HomeMy Public PortalAbout6218 OAK AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION Ice et (z-so) APPLICATION FOR PLUMBING PERMIT
I hereby affirm that I have a' certificate of consent to self
insure,or a certificate of Workers'Compensation Insurance,or l
a certified copy thereof(Sec.3800,Lab.C.) COUNTY OF LOS ANGELES BUIL INC-►ND SAFETY
Policy No. Comps
Certified copy is hereby furnishe FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUI . ING
ADDRESS
0 Certified copy is filed with the ty building inspection NUMBER FIXTURE OR ITEM • FEE
rle at met LOCALITY
WATER CLOSET
Date Applicant NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
LAVATORY MAIL
(This section need not be completed if the work involved ADDRESS
by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO,-ff,,520
I certify that in the performance of the work for which this DISHWASHER
permit is issued, I shall not employ any person in any manner CONTRACTOR 0
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS o
rJ Date Applicant U
SWIMMING POOL RECEPTOR 13-
NOTICE TO APPLICANT: If, after making this Certificate of CITY EL.NO _
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE �t /, , LIC. n
Compensation provisions of the Labor Code,you must forth- WATER HEATER LICENSE NO. �Q 7r CLASS `. 3
with comply with such provisions or this permit shall be DISTRICT NO. PROCESSED-B
deemed revoked. i GAS SYSTEM OUTLETS f/
LICENSED CONTRACTORS DECLARATION OUTLETS OVER �� a
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
INAL
9 (commencing with Section 7000)of Division 3 of the Busi- DATE VALI DATION
ness and Professions Code, and my license is in full force and
effect.
f7 � FINAL f/;`. •A
LicenseNumb Lic.Class- BY
Iz
Contractor Date
F1 I am exempt from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus- t
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): ;!-31 Q 3 A
I, as owner of the property, am exclusively contracting
with licensed contractors to construct the project # 0 0 0 0 0
(Section 7044,Business and Professions Code). 2 o 0 1 250
CONSTRUCTION LENDING AGENCY o 12-505)
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.). �. 1 — 2
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-me ed property for inspection purposes.
gnatur Permittee Date
r+
76A887-GE#'617 2-62
APPLICATION FOR PI...UM - NG PERMIT
OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ac
An
BUILDING AND SAFETY DIVISION BUIL BUILIADDRESS
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A.JENSEN, SUPT OF BUILDING LOCALITY
ble'0 151;6
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE ?
OWNER
a WATER CLOSET 51.25 MAIL
BATH TUB 1.25 ADDRESS
CITY TEL. NO. j
y SHOWER 1.25
`Y LAVATORY 1.25 CONTRACTOR ewi[�
SINS 1.25 ADDRESS f 7 Al. /leme Aaco
DISHWASHER 1.25 CITY aL �1; Vi� TEL. NO.6 197
LAUNDRY TUB 1.25
CONTRACTOR'S
REGISTRATION NO. /7 7 D �� COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. 1.1 GROUPZONE P OCE D 1 Y—
WATER HEATER 1.50 T
GAS SYSTEM OUTLETS 1.50 INDUSTRIAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .90 INSPECTIO6N RECORD,' �-
ad
' v
N
z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 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
PLUMBING. HOT WATER HEATER
I 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 I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. . UTILITY CO.NOTIFIED. •j
SIGNATURE7
OF PERMITTEE FINAL
ALIDATION - ROBERT At./x0oD
CK.. M.O. CASH SUPERVISING MECHANICAL ENG'R
L11<,0
8049 GECL7 5 D 13.7J`�^'
Y ra
05•C•
:6X867..•-CE-4t817 2-82 _
+ APPLICATION FOR ! LU ING PERM1
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING AND SAFETY DIVISION REss (02. QGGJOHN A.LAMBIE. COUNTY ENGINEERWILLIAM.A.JENSEN.SUPT OF BUILDING CALITY rLojWphFOR APPLICANT TO FILL IN AREST
OSS ST. Q
NUMBER -FIXTURE OR-ITEM EACH FEE OWNER
WATER CLOSET $1:25 Z SSD
MAIL
BATH TUN 1.25 2.S ADDRESS
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1.25Z Q CONTRACTOR 0 W I S
j SINS 1.25 f ,�tJ? ADDRESS
DISHWASHER 1.25 CITY . ivi ILI TEL. NO.r p,I gQ G
CONTRACTOR'S .4Z�/J��p COUNTY
❑
LAUNDRY TUB, 1.25' REGISTRATION NO. ! b
CLOTHES WASHER 1.25 x ^ DISTRICT NO. GROUP ZONE I PRMCED BY
WATER HEATER 1.50 I f�Q g Q—,
GAS SYSTEM OUTLETS 1.505WASTE APPROVAL INDUSTRIAL
OUTLETS OVER 5 PER SYSTEM 30 INSPECTION RECORD 3 Off.
