HomeMy Public PortalAbout9920 MILOANN ST_Plumbing__ PLUMBING 1
DEPARTMENT OF COIINTY ENGENEER
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS 1 1—
F094,
FO , APPLICANT TO FILL IN LOCALITY7_1 C
NEAREST—'"J-
ADDRESS �� `���.A/AJ CROSS ST. 0`L��r
DISTRICT NO. GROUP ZONE PERMIT NO.
LOCALITY ���`"j �/, P 0, - (7` 1•��-1
NEAREST O
CROSS ST. .. ,I.AJ I • RECEIVED BY Ready for Inspection DATE ISSUED
OWNER �. �"[ J�- 4"•� VS�
MAILC 6� a jq_ WASTE APPROVAL
ADDRESS I"r(
CITY&1,04e- r.ft_r TEL.NO. INnSPECTION RECORD
PLUMBER P P I e6tfi er✓�-- r� '��-��5'4/ T.d rtJc7'P"" N !�
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ADDRESS 14-6—
[[ 12 ::' ._.K feria e%✓pb G �ti/1..i t9 r
4.44'
CITY 0.y a'Tlr`P- Cstit�� 1 TEL.N4-al'�7;r e� —� d.r.:
^,✓ ❑STATE
LICENSE NO. P.00UNTY J
PERMIT FEES z
VUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET(TOILET) @ 0.80 $ Q'
O
BATH TU§::2 0.80
41 SHOWER • @0.80 (/
LAVATORY(WASH BASIN) @ 0.80
KITCHEN SINK @ 0.80
LAUNDRY TUB OR TRAY @ 0.80
SLOP SINK @ 0.80
FLOORSINK @ 0.80
FLOOR DRAIN @ 0.80
DISHWASHER @ 0.80
DRINKING FOUNTAIN @ 0.80
URINAL @ 0.80
GAS SYSTEM..._--_.....OUTLETS @ 1.00
WATER HEATER @ 1.00 �/�
MISCELLANEOUS /Jd��oe sD Y',aN
APPROV}.S.� '
..''DATE INSPECT/Ofi'S SIGNATURE
UNDER SLAB WORK''
PERMIT $ 1 00 ROUGH PLUMBING== -7/20/1
TOTAL FEE &_O GAS PIPING I
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- GAS VENT
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING. PLUMBING FIXTURES
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY GAS TEST
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE AB DESC�D RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED r
SIGNATURE JjIt
OF PERMITTEE ys,-w.1 ..L.- !7 -= .._.-...._............
;;fi- I. FINAL IFA r 4ia
70A667 DBS 17 (1l43- v ' r
I WORKER'S COMPENSATION DECLARATION 20o028'DPW 9/89
fl hereby affirm that I have a certificate of consent to self Insure, 78A887A 'PPLICATION FOR PLUMBING PERMIT u
'or a certificate of Worker's Compensation Insurance, or a certified I
copy thereof(Sec.3800 Lab.C.) '
jCOUNTY OF LOS ANGELES DEPT.OF PUBLIC,WORKS DEPT.OF PUBLIC WORKS DIV.
olioy No. Company
i� Certified copy is hereby furnished.
i
ILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRE S Certified copy-Is filed with the county building Inspectionr
department.
['.,NUMBER FIXTURE OR ITEM FEE LOCALITY
Date Applicant WATER CLOSET NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST.
BATH TUB ASSESOR
COMPENSATION INSURANCE MAP..BOOK PAGE PARCEL((This,section need not be completed if the work Involved by theSHOWER
permit is for one hundred dollars($100)or less.) 1 OWNER
I certify that in the performance of the.work for which this permit LAVATORY +
Is Issued, I shall not employ any person in any m so as to SINK ADDRESS 47
become subject to the Workers'Compens on L•aI��
DISWASHER CITY 44 tO TEL.NO. �/
Date �~ Applicant CLOTHES WASHER 1.
