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HomeMy Public PortalAbout6126 LOMA AVE_Plumbing__ 76A667A CEA17(REV 6/78) ©'s41, APPLICA ION OR PLUM91MG PERM iT COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN(PRINT OR TYPE)_ BUILDING ADDRESS NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET ' NEAREST ` BATH TUB CROSS ST SHOWER OWNER i LAVATORY MAIL ADDRESS SINK CITY qE DISHWASHER CONTRACTO CLOTHES WASHER ADDRESS 1 ,SWIMMING POOL RECEPTOR lCRLAWN SPRINKLER SYSTEM TATE WATER HEATER ICENSE NCIS � GAS SYSTEM OUTLETS APPROVALS, DATE INSPECTOR S SIGNATURE UNDER SLAB WORK OUTLETS OVER 5 PER SYSTEM ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER {®� PLUMBING FIXTURES GAS TEST„ Plan Check fee UTILITY CO NOTIFIED n PLUMBING PERMIT ISSUING FEE$ TOTAL FEE FINAL Plan check applicant PLAN CHECK VALIDAT(ON 1 Name Address i City Tel No Qm I HERE ACKNOWLEDG AT I HAVE READ THIS APPLICATION AND STATE ;2t7 G 7 - L THAT THE ABOVE IS CORRE ND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES '# O o O a O 5 AND STATE LAWS REGULATING PLUMBING PERMIT VALIDATION I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS 2 O o1, a 0 0 REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE ' LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL O 0 0 1 0„0,0 C,7 PROPERTY SIGNATURE •� 11, 7 9 OF PERMIT oflq) 'oA 2 ` - (STRICT NQ CE55 D CQ/) , INDUSTRIAL WASTE APPROVAL COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0306190007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 260 UN: .002 6126 LOMA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801632 ASSESSOR INFORMATION NEAREST CROSS STREET: LONGDEN 5384-012-006 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 21 HOSE BIBB(S) 1.00 FIX 16.20 S . 25 LAVATORIES/SINKS 1.00 FIX 16.20 06/19/03 JK 12/16/03 45 WATER CLOSET/URINAL 1.00 FIX 16.20 OWNER: TEL. NO: TOTAL FEES 92.55 FINAL DATE FINAL ODE: KU•KUNG-YEE (626) 285-1909- 61'26 LOMA AV z _�/ --- -- TEMP 917801632 5E$tTTMON OF WORKJ--- ADD MASTERBD & BATH; 76SF-FRONT PORCH & 15SF REAR PORCH APPLICANT: . SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO UNDER SLABR ZJ 03 WATER SERVICE IJ PLASTIC Y/N METAL Y/N ARCHITECT OR O: ROUGH PLUMBING LIC. NO: it - - GAS PIPINGL� GAS VENT HOT WATERHEATER PLUMBING LAWN SPRINKLERS UTILITYGAS TEST ANY NOTIFIO cWV GRAY WATER SYSTEM 10 to At REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 _ PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS - PL 0508 0803210004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT: LEGAL ID FEES PAID BUILDING ADDRESS ITR 5904 LT 260 UN. 002 6126 LOMA AV I IFEE DESCRIPTION. QUANTITY UOM AMOUNT TEMP CA 917801632 ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 15384-012-006 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY, C 1 107 BATHTUBS/SHOWERS 2 00 FIX 32 40 1 TENANT 125 LAVATORIES/SINKS 2 00 FIX 32 40 11SSUED ON PROCESSED BY- PLAN BY -EXPIRES ON I 1 145 WATER CLOSET/URINAL 1 00 FIX 16 20 103/21/08 SR 09/17/08 1 1 160 DWV REPAIR OR ALTER 1 00 SYS • 16 20 1 1 (OWNER TEL NO 1 TOTAL FEES ' 124.95 IFIN AT FI BY CODE I IHUANG, KUANG - 1 I 1 16126-LOMA AV 1 1 / 1 ITEMP 917801632 ID CRI TION OF WORK _ IPLUM13ING FOR NEW BATHROOM I (APPLICANT- TEL NO I 1 1 IKWOK _(323) 697-2120- I 1 1260 E GARVEY AVE I ISPECIAL CONDITIONS I MONTEREY PARK 91775 1 1 (CONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE 1 1 ICHAO PAN (626) 960-8826- I I I 12237 MAC DEVITT ST LIC NO (UNDER SLAB WORK 1 1 1 IWEST COVINA, CA 91790 745705BHIC I 1 1 1 1 I IWATER SERVICE 1 1 1 1 I IPLASTIC Y/N• METAL Y/N I 1 1 (ARCHITECT OR ENGINEER TEL. NO I I I IKWOK, TERENCE (323) 697-2120- 1 IROUGH PLUMBING 1 1 1 1260 E GARVEY AVE LIC. NO I 1 1 1 1 IMONTEREY PARK, CA 91755 C24796 - (GAS PIPING I I I 1 1 IGAS VENT 1 1 1 I I I I IHOT WATER HEATER 1 I 1 1 1 1 I IPLUMBING FIXTURES I I I 1 1 ILAWN SPRINKLERS 1 1 1 I I I 1 1 IGAS TEST 1 1 1 I I I 1 1 (UTILITY COMPANY NOTIFIEDI I I I ICWV I IGRAY WATER SYSTEM 1 1 I I I I I I I I I I I I I I I I I I I I I I IREPORT ID DPR263 ROUTE TO BS0508 I 1 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0801100003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID \ BUILDING ADDRESS ITR 5904 LT: 260 UN 002 6126 LOMA AV (FEE DESCRIPTION- QUANTITY UOM AMOUNT TEMP CA 917801632 