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76A6167A(CEO 17131-11/76 eq
APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ®�
NUMBER FIXTURE OR ITEM ® FEE ADDRESS d+C
WATER CLOSET /� LOCALITY L / C/7
NEAREST
BATH TUB CROSS ST.
SHOWER OWNER i
LAVATORY MAIL
ADDRESS,14 SINK CITY TEL.NO
DISHWASHER CONTRACTOR
CLOTHES WASHER VA
ADDRESS ` Q 60
SWIMMING POOL RECEPTOR s�
p?
CITY TEL.NO. �1
LAWN SPRINKLER SYSTEM
WATER HEATER STATE ENSE NO. �p/w CLASS
GAS SYSTEM OUTLETS a. DISTRICT NO. GROUPNEaROCEISSD�BY
S
0 TLETSOVE
5INDUSTRIAL �� �•
WASTE APPROVAL 0
INSPECTION RECORD
Fa
Plan check fee
PLUMBING PERMIT ISSUING FEE$ a
TOTAL FEE
Plan.check applicant
APPROVALS DATE INSPECTOR'S SIGNATURE
Name
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel.No. GAS PIPING 0'Z'77
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE GAS VENT
THATTHE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
AND STATE LAWS REGULATING PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS PLUMBING FIXTURES O
REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST
LEGAL WNER OF,AND INTEND TO RESIDE IN THE ABOVE D RIBED RESIDENTIAL
PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE ! ,
C1FPERMITTE (/ FINAL 417 ✓n'L..e
PLAN CHECK VALIDATION CK. M:o. CASH PERMIT VALIDATION CK! M.O. CASH
1 .5Und;
®s
78A607-CE817 10-60
ellliPPLICATI®N FOR PLUMBING PERMIT
COUNTY
NTOFO�G�
DEPARTMENT CGDWER
BUILDING AND SAFETY DIVISION sVMING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
WILLIAM A. JENSEN, SUPT OF BUILDING i
�,w:... LOCALITYIrin
dim- r
FOR APPLICANT TO FILL IN NEcitOARES ss T. L
NUMBER FIXTURE OR ITEM OWNER
Y WATER CLOSET ' R J
MAIL
BATH TUB ADDRESS
CITY .NO.
SHOWER '
CONTRACTOR
LAVATORY
s ADDRESS
SINK
DISHWASHER CITY TBL.NO. p
TE
LAUNDRY TUR IrTITI NS
REGINO. COUNT1! ❑
CLOTHES WASHER DIST No. GROUP
ONK P ESSED BY
WATER HEATER
AAS
SYSTEM a INDUSTRIAL
WASTE APPROVAL r
INSPECTION RECORD n.
O
;. V
a
.' O
F'.
N
Q $1.00 PER ITEM
OR FIXTURE $ APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK 9
H TOTAL FEE ROUGH PLUMBING 'RA 7n IGAS PIPING
PIPING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION i
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
PWITH ALL LUMBING. COUNTY ORDINANCES AND STATE LAWS REGULATING ` HOT WATER HEATER
' i HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR :'� PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL OPERTY. UTILITY CO.NOTIFIED
SIGNATURE
'I:. OF PERMITTE FINAL p� '�f -fl'I
VALIDATION �F�OBERT A. WOOD
M.0.
CK. M.o. SH UPERVISING MECHANICAL ENG'R
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I
I hereby a7firm that I have a certificate of consent to self 20-0026 DPW 6/87
insure, or a certificate of Workers'Compensation Insurance, 76A667A
or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS
•
Policy No. Company
Certified copy is hereby furnished.
r_1 Certified
APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING �
Certified copy is filed with the county building inspec- A g ADDRESS / 7US�
tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY J
r
Date Appligant WATER CLOSET
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST.
COMPENSATION INSURANCE OWNER
(This section need not be completed if the work involved by SHOWER %
the permit Is for one hundred dollars($100)or loss.) LAVATORY MAIL
ADDRESS
I certify that in the performance of the work for which this -
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. s �1G
so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR ,
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of 49 Z
SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers'
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS a
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER '
nd Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL Cj
DATE ((,MPATION C
icense Number Lic. ClassLey
FINAL
ontractor Date BY y i ITErkD C
I am exempt under Sec. !I_ITAr
t 55 465 CF
B.BP.C. for this reason Plan check fee �!'�O"% c'r°�' 'Con!
Date: PLUMBING PERMIT ISSUING FEE$ �`� CHANGE
Signature /
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name ;.EZ4 ) AM:1�-
ereby off irm that I am exempt from the Contractor's License Address
w for the following reason (Section 7031.5, Business and
fe 'ens Code): City Tel. No.
