HomeMy Public PortalAbout10259 NADINE ST_Plumbing__ 70Aee7 17 B as ® APPLICATION FOR PERM
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES PLUMBING 1
WILLIAM J FOX CHIEF ENGINEER
FOR APPLICANT TO FILL IN DISTRICT NO GROUP ZONE PERMIT NO
PLUMBER /� RE 1 ED BY READY FOR DATE ISSUED
ADDRESS V �y ` FIRST INSPECTION ����
BUILDING
CI TEL N ADDRESS
COUNTY EXPIRES /1✓ J LOCALITY -
LICENSE N
NEAREST / /
PERM FEES CROSS ST L h
t
ld
NUMBER TYPE OF FIXTURE OR ITEMFEE OWNER
MAIL
WATER CLOSET (TOILET) @ O SO 8 ADDRESS
BATH TUB 0 050 CITY TEL NO
SHOWER a O 50 1 HEREB ACKNOWLE THAT I HAVE READ THIS
1 LAVATORY (WASH BASIN) @ O 50 APPLICATION AND STATE T THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK @ O SO STATE LAWS REGULATING PLUMBING
1 CERTIFY THAT i POSSESS THE ABOVE VALID LOS
ANGELES COUNTY LICENSE OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROPERTY DESCRI ED ABOVE
GAS SYSTEM OUTLETS @ 050 SIGNATURE OF
WATER HEATER ® O SO PERM ITTE rla'f
SLOP SINK @ O SO INSPECTION RECORD
FLOOR SINK @ O SO
FLOOR DRAIN a O SO
DISHWASHER ® O SO
DRINKING FOUNTAIN ® O SO
URINAL @ O SO 1 ,j
HOUSE SEWER 050 Z
MISCELLANEOUS
(�
E
O
APPROVALS
DATE NSPXCTOR S MAME
rAN
BING
.4.04t
Ir
4
CESSPOOL ® 1 00
SEPTIC TANK DRAIN ( ) PIT ( ) @ 1 00
PERMIT 100 GAS TEST
UTILITY CO NOTIFIED
TOTAL FEE
VV FINAL A /
7SA667 Ts a ao® ,APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFI:"1'Y PLUMBING
COUNTY OF LOS ANGELES
WILLIAM J FOX CHIEF ENGINEER
C
FOR APPLICANT /T�O� FIL/L{ IN n DISTRICT NO GRO P Z NE PERMIT NO
PLUMBER �/ t �{r C. I /"??-/?-
� / EC IVREADY FOR MATE ISSUED
FIRST INSPECTION S
1 ADDRESS �La
CITY x TEL NO BUILDING
ADDRE88 �" f�rn F�
COUNTY
U NS N
EXPIRES
LOCALITY �I Tom' Ck' a k
NEAREST
PERM FEES CROSS ST A f
NYMHBR TYPE OF FIXTURE OR ITEM FEE DW ER ,�`y` 4'
MAIL
WATER CLOSET TOILET 080 ADDRESS
BATH TUB O 50 CITY TEL. NO
MOWER 050 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY WASH BASIN O SO APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND
AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND
KITCHEN SINK 080 STATE LAWS REGULATING PLUMBING
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 050 ANGELES COUNTY oLICENSE OR 1 AM THE LEGAL OWNER
OF THE RE8IDENT�L'PROPERTY DE8CRIBED ABOVE.
