HomeMy Public PortalAbout9512 LOWER AZUSA RD_Plumbing__ 76AG67A(CE-61719)-11/78 °�•`'
AH ,s. LICa 8 ION FORPL, uMBING"P.ERM°i"f. dam.
'BUILDING AND C'AFETY DIVISION
FOR APPLICANT.TO FILL IN(PRINT OR TYPE) BUILDING f.
( J ,6•C Tri SCJ: '
NUMBER FIXTURE OR ITEM ® FEE ADDRES
WATER CLOSET LOCALITY
BATH TUB. : NEAREST fX
CROSSST: C4)
SHOWER OWNER-.;01 �r5, i�7� C.f Gt
LAVATORY MAIL: -
i ADDRESS
�'• SINK • CITY f�cI f�G /^.� , EL:NO.
DISHWASHER A.
CONTRACTOR
CLOTHES WASHER 'ADDRESS )
SWIMMING POOL RECEPTOR
CITY .. C�/8 'TEL.NO. 3 a
LAWN SPRINKLER.SYSTEM
STATE -� LIC. ,
WATER-HEATER LICENSE NO. CLASS
GAS SYSTEM OUTLETS y DISTRICTNO.
GROUP._ Z N PR CE BY
OUTLETS OVER �+
5 PER.SYSTEM INDUSTRIAL
WASTE APPROVAL"
INSPECTIONRECORDw.
X4. 1r_Z _r
p m 0 A...
.Plan check fee
PLUMBING PERMIT ISSUING FEE$
TOTAL FEE ',
Plan check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING r
city Tel..No. -GAS PIPING
1 HEREBY'ACKNOWLED6E THAT I HAVE READ THIS APPLICATION AND STATE GA&VEN ' ;^"� •' - -
THATTHE ABOVE IS CORRECT AND,AGREE.TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. G, HOT WATER HEATER '
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES' '
REQUIRED BY LOS ANGELES CDUN 'AND STATE OF CALIFORNIA OR THAT)-AM.THE 'GAS TEST :�p
F •LEGAL OWNER'I AND INTEND SIDE IN THE ABOVE•.DESCRIBED RESIDENTIAL -
PROPERTY. UTILITY CO.NOTIFIED _
SIGNATURE - - /',�(! _
OF'PERMITTEE FINAL. �' �� -1I-C R
PLAN CHECK VALIDATION• ', CK. M.O, CASH PERMIT VALIDATION ' '. c3l, M.O: CASH
. Ss
• '��.8.9.17 25M SETH 7-47
• ._- '
DEPARTMENT ®� BuiDIN1C" SAFETY APPLICATION FOR PEST
'COUNTY --
OF LOS ANGELES
i 4 WM.J.FOX.CHIEF ENGINEER i
NATURE OF DISTR, O. GRO � o E p . T. o.
.ROUGH FIXTURES COMPLETE 1
HEATER -CESSPOOL -I SEPTIC TAMK , REC 1 BY READY FOR DATE ISSUED
-- — FIRST. INSPECTICN
AS MIBCELLANEOUB e
APPLICAM,FILL IN HEAVILY -OUTLINED PORTION ONLY
... JOB. aL I I
E NAME __ - ADDRESS
W
O
E
ADDRESS ,y LOCALITY Q.
NEAREST
A CITY TEL.No. CROSS ST.. 1� 4r
COUNTY
CERT.No. EXPIRES. NAME i"G/[� Islip
g.
LOCATION OF SEPTIC TANK, OR CESSPOOL= Z MAIL
NORTH O ADDRESS` ��"� �' ✓4 �{ 1
tZ cITY�C�is ''r '`(
TEL.No.
1 AM THE LEGAL POBBEBSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
• PLUMBER.
