HomeMy Public PortalAbout5725 LOMA AVE_Plumbing__ PLUMBING I
DEPARTMENT OF COUNTY ENGINEER
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY•OF LOS ANGELES BUILDING
WILLIAM J. FOX;'013UNTY ENGINEER ADDRESS e�� -9.
e LOCALITY
FOR APPLICANT TO FILL IN NEAREST
BUILDING ff�� / ?g CROSS ST. (
ADDRESS. �A1 � - /s. ��Pd• -
DISTRICT NO. GROUP ZONE PERMMITT NO.
LOCALITY1
NEAREST. '
CROSS ST.. l l.a!! R- �EECE_IVE-D BY Ready for Inspection DATEISSUED
OWNER !< W CI C h 3' ZT
MAIL INDUSTRML
ADDRESS WASTE APPROVAL
clTv TEL.NO. INSPECTION RECORD
PLUMBER. a 1 iarG '. p.� p
ADDRESS >qIZ. Fd �L �':` U�
CITY �g s
(Ij TEL.NO.Jq'sr
j ❑+$TATE Y? 4/ ? P1 L�`tlfti.tA
LICENSE NO. (� �`� COUNTY -- --
PERMIT FEESvf
. G. '7^i O e� .e —ryC _ Z
NUMBER TYPE OF FIXTURE OR ITEM FEE Tp Uj
I WATER CLOSET(TOILET) @ 0.80 $ $ -- F_
l BATH TUB @ 0.80 O
SHOWER @ 0.80 -
LAVATORY(WASHBASIN) @ 0.80 p�
KITCHEN SINK @ 0.80 519-
LAUNDRY TUB OR TRAY @ -0.80 �}
SLOP SINK @ 0.80
FLOOR SINK @ 0.80
FLOOR DRAIN @ 0.80'
DISHWASHER 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.00
GAS-SYSTEM---4-_.-.-.-.OUTLETS ' @ 1.00 'PC'
WATER HEATER @ 1.00
MISCELLANEOUS
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT• $ I 00 ROUGH PLUMBING' AX_ �y
TOTAL FEE .,GASPIPING ..
F HEREBY ACKNOWLEDGE THAT 1 'HAVE READ THIIS''APPLl-_ GA$YENT
CATION"AND STATE THAT THE ABOVE IS CORRECT AND AGREE: HOT WATER,HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES:AND STATE.LAWS`
.REGULATING PLUMBING: PLUMBING FIXTURES
l- HEREBY CERTIFY THAT I AM. PROPERLY REGISTERED
AND/OR LICENSED AS-REQUIRED BYLOS-ANGELES COUNTY. GAS TEST /f A
AND STATE OF CALIFORNIA OR THAT. I AM THE LEGAL OWN
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. : UTILITY CO.NOTIFIED
SIGNATURE ..
OF PERMITTEE--- z ..._ ------
.-.. / p
FINAL #€t
76A667 DBS 17 1/53 �.
•e t-�WORKER''S COMPENSATION DECLARATION 20
76-0026
A667A PW 9/e9 ����'������ �� PLUMBING
PERMIT
I hereby affirm,that I have a certificate'of consent to self insure,-
or a certificate of Worker's Compensation Insurance,br a certified �>
copy thereof(Sec.3800 Lab. C.)
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS:DIV.'
Policy No. Company
❑ f'
Certified copy is hereby furnished._.
,FOR APPLICANT TO'FILL IN(PRINT OR:TYPE) BUILDING_ - -
Certified copy is filed with the county building inspection ADDRESS
department. } NUMBER FIXTURE OR ITEM l Q FEE - LOCALITY - . fie
Date ` •Applicant -`' �„ WATER CLOSET - - .
.. - .- -- NEAREST -
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. LL f�
.. - BATH TUB - -
COMPENSATION INSURANCE
ASSESSOR
(This section need not be completed if the-work involved-by the
SHOWER MAP BOOK PAGE PARCEL
permit is for one hundred dollars($100)or less.)_ W
ONER `
I certify that in the performance of the work.for which this permit LAVATORY - �.(.(
is issued', I shall not employ any person in any manner so as to SINK MAIL f
become subject:to,the Workers'Compensation Laws. ADDRESS S P fz 1
- DISWASHER CITY- TEL.-NO.
i Date Applicant CLOTHES WASHER CONTRACTOR W
NOTICE TO APPLICANT. If";after making'this Certificate of )
Exemption,-you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR
provisions of the Labor Code, you must forthwith comply with such ADDRESS .
provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION CITYTEL.NO.
I hereby affirm that I am licensed under provisions of'Chapter 9 ' WATER HEATER a
(commencing with Section 7000) of Division 3 of the Business and
Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS
t3
OUTLETS OVER - --DISTRICT NO. PR S E B a:
,. 5 PER SYSTEM - Q
License Number Lia Class v
.. -.. FINAL - .. Q,TION W
DATE LIDA .
�Z- a
Contractor DateU)
FINALS C z
❑ I am exempt under Sec. By
B.&P.C.4or this reason
Plan check fee
Date: -
t PLUMBING PERMIT ISSUING,FEE$
Signature
❑ TOTAL FEE 30
SINGLE FAMILY
Pian check applicant
HOME OWNER-BUILDER DECLARATION Name �'
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason (Section 7031.5; Business and Professions Address '`
Code): Y �l 1 . - d 1. s i l 5- 3 o
Cit n Tel. No.
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).
'I=1f{ I—
t
r
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, —i
_Civ.C.) i
a. a i
Lender's Name.
Lender's Address
I certify that I have read this application and state that the above 5
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
'
gnature t;/ ermi ee DAG
COUNTY OF'LOS'ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0609130018
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 12977 LT: 4 - - 5725 LOMA AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802453
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5387-022-004 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, C
07 BATHTUBS/SHOWERS 2.00 FIX 32.40
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 09/13/06 JK - 03/12/07
21 HOSE BIBB(S) 2.00 FIX 32.40
OWNER: TEL. NO: 25 LAVATORIES/SINKS 2.00 FIX 32.40 FINAL DATE FINAL BY: CODE.:
THAM, ANN (626) 274-1248- 45 WATER CLOSET/URINAL 1.00 FIX 16.20
5725 LOMA AV 47 WATER HEATER(S) 1.00 WTH 16.20
TEMP 917802453 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 DESCRIPTION OF WORK --
TOTAL FEES 205.95 PLUMBING FOR NEW ADDITION
APPLICANT: TEL. NO:
LEE (626) 274-1248-
138 E. ALTA ST. SPECIAL CONDITIONS:
ARCADIA, CA 9106 '
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
HY CONSTRUCTION, CO. (626) 221-9698-
919 S. PALM AVENUE LIC. NO UNDER SLAB WORK
SAN GABRIEL, CA 91776 680979 B
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
LANTRIK DEVELOPMENT LLC (626) 379-4900- ROUGH PLUMBING
744 BONITA DRIVE LIC. NO: l�
SOUTH PASADEN, CA 9130 NONE GAS PIPING
GAS VENT
HOT WATER HEATER 7`
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
�;,
UTILITY COMPANY NOTIFIED
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508