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HomeMy Public PortalAbout5011 PAL MAL AVE_Plumbing__ vaum ri E'Eo m APPLZCAYION FOR PEDUt DBpA81'BOW of soannFG AND sAFgrY cPLUMBING 1 ovprvr OF LOS JUME.ffi WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GJJP ZONE PERMR N0. J .1 y:- a • i� h rLumum Ul. C. NaltinoliamRECEIVED BY READY FOR DATE INUED �. t FIRST INSPECTION q , �� ADDRESS 5933 N. C:.G:ERLY AVE. �7 TEMPLE CITY, CALIF. BUILDING - �,�; ' y CITY TEL NO. ADDRESS COUNTY INLOCALITY ' NKAREST � " PE&M FM Cnow ST. +q9 NUMSER TYR OR minim OR ITEM REE OWNER 1p MAIL WATER CLOSET TOILET 0 o.so m ADDR ■ 7 BATH TUB 0.00 CITY EL. NO. SHOWER O.KO 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIN LAVATORY WASH RANI O. APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND KITCHEN NINE 0.001 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSES THE ABOVE VAUD I= LAUNDRY TUN OR TRAY 0.80 ANGELES COUNTY LICENSE. OR 1 AN THE LEGAL OWNER OF THE 11911DENTIAL PRO DEN RIB ABOVE. GAN UTLETN 0.50 SI WATER HEATER 0.50 •�+�4 vr+ SLOP KINK a 0.50 mmwr= FLOOR NINE 0.80 + + ( 14 FLOOR DRAIN 0.50 1 DISHWASHER 0.00 DRINKING FOUNTAIN 0.50 URIN L 0.001 HOUSE SEWER 0.80 MISCELLANEOUS E O APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT CESSPOOL 1.00 CESSPOOL rk Y 12r SEPTIC TANKn SEPTIC TANK n �@ oil DRAIN ( ) PIT ( ) ® 1.00 SEWER I 1 PERMIT . 1.00 GAS TEST 17 TOTAL FEE s ec-o UTILITY CO. NOTIFIED INAL D.B: 1785M aETB 72-43 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ' 7 ' COUNTY OF LOS ANGELES PLUMBING -j WN.J. FOX.CHIEF ENGINEER NATURM-®Fj INSTALLATION —DISTRICT GROU o PERMIT o. ROUGH FIXTURES COMPLETE 1/ O HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION _ AS MOMEN MISCELLANEOUS /, APPLICANT FILL IN HEAVILY OUTLINED PORTION_ONLY � 4 E NAM 1b�!l�P.-f !/.rri13 G�.in ADDRES® m AD RESUS rfrr��/,! LOCALITY a NEAREST CITY TEL.No so. "9`�dJ�S! CROSS'ST. (� COUNTY U v CERT.No. EXPIRES d'. NAME LOCATION OF SEPTIC TANK, OR CESSPOOL mZ. MAIL NORTH O ADDRIL ,�+1 - _ / .J !/ lRQr✓ CITY `TEL.No I Q 1 AM THE LEGAL POSSffl(fl0R OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLuNaER 1 AM THE LEGAL OWNER SF THE PROPERTY DESCRIBED ABOVE. wt 3 WNER CORRECTIONS i SOUTH J DESCRIPTION OF WORK z BATH TUB FURNACE Q' feHOWER DISHWASHER 17 ---­LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I ETER.�GAS SODA FOUNTAIN GAS PIPING I I OUTL GAS VENT ANNNEEMI CESSPOOL I TOTAL NUMBER OF FIXTURES f) SEPTIC TANK CESSPOOL SEPTIC,TANK SEWER B UTILITY CO.NOTIFIED TOTAL FEE FINAL � r'• `-�4"'•' • D.B.B.17 25M BETE 8-47 APPLICATION FOR PERM° DEPARTMENT OF BUILDING AND. SAS' - � COUNTY OF LOS ANGELES Wm..J. FOX.CHIEF'RHOINEER �� NATURE OF I ®N D'SrRI NO. IR*111, /� R_MlT_R5. ROUGH FIXTURES. COMPLETE J ( / �Y � 7 (! HEATER __CESSPOOL -I SEPTIC TANK RECEIVED BY READY FOR DATB 188UED FIRST INSPECTION (�! S• MISCELLANEOUS C'n -e•�d':y--- �n ` APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY NAME JOB B ws ADDRESS ADDRESS LOCALITY t d� NEAREST 14 CITY ' L.No. CROSS ST. A:" WoewodoofA COUNTY CERT.No. EXPIRES 0�' NAMES (� LOCATION OF ►�E TANK, OR CESSPOOL X MAIL ® , NORTH ADDRESS CI & A�c v - 1 Fy TEL.No. I AM. THE LKglAL POSSESSOR OF THE ABOVE LO ANGELES COUNTY CERTIFICATE QF QUALIFICATION.. PLUMBBR 1:AM THE LEGAL OWNER OR THE PROPERTY DESCRIBED • ABOVE. 