I AM THE_LEGAL OWNER O THE PROPERTY DESCRIBED
ABOVE. �?��L`3
owNcR
CORRECTIONS
l ' . . .. ! / Ad k
SOUTH J
DESCRIPTION OF WORK z
BATH TU9v FURNACE L7
ER DISHWASHER O
-AVATORY t REFRIGERATOR
r
'✓KITCHEN SINK v WATER SOFTENER
FLOOR SINK • SAND TRAP
GLOP SINK FLOOR DRAIN
ASH TRAY URINAL —APPROVALS
WATER CLOSET t DEINKING FOUNTAIN DATE BN9PBCTOR'9 NAME
WATER HEATER - *+ENTAL LAVATORY
ROUGH /,Q,�/ �"l>IL
Yf :PLU6ABING
METE+ y6OAS --------._SODA FOUNTAIN GAS PIPING I I
OUTL
GAS VENT I
,O f CESSPOOL
T AL NUMBER OF FIXTURES V SEPTIC TANK
EBSPOOL_____SEPTIC TANK 00 SEWER
.S ).V UTILITY CO.NOTIFIED I `. t1
TOTAL. FEE
FINAL
a9.Sr1.78SM ETH 11-46 APPLICATION
FOR PZPJW'OF BUILDING
AND
7FmTp .
COUNTY OF LOS ANGELS
? WN.J.FOX.CHIEF ENGINEER
-- -PLUMBING.
NAT[JIdE OF INSTA TIOl`T. ®esTRmoo. . GitovP o P �AlT
ROUGH FIXTURES COMPLETB
R� Y 'READY FOR DATE ISSUED
HEATER .. CESSPOOL -I:SEPTIC'TANx._ FIRST'INSPECTION
AS M18CELLANEOUB L ��.
APPLICANT FILL IN NEObTLINED PORTION ONLY
G )k moo JOB
.
' tr •. NAM o a '
' •ADDRESS „
mg - 'ADDRESS-L�f�Dg71�'�7I�o.o• 1}®I{vV��j_$y L�1V'P� LOCALITY �/'P/}�3h�eC� ` �
_CITY - �L AS S�L-9 �L11;1k-:�jTc6 P NEAREST Bfl s'1•. !! �,(iG_�t li, cl,;/ L
COUNTY r
CERT.No. EXPIRES NAMIS'
LOCATION OF SEPTIC TANK,.OR CE13SP®®L Z MAIL Q _
' NORTH G ADDRESS
-
` CITU TEL.No.
1 AM THE LEGAL POSSESSOR. OF THE A®OVE LOS '-
+ ANGELES.COUNTY CERTIFI/CCA 6:O�gUf1LIFIC��A/rTION.
• - .. 1 ! `' �'t-.�'�,//,//- ,LWi Q Ill•/.'f�?iZ/ -
• •. � tf F�' t� � PL[1IA96R x
GTHE LEGAL OWNER.OF THE.PRO6ERTY.DEBCR118ED
AB IL _
OWNER
CORRECT16NS
SOUTH
J.
DESCRIPTION, OF WORK,
• ' Z
BATH TUB FURNACE
---SHOWER DISHWASHER r G
IAVATORY REFRIGERATOR
KITCHEN SINK �_. WATER80FTEMER .
• FLOOR SINK SAND TRAP
LOP SINK FLOOR DRAIN
WASH'TRAY URINAL
APPROVALS
WATER CLOSET DRINKING FOUNTAIN: DATE INaPeeTOR'e NAtvE '
WATER HEATER•: DENTALLAVATORY 1 ROUGH PLUMBING
METER----"GAS FODA.,FOUNTAIN j 6A8 PIPING I I
OUTL I
am
f GAS VENT `
-CESSPOOL
TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOI PEPTIC TANK '77. i 'BEWER'
.I
UTILITY CO.NOTISVIED
.TOTAL FEE _
FINAL
10.95
)05-17 APPLICATION FO PLUMBIi"G PERMIT
1
DIVISION OF BUILDING AND SAFETY
Deportment of County Engineer
C 337L County of LOS Angeles BUILDING
JOHN A.LAMBIE, COUNTY ENGINEER ADDRESS 95].2 Lower Zzwa Rd.
CASSATT D.•GRIFFIN�SUPT OF BUILDING
LOCALITY R08e1de8d
FOR APPLICANT TO-FILL IN NEAREST
CROSS ST.
