8086) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS PolPolicy No.—Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspec- ADDRESS tion deportment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY - - S WATER CLOSET s 1 t Date Appli4ant NEAREST 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($100)or less.) LAVATORY MAIL ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in an manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensate n Laws. DISHWASHER i j CONTRACTOR -' r.... Date ( Applicant \�5 CLOTHES WASHER �^ NOTICE TO APPLICANT: If, after making this Certific a of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY LAWN SPRINKLER SYSTEM TEL. NO. with comply with such provisions or this permit shall be STATE L)C. J deemed revoked. WATER HEATER LICENSE NO. ' 1 r CLASS LICENSED CONTRACTORS DECLARATION DISTINCT t�0'. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and,my lice is in full force and effect. 5 PER SYSTEM V ` FINAL VALID4TION W L• :<. DATE License Number- —Lic. Class FINAL Contractor. Date BY } Q ❑ I am exempt under Sec. lZ B.BP.C. for this reason Plan check fee � Date: PLUMBING PERMIT ISSUING FEE$ ✓ f . Signature ,y TOTAL FEE SINGLE FAMILY Plan check applicant ei s,,';;'R,• ;�. HOME OWNER-BUILDER DECLARATION Nome • + �' I hereby affirm that I am exempt from the Contractor's License Address • • .• Law for.the following reason (Section 7031.5, Business and Professions Code): City Tel. No. r' 7 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date