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Home My Public Portal About5717 LOMA AVE_Plumbing__ DIS-17 Q 7 1254 APPLICATION I N FOR -PLUMBING.-PERMIT '' D5. ' DIVISION OF BUILDING AND .SAFETY 1 Department of.County Engineer County of Los.Angeles s(�I Lo 1 Nc WM. J. FOX, COUNTY ENGINEER ADDRESS r CASSATT D. GRIFFIN, SuP•T:OF BUILDING - LOCAL _ FOR .APPLICANT TO FILL IN NEAREST CROSS S OWNER DISTRICT NO. GROUP'. ZONE READY FOR.INSPECTION . MAIL ADDRESS INDUSTRIAL CITY .S_ �- - "i TEL: NO. / J ,'7 WASTE APPROVAL j � PLUMBER �, 1 NSPECTION RECORD ADDRESS 7 ,f[ CITY - TT"EL. NO: �' ��:C... ... '°�-`SMA.y4 I�.rT- inFt'C� .S,_ LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE - WATER CLOSET (TOILET) BATH TUB SHOWER [_ - _ LAVATORY (WASH BASIN) KITCHEN SINK - DISHWASHER LAUNDRY TUB OR TRAY a CLOTHES WASHER TOTAL NO. @ 0.80 _ APPROVALS . DATE . INSPECTOR'S SIGNATURE- _GAS SYSTEPM OUTLETS @ 1.00 UNDER SLAB WORK t _ / WATER HEATER. @ 1.00 +Do' ROUGH PLUMBING PERMIT. 1 00 GAS PIPING TOTAL FEE ;._GAS VENT _ I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION _-HOT WATER HEATER_ _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 'PLUMBING FIXTURES -A PLUMBING. IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST - �I�� 'g 5�'1+V.1.A - -� LICENSED AS REQUIRED'BY LOS ANGELES COU14TY AND STATE OF t.UTILlI"Y CO..NOTIFIED_ CALIFORNIA OR THAT I AM LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIATHFF]] L QPE j SIGNATURE OF PERMITTEE- r.- e 1 .FINAL Y WILLIAM J. FOX, COUNTY ENGINEER VALIDATION L /f DEPUTY' . WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1 nave a certificate of consent to self 20-0026 DPW 6/87 I '''insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof,(SEK., 800, Lqb. C.) */y^/��/f� COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy Nol:�o iy - T G - ._ ,E] Certified copy islhereby furnished. Q FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUIMING ADDRESS Certified copy is filed with the c unty buildjng'inspec- tion department. t� NUMBER FIXTURE OR ITEM p ` @ FEE LOCALITY Date#&/k9 Applicant-° " WATER (^O { SST. Q� H:: 7T " CERTIFIC TE OF EXEMPTION FROM WORKERS' Co BATH TUB CROSS COMPENSATION INSURANCE ° SHOWER m OWNER (This section need not be'completed if the work involved by MAIL the'permit is for one hundred dollars($100)or less.) LAVATORY (� ADDRESS I certify that in the performance of the work for which this , permit is issued, I shall not employ any person in any'monner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER f CONTRACTOR //% IJN CLOTHES WASHER ��' e Date Applicant ADDRESS r NOTICE TO APP CANT: If, after akin,_ his ertificate SWIMMING POOL RECEPTOR r � +� Exemption, you should become subject to the Workers CITY 64. NQ. a Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or, this permit shall be STATE f' LIC. / deemed revoked. WATER HEATER LICENSE NO. w(/ CLASS- / LICENSED CONTRACTORS DECLARATIONDI TRI fROCESSED BY I hereby affirm-that I am licensed under provisions of Chapter.9 GAS SYSTEM • ° OUTLETS ' 0,3 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and,my license is in full force and effe t. 5 PER SYSTEM y DATE �/ VALIDATION License Number O Lic. Class U. I F ,��-/� NAL I=Contractor=tom✓> ate FQ, ElLJ I am exempt under Sec. W B.