OWNER DISTRICT`�NO. GROUP I ZONE I a o N PE 1oH
MAIL /J / E W
ADDRESS Same 5 i
USTRIAL
CITY TEL.NO. WASTE APPROVAL
PLUMBER GENERAL INSTALLATION CO. INSPECTION RECORD
ADDRESS 6555 Won Blvd. 4 � h �"' hAU r�1 woc� �L�-r. ,►..�,�
CITY L.A. 43 TEL.NO. PLeasunt 3-2541
LICENSE No: 787 C-36 151839
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $1.00.. 5 f �T--
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
q CLOTHES WASHER @ $1.00 ^^�^
db WATER HEATER @ $1.00 3. 00
GAS SYSTEM @ $1..00/
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 00 , ROUGH PLUMBING -
GAS PIPING
TOTAL FEE q 00 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. `
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TESTLICENSED ANGELES COUNTY AND rfJ
OF
CALIFORNIASOR THATDI BAMLOS THE LEGAL OWNER OF THEATE ABOVE UTILITY CO.NOTIFIED lrill ,f
DESCRIBED RESIDENTIAL RT / y j
SIGNATURE ! 1' / II 1 '*4v
OF PERMITTEE FINAL
IOHN A.LAMBIE,COUNTY ENGINEER LIDATION ROBERT A.,LOIP.CHIEF PLBG. INSPECTOR
K. M.0. CASH
�� 3.0 0 ,�
`6A667 088 17 1-51 APPLICATION FOR PERMIT
DEPARTMENT'OF BUILDING AND SAFETY.,
COUNTY OF LOS ANGELESP R .
FXN
WILLIAM J. FOX, CHIEF ENGINEER
D RTCT No. OR ZONE
FOR APPLICANT TO FILL n IN
PLUMBER REC €ySY RST INREADYSPECTION
FOR DATE ISSUED
I
FI
'ADDRESS d -/iy✓d +�)�, UA.
/l r
sullmliNer �.
OITY i�� TEL.No. , Q"6}i-jxJ'? ADDRE68
COUNTY y /
L NBE NO. / EXPIRES -y (� ,7��w' LOCALITY r
NEAREST
PERMIT FEES / 1 cRo9s BT. -
NUMBER TYPE OF FIXTURE UR ITEM FEE h OWNER
MAIL
WATER CLOSET(TOILET) (11 0.50 10 ADDRESS
BATH TUB @ 0.50
CITY TEL No.
SHOWER @ 0.50 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BA91N) 0.50 APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK R 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS TME ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0 0.50 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER
OF THE RESIDENTIAL P dPERTY_DEB RMBED ABOVE.
OAS BY8TEM DUTLETS 0 0.50 SIGNATURE OF
WATER HEATER Q 0.50 PERMITT
SLOP BINK 0 13.513 INSPECTION RECORD/
FLOOR SINK 0 -0.50
FLOOR DRAIN 0.50
DISHWASHER 0.1143 �����✓
DRINKING FOUPLTAIN 0.60
URINAL 0,50 Q
HOUSE SEWER 0.60 _Z
MIBCELLANEOUB 0
O
APPROVALS
TE IMBPECTOR-B NAMC
ROUGH PLUMBING e,,-
GAJI PIPING
GAB VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANKS SEPTIC TANK
DRAIN ( ) PIT ( ) 1.00 SEWER
PERMIT 1.00 GAS TEST
TOTAL FEE >6 �� UTILITY CO.NOTIFIED
FINAL y.
_ 76Pi667"(CES=817)-B-71 ,
APPLICATION FOR PLUMBING" PERMIT.;:
COUNTY OF LOS ANGELES .
DEPARTMENT OF COUNTY ENGINEERr .
, 70-cif
y�S 9
BUILDING AND SAFETY DIVIaION BUILDING
ADDRESS 4 y[
LOCALITY 1 (71�~
FOR APPLICANT TO FILL IN=(PRINT OR-TYPE) -NEAR EST `,i.. �� '
CROSS.ST. L
NUMBER FIXTURE'OR ITEM -® FEE: 1
" OWNER :• -
WATER CLOSET .1.75. ""
MAIL � .. :d• P .!
BATH TUB 1.75 ADDRESS
SHOWER 1.75 C'I _ TEL. N
LAVATORY 1.78 CONTRACTOR".
"'
SINK 1.75 ADDRESS
DISHWASHER 1.75- 1 �. ti
CI
TY TE L.,'N'O.
CLOTHES WASHER 1.7.6 STATE LIC
LICENSE NO. CLASS
SWIMMING POOL RECEPTOR 1.75
DISTRICT NO. GROUP ZONE PROCESSED..B'Y
LAWN SPRINKLER SYSTEM 1.75 P .