AV 7K,
o "' m
u
_y`s'F+w .`•C�<0 L��-�. i�=��-Fi�>.z,se 1!�
z
-APPROVALS DATE INSPESTO{�x"§�#LGNATURE
PERMIT S 2 00'
UNDER SLAB WORK j~? tri f i i�pri'I
ROUGH PLUMBING
TOTAL FEE /3 2s GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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'XEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AN '/OR PLUMBING FIXTURES j
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE.IN,THE ABOVE DESCRIBED REBID TIALhpltOPERTY. UTILITY CO.NOTIFIE I f
SIGNATURE
OF PERMITTEE FINAL
ALIDATION WOOD
cK. M.O. CASH SUPERVISING MECHANICAL ENG'R
L Uo 9.0 7 3 JAN 3 5 D 13.75-
7SAELI! -CE#817 2-62 TEMPLE L Ca FI ,
L�
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION PADDRESS
UILDING
JOHN A. LAMBIE. COUNTY ENGINEER �p�
WILLIAM&JENSEN, SUPT OF BUILDING OCALITYFOR APPLICANT TO'FILL IN NEAREST
A os ST.
NUMBER FIXTURE OR ITEM EACH FEE• OWNER T.
WATER CLOSET $1.25 MAIL
BATH TUB 1.25 ADDRESS
CITY TEL. NO
SHOWER 1.25
LAVATORY 1.25 'CONTRACTOR �9
SINS 1.25 ADDRESS
DISHWASHER 1.25 CITY TEL.NO.
LAUNDRY TUB 1.25 CONTRACTOR'S STATE ❑ '
REGISTRATION NO. COUNTY ❑
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE F=�L a
WATER HEATER' 1.50 \
GAS SYSTEM. OUTLETS 1.50 INDUS AAL
WASTE APPROVAL
OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD d
O
U
- OC
/ O
Lu
N
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING„ f
TOTAL FEE .-r-"-PIPING ! p
.lB.rud I
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIREDBY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE.DESCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL I /�r I '�ji�����/f�!✓f
VALIDATION ROBERT AWOIOD
CK. M.O. CASH SUPERVISIN MECHANICAL ENG'R
01CO 2 2 1 21.0 [,DA 5 D 3.50- 7
76A667C (CE-8178) -975
- APPLICATION FOR PLUMBING PERMIT
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILL IN (PRINT OR TYPE( BUILDING ^le I lJIr
NUMBER FIXTURE OR ITEM @ FEE ADDRESS �`C
WATER CLOSET LOCALITY �' e
BATH TUB NEAREST
CROSS.ST. W V
SHOWER OWNER-. S
LAVATORY MAIL
ADDRESS
SINK CITY l Lfr TEL.NO. �tt-
DISHWASHER r�
CONTRACTOR C i�L 4
CLOTHES WASHER /� C^
Imo+ 2v f �
SWIMMING POOL RECEPTOR ADDRESS a ��
/
CITY LI-`L CI TEL.NO. Y G-7U70
LAWN SPRINKLER SYSTEM
STATELIC
WATER HEATER LICENSE NO. "J CLASS a
O
U
GAS SYSTEM OUTLETS DISTRICT NO. GROUP JW.NEJ ROC `SED BY
OUTLETS OVER 's' U8 � C3
5 PER SYSTEM. INDUSTRIAL U
WASTE APPROVAL ti
INSPECTION RECORD Z
Plan check fee
PLUMBING PERMIT ISSUING FEE $ �O
TOTAL FEE
Plan check applicant
Name APPROVALS DATE INS PECTOR'S•S IGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel. NO. GAS PIPING
I HEREBY ACKNOWLEDGE THAT I 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.
