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Home My Public Portal About5649 LOMA AVE_Plumbing__ 76A667 UBS,7 ,I-so - APPLICATION FOR PERMIT 'DEPARTMENT OF BUILDING AND SAFETY COUNTY'OF LOS ANGELES ' WILLIAM J. FOX, CHIEF ENGINEER DISTRICT OUP 'ZONE FOR APPLICANT TO FILL IN PLUMSE,VALL€Y BOULEVARD PLUMBING CO. RED EI ED BY READY FOR DATE ISSUED FIRST INSPECTION ADORESEB300 EAST VALLEY BLVD. _ pp2f 1717 A BUILDING 34 CITY ROSEMEAD TEL. No�11TT. G2f'GADDRESS �� i COUNTY C.33M 30, LOCALITY f�(�� CC LICENSE NO.93M NEAREST PERMIT FEES CROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER /j/• 6/Gt%�'��//w'� . MAIL WATER CLOSET(TOILET) 0.50 $ ADDRESS BATH TUB @ 0.50 CITY TEL. No. f SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 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 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED AB VE. GAS SYSTEM—J—OUTLETS @ 0.50 - SIGNATURE OF WATER HEATER @ 0.50 PERMITTE SLOP SINK @ 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING. FOUNTAIN. @ 0.50 URINAL @ 0.50 Q HOUSE SEWER @ 0.50 Z MISCELLANEOUS L7 !Y O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL - @ 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT I 1.00 GAS TEST �+— UTILITY CO.NOTIFIED / An. TOTAL FEE $ i / v FINAL WORKERS'COMPENSATION DECLARATION • 76A666pPW4/�D APPLICATION FOR PLUMBING PERMIT i hereby, affirm That I have d certificate of consent`to:self in- 76A66yA - sure,or certificate of Workers'Compensation Insurance,ora "certified copy thereof'(Sec. 3800, Lab C ) COUNTY-OF.LOS ANGELES: DEPT. OF PUBLIC WORKS, Policy Na: Company Certified copy is hereby furnished. ., BUILDING FOR APPLICANT TO FILL IN (PRINT-OR TYPE) Certified copy is filed with the count b it ing inspection ADDRESS department. �� FIXTURE OR �° LOCALITY r "` NUMBER ITEM FEE WATER CLOSET`(TOILET) ! . Dote Applicant NEAREST' SOF Y ll�ERTIF,CEXEMPTION.FROM WORKERS' BATH TUB CROSS ST:' COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if the-work involved by MAIL ' the permit is for one hundred dollars (;100)or°less.)"_ LAVATORY ADDRESS 1 certify that in the.performonce-of'the work`for which this per- mit is issued, I shall riot employ any person ip any manner so SINK CITY TEL:NO. as to become subject to the Workers'Compensation Laws. DISHWASHER' CONTRACTOR . C N to '-Applicant. CLOTHES WASHER ADDRES NOTICE TO APPLICANT: if, after making this Certificate of Ex- em' x- SWIMMING POOL RECEPTOR emption, you should become subject to,the Workers'Compen CITY TEL. NO.�� f�oI sation provisions of the Labor Code,you must forthwith comp- LAWN _SPRINKLER SYSTEMS ly,with such provisions orthis,permit shall be deemed revok- STATE LIC. ed.' WATER HEATER LICENSE NO. �GJO , � CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY 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 and Professions Code, and my license is.in full force and of 5 PER SYSTEM FINAL VALIDATION fect. - HOSE BIB DATE ✓ } License Number2 Lic.,Closs CIE O .. / FINAL. V Contractor Date BY Q I am,exempt under Sec.- U H B.&P.C.'for this reason W Plan-check fee a Date: PLUMBING PERMIT ISSUING FEE$ Signature c TOTAL FEE. O -SINGLE FAMILY . Plan check a' hcant' HOMEOWNER,BUILDER DECLARATION PP it4 i1. I hereby affirm that I am exempt from the Contractor.'slicen'se Name - �+ Law for the following reason (Section 7031.5,-Business and Professions Code): Address s -EMS t'E;. Cit Tek- No: A I, as owner of the property; will do the work:and.the y.. structure is not intended or offered for sale Section 7044, 'HECKi a Business and Professions Code). ( �� GE 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 i r (Sec 3097•, Cry:C.).. 