GAS SYSTEM OUTLETS ® O 5
SIGNATURE OF 6 ea_Y/F pot 1
WATER HEATER 050 PERMITTBB
SLOP SINK 050 SPECTION M=lw
FLOOR SINK 050
FLOOR DRAIN 050
DISHWASHER 050
DRINKING FOUNTAIN 050
URINAL @ 050 rl
HOUSESEWER 050 Z
MISCELLANEOUS
O
APPROVALS
DATE INSPECTOR B NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL 100 CESSPOOL
J
SEPTIC TANK SEPTIC TANK I
DRAIN ( ) PIT 100. �A�S
ER I
PERMIT 1 00 TEST
UTILITY CO NOTIFIED
TOTAL FEE 8
FINAL
WORKER SCOMOENSATIONIDECLARATION , DPW 9189 APPLICATION FOR PLUMBING PERMIT
I hereby,affirm that I have a certificate of consent to self Insure
or a aertifigate of Worker s Compensation Insurance or a certified _ _J
copy thereof(Sec 3800 Lab C - ' �
�� COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV 7
Policy No . �. Company 5:ayMjps—'�
❑ Certified copy is hereby furnished J t
�--�� ` 1 ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING '
L_ Cerbfied copy is filed with the county buikimg'nrepecuon ADDRESS
department ' ` NUMBER i FIXTURE OR ITEM r® FEE LOCALITY
Date ApplicantT� ` WATER CLOSET -� NEARF_ST �-
CERTIFICATE OF EXEMPTION FROM WORKERS CROSS ST
COMPENSATION INSURANCE TUB ASSESSOR /
(This section need not be completed if the work Involved by the SHOWER MAP BOOK I PAGE PARCEL
permit Is for one hundred dollars($100)or less) OWNER
I certify that in the performance of the work for which this permit 7 LAVATORY LOD
i
is issued I shall not employ any person in any manner so as to MAIL /L
become subject to the Workers Compensation Laws ADDRESS
� DISWASHER O CITY:ranmw u' TEL NO
Date Applicant CLOTHES WASHER ' I ,
NOTICE TO APPLICANT If after making this Certificate of CONTRACTOR
Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR ADDRESS
provisions of the Labor Code you must forthwith comply with such
provisions or this permit shall be deemed revoked _ LAWN SPRINKLER SYSTEM
LICENSED CONTRACTORS DECLARATION WATER HEATER C TEL N 'L d
1 hereby affirm that I am licensed under provisions of Chapter 9 STATEO
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO CLASS 0
Professions Code and my license is in full force and effect
OUTLETS OVER DISTRICT NO PROCESSED BY It
5 PER SYSTEM O 0
License Number Lic ClassFINAL
W
DATE v�l� VALIDATION a
Contractor Date-d'd--M (q
P�E] 1 I am exempt under Sec e,q gy L ?
B&P C for this reason v v r
Plan check fee ,
Signature /O jvL PLUMBING PERMIT ISSUING FEE$
E] 100
FEE � .�
\ e
Plan check applicant
�T
SINGLE FAMILY
HOME OWNER BUILDER DECLARATION Name �7
I hereby affirm that I am exempt from the Contractor s License Law , y ' 376Cj( ,
88 00
for the following reason(Section 7031 5 Business and Professions Address _ A
Code) 1 ITEMS
❑ —1 as owner of the property will do the work and the structure City Tel No i I TOTAL $8■.0Q
is not intended or offered for sale(Section 7044 Business
and Professions Code) i , CA32H 88■Ot1
CONSTRUCTION LENDING AGENCY - CHANE OO
I hereby affirm that there is a construction lending agency for the
performance of the work for which this permit is issued(Sec 3097
Civ C)
0000-0001 9/19/911
Lender a Name 2935 \ 1 AM 9:51
Lender s Address i
I certify that I have read this application and state that the above
Information is correct I agree to comply with all County ordinances f ,
and State laws regulating Plumbing and hereby authorize\ /
representatives of this County to enter upon the above mentioned ` l
property for inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE
A � �
COUNTY OF IAS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0710160012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
ILEGAL ID FEES PAID I BUILDING ADDRESS I
ITR 15862 IT 12 I I 10259 NADINE ST I
I [FEE DESCRIPTION QUANTITY UOM AMOUNT I TEMP CA 917802728 I
(ASSESSOR INFORMATION NUMBER I 1 NEAREST CROSS STREET
18586 027 012 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 597 GRID B3 LOCALITY TEMPLE CITY Cl
1 147 WATER HEATER(S) 1 00 WTH 16 20 I I
ITENANT 1 TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
110/16/07 SR 04/13/08
(OWNER TEL NO �I (FINAL PAW FI CODE i
IHONG DICKSON CAROL 1 I to,-771
1
110259 NADINE ST 1 1 , [
ITEMP 917802728 1 1D 3CRIP 'TON OF WORK I
I I (REMOVE/REPLACE GAS WATER HEATER I
(APPLICANT TEL NO I I I
IFAST WATER HEATER COMPANY (800) 454 8955 [ I I
112601 132 NO AVE NE I ISPECIAL CONDITIONS I
IKIRKLAND WA 98034 I I I
ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE I
IFAST WATER HEATER (800) 454 8955 I _ 1 I
112601 132ND AVE NE LIC NO I (UNDER SLAB WORK I I I
IKIRKLAND WA 98034 877489 1 I I 1
IWATER SERVICE I I I
IPLASTIC Y/N METAL Y/N
(ARCHITECT OR ENGINEER TEL NO 1 I I I I
IROUGH PLUMBING
LIC NO
IGAS PIPING I
I Icas VENT I I I
[ i IHOT WATER HEATER I I I
[ I IPLUMBING FIXTURES I I I
ILAWN SPRINKLERS I I I
[ IGAS TEST I I 1
I1UTILITY COMPANY NOTIFIED[ [ I
CWV
IGRAYiWATER SYSTEM
I I I I I I
I I I I I
I 1 I I I I
I I � ♦ I I I I
IREPORT ID DPR263 ROUTE TO BS0508 [ I I 1
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