WATER HEATER 1.75 „INDUSTRIAL'
WASTE APPROVAL
GAS SYSTEM OUTLETS 1'.75
INSPECTION RECORD
OUTLETS OVER 30
5 PER SYSTEM
Plan check fee See reverse.
PLUMBING PERMIT ISSUING FEES 3'" 00
TOTAL FEE
-.APPROVALS DATE- INSPECTOR'S SIGNATURE '
Plan check applicant UNDER SLAB WORK
Name• ROUGH PLUMPING '
Address GAS PIPING
City Tel..'NO. GAS'VENT
•1 HEREBY ACKNOWLEDGE THAT I HAVE`R.EAD THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND g6RE6 TO.COMPLY PLUMBING FIXTURES'-
WITH ALL CO UNT•Y ORDINANCES AND STATE LAWS REGULATING
PI:umfimr. 'GAS TEST '
1 HEREBY CERTIFY THAT-1 AM PROPERLY 'REGISTERED .AND/OR UTILITY CO. NOTIFIED
LICENSED AS. REQUIRED BY LOSGELES COUNTY AND-STATE OF
CALIFORNIA OR THAT I A T GA 'OWNER•OF; AND INTEND TO '
RESIDE IN THE ABOVE DES D RES E TIAL'PRO TY..ti -FINAL -
SIGNATURE. -
O'F PERMITTE -
PERMIT VALIDA EK; M.o. CASH
PLAN CHECK VALID ION CK.. M. .i CASH v
72. �: JUL- : o .5
76A867A (09 81.7F) -4/77 ;,
a
APPLI 'ATION: FOR—PLUM BING PERMIT
B ING AND SAFE VISION
FOR APPLICANT TO FILL IN[PRINT OR TYPE) BUILDING
NUMBER 'FIXTURE OR ITEM• ® FEE ADDRESS ( Jr��' L���1�/Ts� �✓"
WATER CLOSET
NEAREST .�•.
BATHTUB CROSS ST.
SHOWER OWNER ^FZ1p
MAIL /
LAVATORY ADDRESSZ
SINK CITY J"2r---;00 01K*C—'C/ TEL NO.
DISHWASHER CONTRACTOR
CLOTHES WASHER Qy :
ADDRESS
,9
SWIMMING POOL RECEPTOR
CITY TEL.NO. c7 dr��l
LAWN SPRINKLER SYSTEM
STATE LIC.
WATER HEATER LICENSE NO... CLASS
GAS SYSTEM OUTLETS DI CT NO. GROUP ONE CESSED
OUTLETS OVER dCJ —I _ O
5'PER SYSTEM INDUSTRIAL v
WASTE APPROVAL
INSPECTION RECORD
• '� • ' /,���f2 . 6�•��-��" ate' - � y
Plan check fee
PLUMBING PERMIT ISSUING FEE$ �O
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB
19
Address ROUGH PLUMBING OF
City Tel.No. GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION:AND STATE GAS.VENT -
THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER '
1 HEREBY CERTIFY'THAT I AM PROPERLY REGISTERED'AND/OR LICENSED AS PLUMBING FIXTURES
REQUIRED BY LOS ANGELES.000NTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST•.
LEGAL OWNER OF,AND.INTEND ESIDE IN THE ABOVE DESCRIBED RESIDENTIAL _
PROPERTY. UTILITY CO;NOTIFIED
SIGNATURE
OF PERM ITTE FINAL
PLAN aHET%,Zf1f DL-TI CO V! el ENGAT N PERMIT VALIDATION �- CIC. M.O. CASH
7 9 6 DEC 1 5 .0 7.x•.0 A-C,
-POLICY HOLDER. ' - -
POLICY NUMBER:
76A667-CE91712/59 TEMPLE,CITY
API'LICATION FOR PLUMBING PERmi T
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER FBU
BUII.DIN S FETY MSION' LDING � ,N AIE. OUNTY ENGINEER DDRESS WILLIAM A.JENSEN.SUPT 00 BUILDING
O
FOR APPLICANT TO FILL.IN CROSS T. Lov
NUMBER 'FIXTURE OR ITEM
WATER CLOSET
ADDRESS . �..�vV i'='�{{��
:a
BATH TUB
SHOWER - CITY C-Am No.
LAVATORY CONTRACTOR
SIPiS ADDRESS
DISHWASHER CITY TEL NO.