&P.C. for this reason N) Plan"check fee z Date.. PLUMBING PERMIT ISSUING FEE$ Signature 1� ._ TOTAL FEE TQ 1-50 Plan check applicant SINGLE FAMILY xi z"s HOME OWNER-BUILDER DECLARATION Name 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. I LJ -❑ 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 _ r, •, _ 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 lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mention d property for inspection purposes. ti SEEi REVERSE FOR EXPLANATORY LANGUAGE gnat a of Perm ttee• ate WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby; affirm-that I have a certificate of consent to self in- 226 DPW PW a/87 sure;or a certificate of Workers',Compensation,lnsurance,ora CE 80(REV.'V86) certified copy(hereof (Sec. 3800, Lab. C.). - • COUNTY OF LOS. ANGELES DEPT. OF. PUBLIC'WORKS Policy No. Company a 'Certified copy,is hereby furnished ,. BUILDING FOR APPLICANT TO FILL IN,(PRINT OR TYPE) PCertified copy is filed with the county building inspection ADDRESS 7 'department. NUMBER FIXTURE.OR ITEM @ FEE Date Applicant , CALITY %D�' NEAREST Pf WATER CLOSET(TOILET) J� /� ' v ` CERTIFICAT6OF EXEMPTION-FROM WORKERS" BATHTUB CROSS sr. j—(2S �C C(/ISIS COMPENSATION INSURANCE OWNER r,k)q 0/ ,� SHOWER d K . o`l^ . I 13 (This section need,not be completed if the work involved by MAIL / the permit is for one hundred dollars (5100)or less.) LAVATORY 00 ADDRESS ! �fjLj AV Q. I certify that in the performance of the work for which this per- mit is issued, I shall not em to do person in an manner so SINK - CITY •��(,� TEL NO _ '/ P Y YP Y _ Ll� 2 as to.become subject,to the Workers'Compensation Laws. DISHWASHER CONTRACTOR IA _ O �' Date� I�--� CApplicant �.3-�--� CLOTHES WASHER. ADDRESS NOTICE TO APPLICANT: If, after making this Certificate'of Ex- SWIMMING POOL RECEPTORA 4A emption,you should become subject to the Workers'Compen- CITY TEL. NO. ,sation provisions of the Labor Code, you must forthwith comp- 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 DISTRI T NO. PROCESS ) I hereby affirm that I am licensed under.provisions'of Chapter GAS SYSTEM OUTLETS + `` U 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER J VVV fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDAT DATE D C License Number Lic. Class V FIN OC Contractor D_ate BY O I am exempt under Sec. W CL B.&P.C. for this reason Plan check fee _ Date: PLUMBING'PERMIT ISSUING FEE$ Signature z 8 4 7,0 A TOTAL FEE SINGLE FAMILY C/ # a o 0 0 to-15 HOME OWNER-BUILDER DECLARATION Plan check applicant Lo p < I hereby affirm that I am exempt from the Contractor's License Name ( i 0( > .1 - 4650- Law for the following reason (Section 7031.5, 'Business and �'v [ Professions Code): Address o o 0 46 5 0= I, as owner of the property, will do the work.and the City'. �� Tel. No. 1 201 —87 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 oll'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 . . Sign ture of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0612270017 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: - LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 12977 LT: 5 BL: .001 5717 LOMA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802453. ASSESSOR INFORMATION NUMBER: - NEAREST CROSS STREET: LAS TUNAS 5387-022-006 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE .CITY, C 13 DISHWASHER(S) 1.00 FIX 16.20 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 51 LOW .PRS GAS. 5 OUTLET 1.00 SYS 16.20 12/27/06 VG 06/25/07 TOTAL FEES 76.35 OWNER: TEL. NO: FI AL DATE q !/FIN�yALy BY: CODE: TSAI, WEN CHI (626) 576-7123- 5717 LOMA AV TEMP 917802453 DESCRIPTION OF WORK PLUMBING FOR NEW KITCHEN APPLICANT: TEL. NO: ' FAN - (626) 454-0816- 355 PEACH ST #A SPECIAL CONDITIONS: MONTEREY PARK 91754 CONTRACTOR: TEL. NO: 'APPROVALS - DATE INSPECTOR SIGNATURE WU WU CONSTRUCTION (626) 487-2884- 4518 HORN13ROOK AVE LIC. NO UNDER QOPFiORK - BALDWIN PARK 91706 864088 WATER SERVICE PLASTIC Y/N METAL Y/N _ ARCHITECT OR ENGINEER: - TEL. N0: - ROUGH PLUMBING LIC. N0: GAS PIPING ' GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508