HomeMy Public PortalAbout9663 OLIVE ST_Plumbing__ aCOUNTY OF LOS ANGELES APPLICATION FOR PERMIT
Depar
tment of County Engineer
DIVISION OF BUILDING & SAFETY
WILLIAM J. FOX, County Engineer
FOR APPLICANT TO FILL IN DISTRI.C'T NO. GROUP ZONE
-� (�93L/ `f.
PLV BER ®ONS PLUMBING SERVICE RECEIVED BY READY FOR DATE ISSUED
ADORES Q Q So. Baldwin Avenue X
D0FIRST INSPECTION �� J
-- 2 838 p+r. 7-0882 Arcrj,�, California
CITY ADDREBB GS
COUNTY `r LOCALITY
LICENSE. NO. V EXPIRES
NEAREST
PERMIT FEES CROSS ST. �i7f
NUMBER TYPE OF FIXTURE OR ITEM 'FEE OWNER d
MAIL
WATER CLOSET(TOILET) G 0.50 9 ADDRESS
: BATH TUB 0 0.50 CITY TEL. NO.
SHOWER 0 13.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY-(WASH BASIN) 0 0.50. APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE, OR 1 AM THE LEGAL OWNER
OF THE RE9IDEN. L PROPERTY DESCRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50
WATER HEATER (I1 0.50 SIGNATURE
RITTEF
SLOP BINK 0.50 INSP#TION RECORD
FLOOR BINK O.SO Q /�
FLOOR DRAIN a 0.50 7 w
DISHWASHER @ 0.513
DRINKING FOUNTAIN 0.50 s. fg/Q C�l p / •
URINAL O.SO M AVA6 dl;° e,' Q
HOUSE:SEWER a 0.509� � �y• Z
MISCELLANEOUS (a
APPROVAL
D /E, INSPECTOR'S N E
ROUGH PLUMBING rte' M
P '
GAS PIPING
OAS VENT
CESSPOOL 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
''•s DRAIN I( ) PIT ( ) 1.00 SEWER
y
PERMIT 6' 1.00 GAB TEST 'A
UTILITY CO.NOTIFIED
FTOTAL FEE
TO 611 FINAL s.'/•`!/
76A667 DRS.#17 6-52 r
jR/ORKERS'COMPENSAT�ON`DECUjRATION V I I'APPLICATI• IV FOR PLUMBI1V60ERMIT:
Lr .affirm that I have a certificate of consent to self II 76A667A
insure, ,it a certificqto of WorkersCompensation Insurance, 1 CE 817(REV. 10%81) r
or a cer'ified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGEr�.ES i �111LDING AND SAFETY
P
n ompany�'F?.�JV(�III� j
r; __. t
❑ ,� ' ' copy is hereby furnished. I ILDING .
I FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS L �
Certified copy is filed with the county building inspec- i NUMBER FIXTURE OR ITEM @ FEE
tion department, I L CALITY
Date eS Appli4anfL4&mr4 I WATER CLOSET f�EAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB cI.}ROSS ST.
COMPENSATION INSURANCE I SHOWER OWNER
(This section need not be completed IF the work involved by ry•�)'1�gp`IL
the permit Is1for one hundred dollars($100)or less.)' �' LAVATORY HUDRE
I certify thati in the performance of the work for which this
'permit is issued;I shall not employ any person in any manner SINK CITY TEL. NO.2g,C--
so as to become subject to the Workers'Compensation Laws. DISHWASHER
1. 1r I CONTRACTOR
Date Applicant I CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of ADDRESr
Exemption, you should become .subject to the Workers' SWIMMING POOL RECEPTOR
CITYC-D /�/( TEL. NOZ�r 7,�
Compensation provisions of the Labor Code, you mSst forth-" LAWN SPRINKLER SYSTEM '` -
with comply with such provisions or this permit shall be STATEr�— LIC.
deemed revoked. WATER.HEATER l;ICENSE NO. U 71446 CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY
`.1 V/1
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS I �
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER04
and Professions Code,and my license is in full force and effect. 5 PERS TE c Q FINAL V IDATION O
DATE
License NumbeAt5744a� Lic, Class09
-D5%
INAL 0
Co� SIA/ YV
d
❑ I am exempt under Sec:
B.BP.C. for this reason i Plan check fee /� �' ��� , r^•.�• s ,
Date: PLUMBING PERMIT ISSUING FEE$
Signature- i
TOTAL FEE j(J !'� ..!� .�` �!'� ✓ Y iJ , • 2 4 4,4 A
v e .�
Plan check.applicant „
SINGLE FAMILY � �IYo.o••0 0 0 5
HOME OWNER-BUILDER DECLARATION ( Name^ '
1 hereby affirm that I-am exempt from the Contractor's License r N�`` LEtt '//" ) ° ° 3 0,5 0
Address20
Law for the following reason (Section 7031.5, Business and
Professions Code): i Cit o 'o - 3 (150'0
Tel. No� (
❑ I, as owner of the property, will do the work and the
L—$5
structure is not intended or offered for sale (Section 7,
7044, Business and Professions Code).
CONSTRUCTION LENDING AGENCY
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.).
Lender's Name I
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
ordinances and Staws regulating Plumbing, and hereby
authorize rep to ve of this County to enter upon the i
a ove-me ne pr p for inspection urposes. 1
SEE REVERSE FOR EXPLANATORY LANGUAGE I
Signat of Permit a Date
I
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0401200018
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL S PAID BUILDING ADDRESS:
ON FILE _ 9663 OLIVE ST
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803250
ASSESSOR FOR A IO MBER: NEAREST CROSS STREET: TEMPLE CITY BLVD
8588-024-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 2.00 FIX 32.40
TENANT: 21 HOSE BIBB(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: PL EXPIRES ON:
25 LAVATORIES/SINKS 2.00 FIX 32.40 01/20/04 VG 07/18/04
45 WATER CLOSET/URINAL 1.00 FIX 16.20
OWNER: TEL. NO: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 FINAL DATE FINAL BY: CODE:
METRILLO CECILIA (626) 309-7598- TOTAL FEES 141.15 /
9663 OLIVE STS Z S� �1
TEMP 917803250 DESCRIPTION OF WORK
PLUMBING FOR NEW BATHROOM
APPLICANT: TEL. NO:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: - TEL. NO: -
ROUGH
0: RO G PLUMBING
LIC. NO:
GAS PIPING
GAS VENT
HOT WAT9R HEA ER
PLUMBING FIXTURES
AWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
CWV
GRAY W TER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508