'NOTICE TO APP.L•I ANT: If, after making t rtificate of CONTRACTOR
Exemption,you should become subject to the W e s'Compensation SWIMMING POOL RECEPTOR ADDRESS
provisions of the Labor Code,you must forth omply with such (1
provisions or this permit shall be deemed revo ed. LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATIONCITY �� TEL.NO. C-„- d
I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER /+
(commencing with Section 7000)of Division 3 of the Business and GAS:SYSTEM OUTLETS LICENSE NO CLCA$S 310 (�
Professions Code,and my license is in full force and effect.
OUTLETS OVER DISTRICT NO. PROCESSED'BY cc
5 PER SYSTEM + 'G' 00
License Number Lic.Class d O
FINAL VAWRNION III
a
_ DATE
Contra Date ��� iv�yy Cn
❑ ' FINAL .3033-1 41.859
I am e t under Sec BY TTr-19
B.&P.C.for this reason
Date:
Plan check fee ► TOTAL 41.8-5
Signature PLUMBING PERMIT ISSUING FEE$ !�p CHECK 41.85
❑ r TOTAL FEE f tj L HANGE
SINGLE FAMILY
Plan check applicant
'
HOME OWNER-BUILDER DECLARATION Name - #iILi—FI[lii� 7 � `$
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason.(Section 7031.5, Business and Professions Address 's 15Code):
El 1,
Tel.No.
I,as owner of the property,will do the work and the structure I
Is not intended or offered for sale(Section 7044, Business
and Professions Code). ) oil
CONSTRUCTION LENDING AGENCY r
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is Issued'(Sec.3097, ti
CIv..C.)
Lender's Name I
Lender's Address I
I certify that I have read this application and state that the above a
Information Is correct. I agree to comply with all County ordinances
and State laws•regulating PI Ing, and hereby authorize
representatives is Co t ter upon the above-mentioned
property for i pact i SEE REVERSE FOR EXPLANATORY LANGUAGE
P ` ,
Ainnatura of Parmitta Data
' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1309050041
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
ITR: 12268 LT: 27 I 1 9920 MILOANN ST 1
I IFEE DESCRIPTION: QIIANTITY: DOM: AMOLTNT:l TEMP CA 917803927 1
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
18589-007-020 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY 1
103 BACKWATER VALVE(S) 3.00 VAL 141.00 1 I
1TENANT: III CLOTHESWASHER(S) 1.00 FIX 16.20ISSUED ON: PROCESSED BY: PLAN BY:
113 DISHWASHER(S) 1.00 FIX 16.20 109/ 05/13 SR 1
I 121 HOSE BIBB(S) 4.00 FIX 64.80 1 1
(OWNER: TEL. NO: 125 LAVATORIES/SINKS 4.00 FIX 64.80 1 FINAL 04TELFI BY: CODE: 1
IMA OI LING (626) 399-2199- 145 WATER CLOSET/URINAL 3.00 FIX 4860 1
12632 LIVE OAK PARK R 147 WATER HEATER(S) 1.00 WTH 16..20 1 �(/, I
1 164 WATER PIPNG <- 1 1/2 1.00 LIN 16.20 IDES RIPTION OF WORK 1
_1 TOTAL FEES 411.80 1PLUMBING 1
(APPLICANT: TEL. NO: 1 I
ISAME AS OWNER _ 1
I i 1SPECIAL CONDITIONS: 1
1 1 I I
ICONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE 1
ISAME AS OWNER
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1 LIC. NO ]UNDER SLAB WORK
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1 I (WATER SERVICE I I I
(ARCHITECT OR ENGINEER: TEL. NO:
1 1PLASTIC YIN METAL YIN I I
ROUGH PLUMBING
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I LIC. N0:
1 IGAS PIPING �1 I
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1 1 [GAS VENT I I I
1 I IHOT WATER HEATER
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1 I IPLUMBING FIXTURES I I
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1 I ILAWN SPRINKLERS I I I
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1 1 1GAS TEST 1 I [
1 .1 1UTILITY COMPANY NOTIFIED(
1 1 ICWV I I I
1 1 1GRAY NATER SYSTEM I I 1
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1 IREPORT ID: DPR263 ROUTE TO: BS0508 1 I
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