HomeMy Public PortalAbout4915 MCCLINTOCK AVE_Plumbing__ COUNTY OF LOS ANGELES ' TEMPLE CITY # 0508 (-PLUMBING-PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 97.07240029
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA -
PHONE: (818) 285-0488 EXT:
LEGAL ID: !! FEES PAD— DR
TR: 4902 . -LT: 10 -BL: E 1 4915 MCCLINTOGK AV
1 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 'TEMP-CA 917804104
ASSESSOR INFOR14ATION NEAREST CROSS STREET:
8574-024-013 t 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4' LOCALITY: TEMPLE CITY
! 25 LAVATORIES/SINKS 1.00 FIX 16.35
TENANT: 47 WATER HEATER(S) 1.00 NTH 16.35 ISSUED ON: PROCESSED 5 0
TOTAL FEES 60.45 07/24/97 TC 07/24/98
OWNER: TEL. 0: FINAL DATE FINAL BYAJ I CODE:
KRALL VIRGINIA C TR (818) 444-4143- fih /�
4915 MCCLINTOCK AV `�vi
TEMP 917804104 UMIPTION OF WORK
NEW rER HEATER AND NEW LAV SINK IN BATH-HOUSING REHAB.
L.
AMPB CONSTRUCTION (818) 284-3260- .I
_ SPEC AL CONDITIONS:
CTRACTOR: EL. N0: �° �'� APPR A S DATE INSPECTOR SIGNATURE
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AMPB GENERAL CONSTRUCTION (818) 284-3260-
1600 ORANGE STREET LIC. NO �� � `` All D
ALHAMBRA, CA 549061B ,� a ;�
WATEt SERVICE
PLAS IC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
LIC. N0: i ��' _ i f �I a; C - = =��t�'
GAS PIPING
GAS it T
�`li jl _,j r� 1� -!tt--'I-� u'i -) HOT UATER HEATER
PLUMrING FIXTURES
LAWNISPRINKLERF-
GAS
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REPORT ID: DPR263 ROUTE TO: BS0508
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WORKERS'COMPENSATION DECLARATION 7GA667A
I-hereby affirm that I have a' certificate of consent to self CE 6,7 (:.6e) APPLICATION FOR PLUMBING PERMIT
insure,or a certificate of Workers'C pensation Insurance,or
a certified copy thereof(Sec.3800 b.C.)
��,✓/ COUNTY OF LOS ANG LES BUIL ND SAFETY
Policy d::. r r Company
❑ Certified copy is hereby furnis d. FOR APPLICANT TO FILL IN (PRINT OR TYPE) B DING t,
DRESS L IA �Q QV
Certi_fir copy filed with t e ounty bu' i ecfi•n NUMBER FIXTURE OR ITEM • FEE LOCALITY
depa'ufe t. �j �J,/ WATER CLOSET
Date iA7r/% pplicant F!�• NEAREST
/ BATH TUB —� CROSS ST.
CERTIFICATE'OF EXEMPTIO "^1 Oit R
COMPENSATION INSURJKNCE SHOWER .� OWNER
MAIL S
(This section need not be completed if the work involved LAVATORY ADDR S
by the permit is for one hundred dollars ($100) or less.) SINKO
CITY T N O1JJM 0
1 certify that in the performance of the work for which this DISHWASHER
permit is issued, I shall not employ any person in any manner CONTRACTOR
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER
ADDRESS
Date Applicant SWIMMING POOL RECEPTOR LLJ
NOTICE TO APPLICANT: If, after making this Certificate of CITY jEO �v?l
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM rn
STATE
Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE NO 6
with comply with such provisions or this permit shall be DISTRICT NO. SED
deemed revoked. GAS SYSTEM OUTLETS / 3 LICENSED CONTRACTORS DECLARATION OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL --r� Q/ VALIDAT N
ness and Professions Code,and my license is in'full force and DATE U
effect. n
��, (p �� FINAL
License Num r _ Lic.Class 4 BY
Contract o Date C
❑ I am exempt from the licensing requirements as I am a Plan Check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section 7031.5, Busi- City Tel.No.
ness and Professions Code):
❑ I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project 1 58.4A
(Section 7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY 0 0 1 Q
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is
0 0 0 1 3.C'CX '
issued(Sec.3097,Civ.C.).
Lender's Name 0606-80
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinces and State laws regulating Plumbing, and hereby
aut o Mize and
of his Cou y to enter upon the
ab a mention operty insp c ' n urpo
Signature of Permit ee ate/
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