CONTRACTO ' STATE '❑
LAUNDRY TUB REGISTRATION NO. COUNTY ❑
CLOTHES WASHER DISTRICT NO. GROUP ZONE MPESSED BY
WATER HEATEB J d L
GAS SYSTEM .. INDIISTRIAL
WASTE-APPBOVAL
INSPECTION RECORD
O
- O
e F
V
W OR 0
PERFDmTITElM I _
APPROVALS DATE iNSPEC g•S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING rr�
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I HAVE READ. THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE 1$ CORRECT AND AGREE TO COMPLY
i WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT T WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED.AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE. OF GAS TEST I;
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER .OF.THE ABOVE
DESCRIBED RESIDENTI PROPERTY. r UTILITY CO.NOTIFIED
SIGNATURE 4 ! � it A I/M
OF PERMITTE E S` p'
FINAL � •h.l � N
�a VALIDATIO ROBERT A.WO D.
CK. M.0. CASH SUPERVISING MEC1lAN CA1:,ENG'R
�h1,o 7 8 6 0 ir�Y j 5 4.00-
�° ..
76A667AdGE'617131-"11/:76
� 'R_ �°�1 •RLUmBl Q,PERMIT. -
POLICY HOLDER:, =
POLICr a NUMBER: ( BUILDING AND SFI�FET1f DIVISION -
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
NUMBER - FIXTURE OR ITEM ® FEE ADDRESS
p
, WATER CLLOCALITY,
OSET - r •�� `V.". � +� '
NEAREST
BATHTUB
•CROSS ST.
SHOWER OWNER
LAVATORY MAIL -
ADDRESS �.
'SINK CITY' TEL.-NO.,
DISHWASHER CONTRACTOR 'r
CLOTHES WASHER
ADDRESS. �•� Pew
SWIMMING POOL RECEPTOR
CITY', e , TEL.NO.'. _ Z
LAWN SPRINKLER SYSTEM - STATE.. , LIC:
WATER HEATER LICENSE NO: CLASS._.
GAS SYSTEM OUTLETS00 DISTRICT NO. GROUP NE PRCt 5AED BY
OUTLETS OVER'
5 PER.SYSTEM - INDUSTRIAL -
WASTE APPROVAL
INSPECTION RECORD IN,
u
Plan check fee
PLUMBING PERMIT:ISS.UING FEE$
r TOTAL.FEE T
7
PI'an check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE•
Name
UNDER.SLAB.WORK'
Address. ROUGH PLUMBING
City Tel.•No. JHAH
GAS PIPING %
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS.APPLICATIGAS VENT • _
THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH'ALL COUNT .• HOT WATER'HEATER
AND STATE LAWS REGULATING PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES!
,REQUIRED.BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR GAS TEST•
LEGAL OWNER:OF;'AND INTEND TO RESIDE IN THE'ABOVE DESCRIBE . -
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE ..
OF PERMITTE— FINAL
PLAN CHECK VALIDATION CK. M.O. _ CASH PERMIT VALIDATIO CK: M.O. CASH
ION
WORKER'S I have
a certificate
of consent to 17W67 DP1N9/59 APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a certificate of consent to self Insure, 178A887A I I
or a certificate of Worker's Compensation Insurance,or a certified
copy thereof(Sec.5800 Lab.C.) -
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF P BLIC WORKS DIV.
Policy No. Company - �!
❑ Certified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUADILDING
❑ Certified copy is filed with the county building Inspection
PRESS
department., NUMBER FIXTURE OR ITEM G FEE LOCALITY `
Date Applicant
WATER CLOSET NEAREST
CERTIFICATE ST.
