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Home My Public Portal About10411 LOWER AZUSA RD_Plumbing__ 76A667-;E8 e7-8-57 \ APPLICATION FOR PLUMBING PERMIT 1 COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER FNEARSE G J� / BUILDING AND SAFETY DIVISION S D y �I 6j O JOHN A. LAMBIE. COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT OF BUILDING Y `('l /cFOR APPLICANT TOFILL IN TT. NUMBER FIXTURE OR ITEM OWNER WATER CLOSET MAIL / �!✓�� f BATH TUB ADDRESS SHOWER CITY TEL.NO. LAVATORY CONTRACTOR D A e I SINK ADDRESS C D DISHWASHER CITY :�'TEL.NO. G I -�� ?o LAUNDRY TUB CONTRACTO 'S STATE ❑ REGISTRATION NO. Y./ / COUNTY ❑ CLOTHES WASHER DISTRIC O. G P _7O E READY FOR INSPECTION WATER HEATERV}(y.�,!\] GAS SYSTEM INDUSTRIAL WASTE APPROVAL -.. INSPECTION RECORD t APPROVALS $1.00 PER ITEM DATE INSPECTOR'S SIGNATURE ,^ OR FIXTURE O UNDE4 SLAB WORK $ � f7 r PERMIT 00 ROUGH PLUMBING S 1 GAS PIPING TOTAL FEE 00 GAS VENT y V^ I HOT WATER HEATER HEREBY ACKNOWLEDGE THAT 1 HAVE- READ THIS APPLICATION 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 1 AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT AM HE LEGAL OWNER OF THE ABOVE UTILITY CO. NOTIFIED DESCRIBED RESIDENTI PR TY. 13�a SIGNATURE OF IOF PERM TTEE FINAL 9 d i Y VALIDATION ROBERT✓A. WOOD, SUPERVISING MECHANICAL ENG'R M. 0. CASH 2998m JUL 18 5 A 8.00 M r r WORKERS'so - aSATION DECLARATIONAPPLICATION FOR PLUMBING PERMIT hereby, affirm that I haveavea certificate of consententto•self in- 20-0026 DPW 4/90 sura;or a cdfificate of Workers'Compensation Insurance,or a 76A667A certified copy thereof(Sec. 3800, Lab. C.) Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN (PRINT OR TYPE) Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET.(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB . CROSS ST. [ COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK - mit is issued, I shall not employ any person in any manner so CIT N ✓ � as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS tion,you should become subject to the Workers'Com en- SWIMMING POOL RECEPTOR em P Y I p CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed-revok- STATE LIC. ed. WATER HEATE LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION 'D DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS -rep9(commencing with Section 7000)of Division 3 of the Business OUTLETS and Professions Code, and my license is iri full force and ef- 5 PER SYSTEM FINAL 1 /j_/�� -VALIDATION fect. HOSE BIB DATE License Number Lic. Class ACCT.0 FINAL 3-603 43.80 C Contractor Date BY U 1ITEMS cc 0. I am exempt under Sec. TOTAL 43 m '87.0 B.BP.C. for this reason Plan check fee CHECK 43.80 0. Date: PLUMBING PERMIT ISSUING FEE$ Signature Ip CHARGE oOO U) TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant gTO-0001 10I 6/95 I,hereby affirm tha(I am exempt from the Contractor's.License Name F'-662 1 AM 9:53 Law for the following reason (Section 7031.5, Business and Prof ssions Code): Address I,.as owner of the property, will do the work and the City Tel. No. 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 all County ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above- entio ed prop rt oc in ection purposes. �� SEE REVERSE FOR EXPLANATORY LANGUAGE Si toe of Per ittee ate COUNTY'OF LOS ANGELES TEMPLE CITY # 0508 'PLUMBING PERMIT'_ DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS -PL 0508 981130_0005_,. BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 ---- PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 13645 LT: 14 10411 LOWER AZUSA RD FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803470 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HALIFAX 8585-017-019 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C5 LOCALITY: TEMPLE CITY 25 LAVATORIES/SINKS 1.00 FIX 16.20 TENANT: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 47 WATER HEATER(S) 1.00 WTH 16.20 11/30/98 UT 11/30/99 64 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 OWNER: TEL. NO: TOTAL FEES 92.55 FINAL DATE FINAL BY: CODE: CHAN;SUNGT (626) 448-7433- 4903 BIRCHLAND PL. TEMPLE CITY, CA DESCRIPTION OF WORK PLUMBING FOR DENTAL OFFICE APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: �� _. APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER / X LIC. NO ' �.,� rf� �. A`, UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: IT] � 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