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Home My Public Portal About5743 LOMA AVE_Plumbing__ 76A667-CE9817 4-64 � APPLICATION FOR PLUMBING RMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS -P� WILLIAM A. JENSEN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST NUMBER FIXTURE OR ITEM EACH FEE .OWNER WATER CLOSET $1.25 MAIL AA BATH TUB 1.25 ADDRESS C SHOWER 1.25 I TEL. NO. LAVATORY 1.25CONTRACTO SINS 1.25 ADDRESS DISHWASHER 1.25 CITY TEL. NO. r LAUNDRY TUB 1.25 REGISTRATION NO. COUNTY p CLOTHES WASHER .1.25 DISTRICT NO. GROUP ZONE PROCESSED BY WATER HEATER 1.50 �(J GAS SYSTEM OUTLETS 1.50 INDUSTRIAL a WASTE APPROVAL 0 OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD U z s 1 APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT $ 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE '�-lzS GAS PIPING L I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER PLUMBING. ' I HEREBY CERTIFY THAT I'AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DE CRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED SIGNATURE OF PERMITTE FINAL _/ G/f/'✓ VALIDATI N ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R }ter) . 2:1.� MAY 15 5 D 5.75- 1 WORKER'S I have a ceSATIONDfconse t to 76A66fiDPW9/89 APPLICATION FOR PLUMBING PERMIT - 20-002 A I hereby affirm that I have a cevtificate•of consent to self insu+e, or a certificate-of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ 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 Q FEE LOCALITY Date Applicant WATER CLOSET Q NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. D 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($100)or less.) LAVATORY J�-v� OWNER R� � f 11- 1 certify that in the performance of the work for which this permit is issued, I shall not employ an person in an manner so as to MAIL P Y Y P Y SINK ADDRESS J !►•4r /ff(rli become subject to the Workers'Compensation Laws. DISWASHER CITY -7- J_' f��'�/' TEL.NO. �'" � Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. > I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000 of Division 3 of the Business and STATE LIC. ( g ) GAS SYSTEM OUTLETS O LICENSE NO. CLASS V Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT j .1p,� NO. PROCESSED BY 0 5 PER SYSTEM License Number Lic.Class 1-" FINAL /p VALIDATION W DATE/l, � Contractor Date CO)FI `�/j�("� ElNAL J Q%r' -(3 Z I am exempt under Sec. FBY B.&P.C.for this reason Date: Plan check fee PLUMBING PERMIT ISSUING FEE$ 3 ❑ -- Signature TOTAL FEE Plan check applicant " SINGLE FAMILY j! :-•�' :s HOME OWNER-BUILDER DECLARATION Name I hereby a irm that I am exempt from the Contractor's License Law A// ",`; " for the lowing reason (Section 7031.5, Business and Professions Address �� /T � --'=°r Cod �le T T,--M.'" City Tel.No.R�'^-. , ,J —/ I, as owner of the property,will do the work and the structureF " is not intended or offered for sale (Section 7044, Business _ .AL _11-'3. 0 0 and Professions Code). , _.F?'. u ,,l_i! CONSTRUCTION LENDING AGENCY Miia a fir! `s 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.) it zj.i)'—I'i It 3.( i l ?i !"t ?��iil i i e 1T, 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 /w p /v-lo-Po DECLARAT ' WORKER'S COMPENSATION ate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT ' 76A667A f hereby affirm that I have a certificate of consent to self insure, ob a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company ❑ -Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING .0�j.3 ,�/ / q,��( �/Z7 ❑ Certified copy is filed with the county building inspection ADDRESS `f' ��/ L( �vGH department. NUMBER FIXTURE OR ITEM p FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 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($100)or less.) LAVATORY OWNER G�� / I certify that in the performance of the work for which this permit CSC: is issued, I shall not employ any person in any manner so as to SINK MAIL become subject to the Workers' Compensation Laws. ADDRESS N UNJ DISWASHER CITY ,rn G� TEL.NO Date Applicant CLOTHES WASHER 00 CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC. 0- (commencing (commencing with Section 7000) of Division 3 of the Business andO LICENSE NO. CLASS Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS V OUTLETS OVER DISTRICT NO. PROCESSED BY o 5 PER SYSTEM U(/ License Number Lic.Class ~ FINAL V DATE f�i -Q(� VALIDATION W Contractor Date (n F-1 FINAL00t Z I am exempt under Sec. O BY B.&P.C.for this reason Date: Plan check fee , Signature PLUMBING PERMIT ISSUING FEE$ � ElTOTAL FEE _ Plan check applicant s SINGLE FAMILY F t = o I hereby affirm HOME Om exempt tlfromRthhe Contractor's Name License Law -L€� :ZU F _ for the following reason (Section 7031.5, Business and Professions Address ---F—�;; Code): s l,l 1 City Tel. No. __ _ 1,as owner of the property,will do the work and the structure j=_i iE20 = 50 is not intended or offered for sale (Section 7044, Business and Professions Code). _• — CONSTRUCTION LENDING AGENCY iW`� 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. F't 3 q t j ) lF?�S'r Lender's Name AM 8:55! 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. _ /v SEE REVERSE FOR EXPLANATORY LANGUAGE COUNTY OF LOS ANGELES TEMPLE CITY # 0508PLUMBING PERMI-T DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS �P_L_05.08_961-1260013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: •LEGAL ID• FEES PAID BUILDING ADDRESS: TR: 12977 LT: 1 5743 LOMA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802453 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 5387-022-001 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 25 LAVATORIES/SINKS 1.00 FIX 16.35 TENANT: TOTAL FEES 44.10 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 11/26/96 LC 11/26/97 OWNER: TEL. NO: FINAL DATE FINAL BY: LEE RUE F;TAI C (818) 285-1588- 2-2 7 g 5743 LOMA AV TEMP 917802453 DESCRIPTION OF WORK BAR SINK FOR DINNING ROOM APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: - ROUGH PLUMBING 1 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