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES _
LICENSED AS REO'UIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST � j'-.7 ���i,-•.._,-�,
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DE
SCRIBED RESIDENTIAL PROPERTY. UTILITY CO. NOTIFIED
SIGNATURE
OF PERMITTEE_\ X /1fF�T?,g. FINAL
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALID IOC cK. .0. CASH
0 9 6:&MAR 7.5 0 a
7GA667C ICE-81'76) -9/76'
T,4. .:-f APPLICATION FOR PLUMBING PERMIT
01m�LE cr i
BUILDING AND SAFETY DIVISION
FOR APPLICANT TO FILLIN (PRINT OR TYPE) BUILDING ��
NUMBER FIXTURE OR ITEM @ FEE ADDRESS (OQ(f f(V
WATER CLOSET LOCALITY er pLlr C E14
NEAREST
BATH TUB CROSS ST. WQ QLD)C
SHOWER OWNER m
LAVATORY MAIL. _SR,
ADDRES OQ I . V
SINK CITY' L`- C1 TEL.NO. �'b—
DISHWASHER CONTRACTOR
- � � SEs
CLOTHES WASHER _ ^
ADDRESS 0% L V"/ //'n
D
SWIMMING POOL RECEPTOR PLC-LC GI. TEL. NO. -? Q
LAWN SPRINKLER SYSTEM
STATE /� LI C
WATER HEATER LICENSE NO. 0I 1 is CLASS � a
�U
GAS.SYSTEM OUTLETS
DIS
TRICT NO: GROUP NE.OYESSBY
OUTLETS OVERCD
5 PER SYSTEM I'ND'USTRIAL Lvu
WASTE APPROVAL y
.INSPECTION RECORD
33 •' aid C�q-c �I�
Plan check fee
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE 5O
Plan check applicant
Name APPROVALS DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
Address ROUGH PLUMBING
City Tel. NO. GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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.
I 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 I AM THE LEGAL OWNER OF, AND INTEND TO
RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY, UTILITY CO. NOTIFIED
SIGNA•TU RE
OF PERMITTEE - FINAL 7_7-??
PLAN CHECK VALIDATION CK. M.O. CASH PERMIT VALIDATION cK. 0. CASH
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0902120015
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ON FILE I I 6218 OAK AV
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917801555
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN I
15385-010-026 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
I 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 I I
ITENANT: I TOTAL FEES 43.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I
I 102/12/09 SR 08/11/09 I
OWNER: TEL. NO: I IFINAL DATE FIN HY: CODE: I
CHEN, PAI CHOU (626) 451-6962- /�
I
16218 OAK AV I JC V I
ITEMP 917801655 I [DESCRIPTION OF WORK I
IGAS LINE FOR HVAC SYSTEM I
(APPLICANT: TEL. NO: I I I
ISAME AS OWNER
I I [SPECIAL CONDITIONS: I
I I I I
(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE
ISAME AS OWNER - I I I
I LIC. NO I (UNDER SLAB WORK I I I
IWATER SERVICE I I I
IPLASTIC Y/N METAL Y/N I I I
(ARCHITECT OR ENGINEER: TEL. NO: I I I I I
I IROUGH PLUMBING
LIC. NO: I I I
I (GAS PIPING
IGAS VENT I I I
IHOT WATER HEATER I I [
IPLUMBING FIXTURES I I I
ILAWN SPRINKLERS I I [
]GAS TEST I I
I I I I
I I iUTILITY COMPANY NOTIFIED( I
I I ICWV I I [
I IGRAY WATER SYSTEM I I I
I I [ I I
I ] I I I
I I I I I I
I I I
IREPORT ID: DPR263 ROUTE TO: BS0508
I I I I I ]