HomeMy Public PortalAbout9241 OLIVE ST_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0703190011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS: I
ITR: 17387 IT: 16 I 1 9241 OLIVE ST I
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803126 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: ENCINITA I
18588-031-023 101 PERMIT ISSUANCE FSE 27.75 I THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY, Cl
1 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 I
(TENANT: I TOTAL FEES 43.95 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: it
1 103/19/07 JK 09/15/07
I
[OWNER: TEL. NO: 1 (FINALTS FINAL B CODE: I
[BILEK, DAN (626) 285-3219- [ 1 �� I
19241 OLIVE ST ( I_,
ITEMP 917803126 I IDESCRIPTION OF WORK I
I I IGAS LINE FOR HVAC SYSTEM 1
[APPLICANT: TEL. NO: [ I I
IECONO AIR (800) 503-2666- 1 I I
13101 ENTERPRISE ST. I SPECIAL CONDITIONS: 1
IBREA, CA 92821
ICONTRACTOR: TEL. NO: 1 [APPROVALS DATE INSPECTOR SIGNATURE 1
IECONO AIR (800) 503-2666- 1 1 I
13101 ENTERPRISE STREET LIC. NO 1 [UNDER SLAB WORK I I I
1BREA, CA 92821 445220 C20 1 I I 1 1
I 1 IWATER SERVICE I I 1
1 IPLASTIC Y/N METAL Y/N 1 I I
(ARCHITECT OR ENGINEER: TEL. NO: 1 I I I I
1 - I IROUGH PLUMBING I I I
LIC. NO: 1 I 1
IGAS PIPING I
1 I IGAS VENT I I 1
1 IHOT WATER HEATER I I I
1 IPLUMBING FIXTURES I 1 I
I I [LAWN SPRINKLERS I 1 I
I I IGAS TEST I I I
I I (UTILITY COMPANY NOTIFIED( I I
CWV
1 I IGRAY WATER SYSTEM I 1 I
I I I I I I
I I I I I I
I I I I
I
I I I I 1 I
I I I I 1 I
I [REPORT ID: DPR263 ROUTE TO: 850508 1 I I I
I I I I I I
76A667-CE*817 10-67
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3 APPLICATION FOR PLUMBING- PERMIT
COUNM OF LOS ANGELES
DEPARTNIENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN(PRINT OR TYPEJ NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM EACH FEE
s�
WATER CLOSET 1.50 OWNER
BATH TUB 1.50
DRESS
SHOWER 1.90 CITY��/'1G TEL.NO.
LAVATORY 1.50 CONTRACTOR
SINK 1.50
DISHWASHER 1.50 CITY .. ��� i jL. TEL.NO.*2/ �Q r
CLOTHES WASHER 1.50 �Q STATE LIC r�
LICENSE NO. �L �L� CLASS
SWIMMING POOL RECEPTOR 1..50 DISTRICT NO. GR gONE O EBBED BY
LAWN SPRINKLER SYSTEM 2.00
WATER HEATER 1.50 INDUSTRIAL
V
WASTE APPROVAL
GAS SYSTEM OUTLETS 1.50 1 INSPECTION RECORD v
OUTLETS OVER 30 a
5 PER.SYSTEM
H
Plan check fee 25% of above. See reverse.
PLUMBING.PERMIT ISSUING PEE S 2 00•
TOTAL FEE 76 APPROVALS DATE INSPECTOR'S SIGNATURE.
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING Q7
Address GAS PIPING
GAS VENT'
City. Tel. No. HOT WATER HEATER
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING. -
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED. AND/OR UTILITY CO.NOTIFIED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND'STATE OF
CALIFORNIA OR TH 1 AM THE LEGAL OWNER O%�Tl�;
TEND TO -
RESIDE IN THE ABO DESCR ED RESIDE-If1L PRFINAL -
SIGNATURE .TACK R. ALLEN, SUPERVISI ANICAL EN`G'R.
OF PERMITTEE
PERMIT VALIDATION CK. M.O. CASH
PLAN CHEC,KWALIDATION CK. M.O. CASH.
L&.16-.96313 OCT 22 5 -0 1 .2.5, %4-
10
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hereby, affirm that I have a certificate of consent to self in- 76 6�A /4/87
sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV.8/86)
certified 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) �'� i
Certified copy is filed with the county building inspection ADDRESS p(
department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
Date Applicant WATER CLOSET(TOILET) NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS'
BATH TUB CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work Involved by MAIL
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this per- SINK
mit is issued, I shall not employ any person in any manner so CITY TEL. NO.
as to be c me s bject to the Workers'
}Compensation
y LLa�wss.�'/n DISHWASHER i
Date Applican),ac Crlit.0 f e �/ CONTRACTOR
CLOTHES WASHER
ADDRESS
NOTICE TO APPLICANT: If, after making t is Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY TEL. NO.
cation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE / LIC.
ed. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION v� DISTRICT NO. ESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS /}
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVERV
and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALI TION >_fect. DATE 0
License Number Lic. Class
BY AL U 1 O
Contractor Date �
I am exempt under Sec. /f,` V W
T a
B.&P.C. for this ea nI 1h Plan check fee ® V l 2z
Date; PLUMBING PERMIT ISSUING FEE$ Q S
Signature
TOTAL FEE
SINGLE AMI Y
HOME OWNER-BUI ECLARATION Plan check applicant
I hereby affirm that I am exempt from the Contractor's License NameO
Law for the following reason (Section 7031.5, Business and dwc-LJ EO
Professions Code): Address 6041
I, as owner of the property, will do the work and the City �J-�.�.i Tel. No. Q 7-7 J
structure is not intended or offered for sale(Section 7044,
Business and Professions Code). ® ,e
CONSTRUCTION LENDING AGENCY �iCC e3•
I hereby affirm that there is a construction lending agency for � I j� 16.50
the performance of the work for which this permit is issued
(Sec.3097, Civ. C.). 1 IT EVi3
`50
Lender's Name TOTAL 16 o s
Lender's Address CHECK 16.55
I certify that I have read this application and state that the
CHANGE .1111
above information is correct. I agree to comply with all County
ordinanc nd State laws regulating Plumbing, and hereby
author, re resentatives of this County to enter upon the �I�1(� --(I[1}i % 5/'�irre
above- en- ned property for inspection pure es.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Perm i ee Dat