079 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-�ed ' inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of'PermitteeDate WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT J hereby, affirm that] have a certificate of consent to self in'- A[667DPW 4/90A sure,or a certificate of Workers'Compensation Insurance,ora certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑. Certified copy is hereby furnished. BUILDING ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) t' Certified copy is filed with-the county building inspection ADDRESS -f 4 ] department. NUMBER FIXTURE OR ITEM @. FEE LOCALITY V'1q WATER CLOSET(TOILET.) ��" r �1� I C� Date Applicant NEAREST' CROSS•ST. CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB COMPENSATION INSURANCE OWNER' ! • SHOWER N i`A i/rr r u, (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less:) LAVATORY ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ an person in ani manner so SINK CITY TEL. NO. „ P. Y Y P Y I��,..... Sia C: �1 as to become subject to the Workers'Compensation.Lows: DISHWASHER CONTRACTOR Date -7 7Applicant 9/f'. CHAIJ•• CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: if, after making this Certificate of Ex- em Tion,you should become subject to the Workers'.Com en- SWIMMING POOL RECEPTOR P Y I P CITY. NC!. /� )Irl sation provisions of the Labor Code, you must forthwith comp- .4 SPRINKLER SYSTEMS v/4 crft {(S 7 u ly with such provisions or this permit shall be deemed revok- STATE ed. WATER HEATER - LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. i PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter. GAS SYSTEM OUTLETS �nn C-Z+1G 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER v� and Professions Code, and my license is in full force and ef- S.PER SYSTEM FINAL VALIDATION fect. // Z(� C .1 U HOSE BIB DATE License Number `h�� y Lic. Class L FINAL a,•.;.- e 0 Coniractor('LIA/iI5 ,�T'C17 C�/v��7.:,a_lZ9te' :1 BY }t : 1 == U - - OC �. I am exempt under Sec. -, 0 1 HEMS U B.&P.C. for this reason }C_, Af =§ 3 n •�a-Oh a Plan-check fee N Date: PLUMBING PERMIT ISSUING FEE$ (j c i-.V rt %, Z Signature TOTAL FEE 3 - -. CHAT 0}1. SINGLE FAMILY. Plan check applicant HOME OWNER-BUILDER DECLARATION PP- I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason. (Section 7031.5,•Business and 0000-r,00I Professions Code): Address J, 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 1 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 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1106010002 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 , PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID 1 BUILDING ADDRESS: - I ITR: 16134 LT: 2' _ I 5649 LOMA AV I (FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917802451 (ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 1 15387-022-014 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl 1 107 BATHTUBS/SHOWERS 1.00 FIX 16.30 1 1 (TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.30 11SSUED ON: PROCESSED BY: PLAN BY: 1 145 WATER CLOSET/URINAL 1.00 FIX 16.30 106/01/11 SR I 192 NO PERMIT OWNER-BLDR 257.00 DOL 257.00 1 I (OWNER: TEL. NO: I TOTAL FEES 333.70 IFI AL DATE - FINAL. Y: CODE: I IJEE, DER (626) 643-3980- 1 1 1.5649 LOMA AV I ITEMP 9178024SI I Iff-ESCRIPTI-ON OF WORK 1 (REPLACE BATHTUB, LAVATORIE AND WATER CLOSET I I I 1 1APPLICANT: TEL. NO: I (SAME AS OWNER - I (SPECIAL CONDITIONS: I (CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 I SAME AS OWNER - I I I LIC. NO 1UNDER SLAB WORK I I I I 1 (WATER SERVICE I I [PLASTIC Y/N METAL Y/N 1 1 (ARCHITECT OR ENGINEER: TEL. NO: 1 I I I IROUGH PLUMBING 1 LIC. NO'. I I 1 IGAS PIPING i IGAS VENT I I I I IHOT WATER HEATER I I I 1 1PLUMBING FIXTURES I I I 1 (LAWN SPRINKLERS I I I 1 I IGAS TEST 1 I I I (UTILITY COMPANY NOTIFIEDI I I cwv I I. I I I I I I (GRAY WATER SYSTEM" 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 1REPORT ID: DPR263 ROUTE TO: SS0508 i. 1