OF EXEMPTION FROM WORKERS' BATH TUB ASSESSOR '
COMPENSATION INSURANCE
(This section need not be completed if the work Involved by the SHOWER MAP BOOK PAGE PARCEL
permit is.for one hundred dollars.(8100)or less.) OWNERC
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 MAILRDDRESS
become sub' ct to the Wgrkers'iCompensation Laws. ,�•-
!`� ! DISWASHER CITY TEL.NO�3j 0 .��
Date �� Applicant / CLOTHES WASHER CONTRACTOR
NOTICE TO APPLICANT: If, afte making this Certificate of .I
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 - R H j CITY � TEL.NO. y�'�
I hereby affirm that.I am licensed under provisions of Chapter 9 / G
STATE
5'
(commencing with Section 7000)of Division .of the Business and i GAS SYSTEM OUTLETS CLASS 5GJ7
Professions Code,and my LICENSE NO.license is in full force and effect. ,
����� � 5OUTLETS OVER
PERYSTEM DI NO� PROCESSED lBY O
License Number Lic.Gass (//)
FINAL VALIDATION a
�� i DATE
Contractor bate m`C g�TE -`�' N
❑ I a exempt under Sec. i BY AL Z
B.&P.C.for this reason �•,
Date: Plan check fee _ SPECTIP"
CHANGE .00
Signature PLUMBING PERMIT ISSUING FEE.$
ElTOTAL FEE r '. l 0000-0001 , 7/10/95
ofin
SINGLE FAMILY
Plan check applicant V t M 4:47
1 F4f` � ,
HOME OWNER-BUILDER DECLARATION i Name 1246
I hereby affirm that I am exempt from.the Contractor's License Law
-for the following reason(Section 7051.5', Business and Professions Address
Code):
❑ City Tel.No.
I,as owner of the property,will do the work and the structure y
Is not Intended or offered for sale(Section 7044, Business '
and Professions Code).
CONSTRUCTION LENDING AGENCY i
I hereby affirm that there is a constructionlending agency for-the '
performance of the'work for which.this permit is issued(Sec. 5097,
CIV.C.) i
Lender's Name
Lendees 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 1
representatives of this County to enter upon the above-mentioned i
property for inspection py(pases. SEE REVERSE FOR EXPLANATORY LANGUAGE
r
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0403260008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL D: FEES PAID BUILD G D R SS:
TR: 12998 LT: 12 9512 LOWER AZUSA RD
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804221
ASSESSOR INFORMATION NUMBER2- NEAREST CROSS STREET: CLOVERLY
8592-002-027 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 2.00 FIX 32.40
TENANT: 21 HOSE BIBB(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN 8 EXPIRES ON:
25 LAVATORIES/SINKS 2.00 FIX 32.40 03/26/04 VG 09/22/04
45 WATER CLOSET/URINAL 2.00 FIX 32.40
OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 F AL AJE FINAL BY:
LAM BRIAN (626) 831-0661- 60 DWV REPAIR OR ALTER 1.00 SYS 16.20
3925 ROSEMEAD 80103 TOTAL FEES 173.55
ROSEMEAD, CA DESCRIP ION OF WORK
PLUMBING FOR ADDITION
APPLICANT: TEL. NO:
GUO SEAN (626) 926-7318-
3220 NEWBOLT CIR SPECIAL CONDITIONS:
HACIENDA HTS, CA
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
HCC DEVELOPMENT (626) 280-8765-
2446 N SAN GABRIEL BLVD #B LIC. NO UNDER SLAB WOR
ROSEMEAD CA 91770 784773 B
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: _ TE N0:
LIC. N0:
ROUGH PLUMBING 's v
GAS' PIPING f,2��"'ff
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CNV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508
it -.
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLU 616E PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0408300010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (6:;,; 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 12998 LT: 12 9512 LOWER AZUSA RD
FEE DESCRIPTION: QUANTITY: UOM: A-POUNT: TEMP CA 917804221
ASSESSOR INFORMATION UMBER: NEAREST CROSS STREET: CLOVERLY
8592-002-027 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
47 WATER HEATERS) 1.00 WTH 16.20
TENANT: - TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
08/30/04 JK 02/26/05
OWNER: TEL. NO: FI L A FINAL BY: CODE
LAM BRIAN (626) 831-0661-
3925 ROSEMEAD BL#103
IROSEMEAD, CA CR TION OF WORK
W ER HEATER CHANGE OUT
APPLICANT: TEL. 0:
(SAME AS O4NER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS '^JAPE INSPECTSIN)URE
(SAME AS OWNER -
LIC. NO UNDER SLAB WORK
WATER SERVICE
!PLASTIC Y/N METAL Y/N --
IARCHITE-CT OR ENGINEER: TEL. N0: ' lF;�J GH PLUMBING
G
L:". I AS PIPING i- ------
i
GGAS VENT --
HOT WATER HEATER
PLUMBING FIXTURES
LAW-W SPRINKLERS
GAS TEST -
UTILITY COMPANY NOTIFIED ---
CWV
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508