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 15384-012-006 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H2 LOCALITY- TEMPLE CITY, C1 1 107 BATHTUBS/SHOWERS 1 00 FIX 16 20 1 ITENANT I11 CLOTHESWASHER(S) 1 00 FIX 16 20 JISSUED ON PROCESSED BY PLAN BY EXPIRES ON 121 HOSE BIBB(S) 2 00 FIX 32 40 101/10/08 SR 07/08/08 1 125 LAVATORIES/SINKS 2 00 FIX 32 40 1 1 (OWNER TEL NO 145 WATER CLOSET/URINAL _ _ 1 00 FIX 16 20 IFINAL ATE FIN BY CODE: IHUANG - 151 LOW PRS GAS 5 OUTLET �1-•00 SYS 16.20 I�� I 16126 LOMA AV TOTAL FEES 157.35 1 ITEMP 991 801632 1 ID$CRIPTYnN OF WORK 1 I IPLUM13ING FOR BATHROOM I 1APPLICANT TEL NO- 1 I 1 1KWOK (323) 697-2120- I 1 1260 E GARVEY AVE 1 ISPECIAL CONDITIONS 1 • IMONTEREY PARK 91775 I 1 1 ICONTRACTOR TEL NO. I 1APPROVALS DATE INSPECTOR SIGNATURE I ICHAO PAN (626) 960-8826- 1 1 12237 MAC DEVITT ST LIC NO 1 (UNDER SLAB WORK / IWEST COVINA, CA 91790 745705BHIC I I 1 1 IWATER SERVICE 1 IPLASTIC YIN METAL YIN 1 (ARCHITECT OR ENGINEER TEL. NO I I _ I IROUGH PLUMBING - LIC NO 1 I 1 I IGAS PIPING 1 1 IGAS VENT 1 1 I IHOT WATER HEATER I I I ` 1 IPLUMBING FIXTURES I 1 ILAWN SPRINKLERS IGAS TEST 1 1 ` (UTILITY COMPANY NOTIFIEDI I I CWV 1 I_ I I I 1 I IGRAY WATER SYSTEM I 1 I I I I I I I I I I I I I I 1 I I I I I I I I I I I 1 IREPORT ID DPR263 ROUTE TO BS0508 I 1 I I I I I I .: WORKERS' COMPENSATION DECLARATION AP UCA750N FOR PLUMBING PERMIT �4w� . ... - - � I hereby affirm that I have a certificate of consent to self '76A667C, insure,pr a certificate of Workers' Compensation Insurance, CE 817(REV 10/81) or a certified copy thereof (Sec 3800, Lob C ) - COUNTY OF LOS'ANGELES• " BUIMING-AND SAFETY Palicy No Company . . . , _ , 1 r _ ❑ Certified copy is hereby furnished A •_ BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) F-1Certifiedcopy is filed with the county building inspec_ ADDRESS tion'department NUMBER FIXTURE OR ITEM @ FEE LOCALITY l' er I \ Date Applicant � � WATER CLOSET -" NEAREST PC4`` CERTIFICATE-OF EXEMPTION FROM-WORKERS"' BATH TUB CROSS ST �j If^ak LGj i 1 COMPENSATION INSURANCE I SHOWER OWNER, ,r, P•5* -�pr.y`,,,, F+, ,o -(This sectlon need not be completed'if the work Involved by - - 11 the permit is for,one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which thisZ. permit is issued; I shall not employ any person m SINK CITY TEL NO any manner so as to become subject to the Workers Compensotiori Laws DISHWASHER - - - - , - CONTRACTOR Date Applicant (. CLOTHES WASHER. ..__ __. - ADDRESS ' i S- d V er NOTICE-TO APPLICANT If, after"m8king this Certificate of SWIMMING POOL RECEPTOR ' Exemption,'you should become subject to the'•Workers' _ CITY : /t �-�•� / TEL Compensation provisions of the Labor Code,,you must forth-, LAWN SPRINKLER SYSTEM M _ with 'comply with such 'p•ovisions or this'permit, shall be . STATEf' L1 3 /� LIC /^ deemed revoked WATER HEATER _ LICENSE NO -. _ O.rP CLASS l_ LICENSED CONTRACTORS DECLARATION `r i _DISTRICT NO PROCESSED BY I hereby affirm that I am licensed,under provisions of Chapter 9 GAS SYSTEM r p e OUTLETS ( L� �U :,.(commencing with Section 7000) of Division 3 of the Business, OUTLETS OVER - and Professions Code,and my license is in full force and effect 5 PER SYSTEM -` _ - FINAL-_- VALIDATION (_/3 DATE C d G �.3 (v License Number t 7 Lic Class Contractor 11 �•5 Date_( I—1 8 fr! BY i -I am exempt under Sec _ WB 8P C for this'reason Plan check fee.JLA _ _ ._ .. . . -- . _ -- �' -! � _, 11• D e PLUMBING PERMIT ISSUING FEE$ (� Z Signdture t r' - TOTAL FEE - Plan check applicant SINGLE FAMILY+ 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 Address - ^ Professions Code) City Tel No ❑ 1, as owner of the property, will do the work and the " structure is not,intended or offered for sale (Section _ ;25922A 7044, Business and Professions Code) � - CONSTRUCTION LENDING AGENCY- #,a 0 a 0.0 5 1 hereby offirm that there is a construction lending agency for the performance of the work for which this permit is issued - -- - -.•, .- • ___ _ _ I ° ° 34,50 (Sec 3097, Civ C ) a Lender's Name _ •I .1, 1.2 96 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 ;Sg'4natureof horize representatives of this County to enter upon the ed rop y r i spec ion purposes /��� - - - SEE REVERSE•FOR EXP.LANATORY.LAWGUAGE___�_ -- -___-- -- •-...-• •- .. ;...• .-• -- _ -, r ittee Date