I, as owner of the property, will do the work and the
structure is not intended or offered for sale (Section
7044, Business and Professions Code). 100
CONSTRUCTION LENDING AGENCY
ereby affirm that there is a construction lending agency for
e performance of the work for which this permit is issued
ec. 3097, Civ. C.).
nder's Name
nder's Address
certify that I have read this application and state that the
ove information is correct. I agree to comply with all County 011.
dinances ands tate laws regulating Plumbing, and hereby
thorize representatives of this County to enter upon the
ve-mentioned proper for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
azure of Permittee Date
COUNT-Y OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1203200017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
ITR: 5904 IT: 8 I 1 6208 MUSCATEL AV N I
I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: SGAE CA 917752627 1
(ASSESSOR INFORMATION NUMBER: IL
NEAREST CROSS STREET: 1
15386 -010-016 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
121 HOSE BIBB(S) 1.00 FIX 16.20 I
(TENANT: TOTAL FEES 44.00 ISSUED ON: PROCESSED BY: PLAN BY: I
I 103/20/12 SR ]
IOWNER: TEL. NO: 1 IIDATE I BY: CODE: 1
ISMITH BYRON F;PHYLLIS A (626) 285-8947- 1
16208 MUSCATEL AV I
1SGAB 917752627 I I JO�'
C P TON OF WORK 1
1 (CHANGE OUT HOSE BIB 1
(APPLICANT: TEL. NO: I
IYARDEN, FARASH (800) 989-1410-
1 I ISPECIAL CONDITIONS: 1
I ' I
1
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
IT L C HOME IMPROVEMENT, INC. (800) 989-1410- I 1 I
1333 S GRAND AVE LIC. NO 1 (UNDER SLAB WORK I I I
125TH FLOOR 299161-B
IWATER SERVICE I I I
1 I IPLASTIC YIN METAL YIN I I I
]ARCHITECT OR ENGINEER: TEL. NO: ]
I - I IROUGH PLUMBING I I I
LIC. NO:
1 1 1GAS PIPING
1 1 IGAS VENT I I I
1 I [HOT WATER HEATER I I
I I I
1 1 1PLUMBING FIXTURES I I I
1 1 ILAWN SPRINKLERS I I
1 1 IGAS TEST I I I
1 1 I I I I
UTILITY COMPANY NOTIFIED(
1 1 Cw I I
1 1 IGRAY WATER SYSTEM 1
I 1 I I
I 1 I 1 [ 1
1 I i I i I
I 1* ADDITIONAL DATA ON FILE
1 I 1 1
I I I I I I
1 1REPORT ID: DM63 ROUTE TO: BS0508
I I I I
COUNTY OF•LOS•ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1301110010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID I BUILDING ADDRESS: I
ITR: 5904 LT: 8 I 1 6208 MUSCATEL AV N I
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT-1 SGAB CA 917752627 1
[ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET:
I I
15386-010-016 01 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY CAI
1 163 WATER PIPING BR/FIX 6.00 FIX 40.80 [ 1
ITENANT: 93 NO PERMIT OTHER OCCP 339.60 DOL 339.60 ISSUED ON: PROCESSED BY: PLAN BY:
TOTAL FEES 408.20 101/11/13 SR
[OWNER: TEL. NO: 1 (FINAL IZTE FINAL CODE:
ISMITH, PHYLLIS
16208 MUSCATEL AV
ISGAB 917752627 1 1 ESCRI TIO OF WORK ]
] I IREPIPE SIX COPPER FIXTURES AND MAIN LINE
]APPLICANT: TEL. NO:
IITZIK, GILADI (818) 705-0625- 1 I 1
117533 MARTHA ST i (SPECIAL CONDITIONS: \ 1
1
ENCINO CA 91316
]CONTRACTOR: TEL. NO: [ [APPROVALS DATE INSPECTOR SIGNATURE 1
]OVERLAND PLUMBING (818) 989-9939- 1 1 1
16910 HAYVENHURST AVE LIC. NO 1 1IINDER SLAB WORK ] I I
1108 599993 1 11 1 1
IVAN NUYS CA 91406 I IWATER SERVICE
I ] IPLASTIC YIN METAL YIN 1 1 1
[ARCHITECT OR ENGINEER: TEL. NO: I ] 1 I
I - ] IROUGH PLUMBING
LIC. N0: 1 _ I
I I I
1
IGAS PIPING 1
1 IGAS VENT I I
1 I [HOT WATER HEATER I I I
1 IPLM-MING FIXTURES
I
1 I (LAWN SPRINKLERS I I I
I I IGAS TEST
] I I I I
IILITY COMPANY NOTIFIED] I I
CWV
1 1
I I [GRAY WATER SYSTEM I I I
I I I I I I
I I I I 1 I
I I I I I I
I I
I I I
IREPORT ID: DPR263I I I 1
ROUTE TO: BS0508