HomeMy Public PortalAbout9427 LEMON AVE_Plumbing__ DBS•17 9•55 APPLICATION FOR ,,PLUMBING PERMIT
DMSION OF BUILDING AND SAFETY
Department of County Engineer 111; 191
County of Los Angeles BUILDING
" WM. J. FOX, COUNTY ENGINEER ADDRESS 7707 L. IVC-1
CASSATT D. GRIFFIN, SUPT OF BUILDING
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
�7 CROSS ST L/ Jle
OWNERpQf�/M Al �FA�j�-r /��j DISTRICT NO GROUP Zy-`II READY FOR INSPECTION
ADDRESS /�/y/ lam. /��I X �I^ ^' J�
/ INDUSTRIAL
TEL NO.JDG "1IIln WASTE APPROVAL
PLUMBER INSPECTION RECORD
ADDRESS
CITY TEL 'NO
LICENSE NO.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) $
BATHTUB
SHOWER
LAVATORY (WASH BASIN)
KITCHEN SINK
DISHWASHER
LAUNDRY TUB OR TRAY
CLOTHES WASHER
TOTAL NO @.080 APPROVALS
DATE INSPECTOR'S SIGNATURE
GAS SYSTEM OUTLETS @ 1 00
ER SLAB WORK
WATER HEATER @ 1 00 UND
ROUGH PLUMBING
PERMIT S 1// 00 GAS PIPING.
TOTAL FEE e)eJ GAS VENT
.I HEREBY ACKNOWLEDGE THAT I 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
PLUMBING
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY
SIGNATURE OF PERM ITTEE — FINAL %�-���Z'�t�i�kf fo�IdLLGLC.1�vJ
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
2.Q 0 �'
AC0 8 1 3 5 I SEP 2 Q
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self 76A667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV 10/81)
or a certifi d copy thereof (Sec 3800, Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Polic o Company
Certified copy is hereb ur tshed
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /�
Certified copy is filed wit t cou y building mspeo- ADDRESS L �/� S
NUMBER FIXTURE OR ITEM LOCAL
tion e r e @• FEE
WATER CLOSET
Date Appl nt NEAREST
CERTIFICATE OF EXEMPT RKERS' BATH TUB CROSS ST
COMPENSATION I RANCE OWNER
(This section need not be completed if the work involved by SHOWER
the permit Is for one hundred dollars ($100)or less.) LAVATORY MAIL
ADDRESS \ \`t+
I certify that in the performance of the work for which this t•
permit is issued, I shall not employ any person in any manner SINK CITY TEL NO
so as to become subject to the Workers'Compensation Laws DISHWASHER
CONTRALTO
Date T If,cant CLOTHES WASHER �� �vv
NOTICE TO APPLICANT If, after making, this Certificate of ADDRESS 1/�J
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY TEL N
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STAT LIC
deemed revoked WATER HEATER LICENSE NO CLASS
LICENSED CONTRACTORS DECLARATION DIS�CT Nq / ROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS v(/f%�(�J(
(commencing with Section.7000) of Division 3 of the Business OUTLETS OVER >,
and Professions Code, and my license is in full force and effect 5 PER SYSTEM FINAL / VAL ION Q
DATE V
License Number Lic Class
FI
Contractor Date B
❑ I am exempt under Sec
B 8P C for this reason Plan check fee _ ►
Date PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE U
SINGLE FAMILY
Plan check applicant 2 3 1 46A,
HOME OWNER-BUILDER DECLARATION Name• # 0 0 0 0 0 5
I hereby affirm that I am exempt from the Contractor's License Addres
O
Law for the following reason (Section 7031 5, Business and 0 - 1650
Professions Code) City Tel No
❑ I, as owner of the property, will do the work and the 0 0 0 1 Jr
structure•is not intended or offered for sale (Section ,
05
7044, Business and Professions Code) I Q 1 6-8 5
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 all County
Itances and State jaws regulating Plumbing, and hereby
representatives of this County to enter upon the
-me coned property for inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
t o mrttee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 �PL'UMBING-PERMI-T--j
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS P170508-9702100005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
GA D: FEES PAID BUILDINGADDRESS:
ON FILE 9427 LEMON AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801303
ASSESSOR INFOR R: NEAREST CROSS STREET: TEMPLE CITY BLVD.
5382-010-047 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 1.00 FIX 16.35
TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.35 ISSUED ON: PROCESSED : PLAN B R ON:
45 WATER CLOSET/URINAL 1.00 FIX 16.35 02/10/97 LC 02/10/98
TOTAL FEES 76.80 --
OWNER: TEL. NO: FINAL ATE FINAL BY: DE:
LIMA JOHNNY;BRKICH ROBERT M SR;CARO
9427 LEMON AV
TEMP 917801303 DESCRIPTION OF WORK
PLUMBING FOR BATH LOCATED IN WORKSHOP
APPLICANT: TEL. 0: N
SAME AS OWNER -
�� O SPECIAL CONDITIONS:
u ❑
CONTRACTOR: N0: �� +u u / APPROVALS D SP C 0 IGNATURE
SAME AS OWNER - I •� 1
LIC. NO SD oUNDER SLAB WORK
El
- -- - ZbAff /
—------- ---- — WATER SERVICE
PLASTIC Y/N METAL Y/N
ITEC !/!1'�� �L �LcJL ccDI
ROUGH PLUMBING
LIC. N0: ibT WATER HEATER
GAS PIPING
GAS VENT
FroRffnM-TTXTUR-T9--
LAWN SPRINKLERS
� GAS TEST
0 UTILITY COMPANY NOTIFIED'
CwV
WATERGRAY
REPORT ID: DPR263 ROUTE TO: BS0508