HomeMy Public PortalAbout10404 MILOANN ST_Plumbing__ 76A667-CF#8172.62 li •-elfv-'Lq=rE cL r r.
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDINGho Y
O
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITYm
d� 0+
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE ;
OWNER e�
WATER CLOSET $1.25 MAIL
BATH TUB 1.25
ADDRES r
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25 CONTRACTOR +-t Y�2�
SINS 1.25 ADDRESS
DISHWASHER 1.25 CITY �R TEL. NO.CON �I�
STATE
LAUNDRY TUB 1.25 REGIS RATS NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER 1.50o57>
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30
INSPECTION RECORD d
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE t GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT 1 A THE AL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE D RIB RESIDENTI PROP TILITY CO.NOTIFIED
SIGNATURE
OF PERMITTE FINAL -lC•6Q- /
VALIDATIODROBERT A.WOOD
CK. M.0. (CASH SUPERVISING MECHANICAL ENG'R
LAfa 00813 JM 15 5 D 3.50w
I11IORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby:afflgn'that I have a certificate of consent to self 20-0026 DPW 6/87
insure,•qr a certificd'te of Workers'Compensation Insurance, 76A667A fut
or a certlied copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS
Policy No. Company "
Certified copy is hereby furnished.. BUILDING
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE)
Certified copy is filed with the county building inspec- ADDRESS )CLAW "100 Q1ntti
NUMBER FIXTURE OR ITEM @ FEE
tion department. LOCALITY
Date Appliqant WATER CLOSET NEAREST t
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATHTUB CROSS ST, k,ALr_
COMPENSATION INSURANCE C OWNER —
(This section need not be completed if the work Involved by SHOWER
the permit is for one hundred dollars($100)or less.) f LAVATORY MAIL
ADDRESS i)O 4 CO
I certify that in the performance of the work for which this
permit is issued,I shall not employ any person in any manner SINK CITY�— TEL. NO. `1,_I j
so as to become subject to the Workers'Compensation Laws.
f DISHWASHER CONTRACTORri
Date 1� ' Applicant CLOTHES WASHER ,
ADDRESS -no
NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR � ��
Exemption, you should become subject to the Workers' CITY TEL. NO. ,•^ c
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM eioC._ J 7�Z`�
with comply with such provisions or this permit shall be STATE _ LIC.
deemed revoked. WATER HEATER LICENSE NO. r .j CLASS
LICENSED CONTRACTORS DECLARATIONDISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license Is in full force and effect. 5 PER SYSTEM. FINAL
'�t VALIDATION oQQ°
, 3_CI l Z �v'e_ b,dh DATE
License Number Lic. Class
+j. FINAL
I
Contractor Date �Li_'ti Z BY Q
❑ I am exempt under Sec. W
B.6P.C. for this reason ® �°
Plan check fee
Date:---its fiLis fiL
PLUMBING PERMIT ISSUING FEE$ A/ 75
Signature
TOTAL FEE 8
Plan check applicant ,-:•i;
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name 'r•-•-.:iaf
fel>-•;ti a ,ISf '•+".?'0
I hereby affirm that I am exempt from the Contractor's License �'-!�+'� � = �-•F
Law for the following reason (Section 7031.5, Business and Address r.
Professions Code): City Tel. No. i
a ;
I, as owner of the property, will do the work and the w•!'in!'t;3� j 11
structure is not intended or offered for sale (Section '
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY ;i t4L y ( t rrr
I hereby affirm that there is a construction lending agency for i f:i�' w' C.=-
the performance of the work for which this permit is issued I
(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-mentioned'property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1305300011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1
ITR: 14053 IT: 2 I 1 10400 MILOANN ST 1
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT-1 TEMP CA 917803471 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
18585-018-002 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY CAI
107 BATHTUBS/SHOWERS 1.00 FIX 16.20 1 I
TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PLAN BY: 1
145 WATER CLOSET/URINAL 1.00 FIX 16.20 106/03/13 SR 1
I I TOTAL FEES 76.40 1 I
1OWNER: TEL. NO: I IFINAL DATE FINAA. BY: CODE:
IFERTIG, DAVID - 1 I I
110400 MILOANN ST 1 I bl� I
ITEMP 917803471 1 IDEPSCRIPTION OF WORK 1
I I IBATHROOM REMODEL CHANGEOUT BATHTUB, TOILET AND SINK 1
1APPLICANT: TEL. NO: 1 I I
IGREEN, EDUARDO
15001 LINCOLN AVE 1 1SPECIAL CONDITIONS: 1
ILOS ANGELES CA 90042 1 1 I
ICONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
1MR FIX, INC. (800) 995-2107- 1 1 I
15681 YORK BLVD LIC. NO 1 1UNDER SLAB WORK I I I
1#202 932510 B
ILOS ANGELES, CA 90042 1 IWATER SERVICE I 1 I
I I IPLASTIC YIN METAL YIN
(ARCHITECT OR ENGINEER: TEL. NO: 1 I I I I
I - I [ROUGH PLUMBING1
LIC. NO:
I (GAS PIPING i 1
IGAS VENT
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I I IHOT WATER HEATER I I I
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1 (PLUMBING FIXTURES I I I
ILAWN SPRINKLERS
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I iGAs TEST I I
1 1UTILITY COMPANY NOTIFIED( I 1
1 I� I I I
IGRAY WATER SYSTEM I I I
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1 IREPORT ID: DPR263 ROUTE TO: BS0508
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