3 ! pWNER CORRRCTIONS SOUTH J DESCRIPTION OF WORK a _Z BATH TUB FURNACE [t: -SHOWER DISHWASHRR Q j_LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP LOP SINK FLOOR-DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE IPIBPQCTOR'®NAM WATER HEATER DENTALLAVATORY ROUSH'PLUM BINS I i METE" SAS SODA FOUNTAIN GAG.PIPING I l OUTL CTAS VENT �,( G� CESSPOOL I /' TOTAL NUMBER OF FIXTURES ,L SEPTIC TANK. _CESSPOOL SEPTICT.ANK SEWER I �► sa UTILITY co.NoreRtsD TOTAL FEE �— ___ FINAL— / � ,Wfirmth'COMPENSATIONDECLARATION 20-0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate sof sonsertt to self-in- 76A667A ,$ure,or a"certificate of Workers'Compensation Insurance,or a CE 817(REV,8/86) 'L JI certified copy thereof(Sec. 3800, Lab. C.) `Policy N$. Company, COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished. Certified co is filed with the count building FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / copy y g inspection ADDRESS Q // Pct- eir department. NUMBER FIXTURE OR ITEM @ FEE • LOCALITY � 114, n Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. $� COMPENSATION INSURANCE' S.HOWER ©� OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY O ADDRESS s� l \ C( 1 I certify that in the performance of the work for which this per- SINK CITY TEL. NO. mit is issued, I shall-not employ any person in any manner so • • �' !yf 7 81 v ;u as to becom subject to the Workers'Compensation,Laws. DISHWASHER, , �/ Q� /1 CONTRACTOR v(/ �. Date IJ /2 " A�plicant CLOTHES WASHER' ®v ADDRESS NOTICE APPLIC NT: If, after mak' g this Certificate of Ex- SWIMMINGPOOL RECEPTOR empt'ion,you should become subject to the Workers'Compen- CITY TEL. NO.. sation provisions of the Labor Code,you must forthwith comp- [AWN SPRINKLER SYSTEM � ly with such provisions or this permit shall be deemed revok- V,� STATE LIC. ed. WATER HEATER a O LICENSE NO.. LASS LICENSED.CONTRACTORS DECLARATION - Q DISTRICT NO. PROCESSED�BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS Q -9(commencing with Section 7000.)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. DATE a License Number Lic..Class f O ' FINAL Contrdctor Date BY O . t= 1 am exempt under Sec.. U W B.BP.C. for this reason Qv Plan check fee 1 17.7 A Date: PLUMBING PERMIT ISSUING FEE$ Q , # 0 0 0 0 0 5 Signature TOTAL FEE• ( 0 0 64.5 0 SINGLE FAMILY i HOME OWNER-BUILDER DECLARATION Plan•check applicant ,( •0 0 0 6 4,5 0 1 hereby affirm that I am exempt from the Contractor's License Name U 1 Law for the following reason (Section 7031.5, Business and pr�/ �b ( 1.2 1 -8 8 Professions Code): Address. n—as owner of'the.property, will do the work and the City Tel..No. ry structure is not intended or offered.f or sale.(Section 7044., �- Business and Professions Code). Poo.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 Lender's Address I certify that I have read,this application and state that the t above information is correct.I agree to comply with all County iordinances and•State Laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the ;�� ve-mentioned pr erty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE tiittee Date y .t WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I'�er'ely affirm that I have a certificate of consent to self 20-0026 DPW 6/87 I'r'i Is or a certificate of Workers'Compensation Insurance, 7SA667A or a certified copy,thereof(Sec. 3800, Lab. C.) .COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS I Policy No. Company I Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified'copy is filed.with the county building inspec- ADDRESS tion department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Te l 04 Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS ST. EL Sr COMPENSATION INSURANCE SHOWER OWNER J 13 o, c-2- d� (This•section need not be completed Ifthe work Involved by MAIL �O , n the permit is.for one hundred dollars 6100 or less. LAVATORY ADDRESS' 1 I certify that in the performance of the work for which this , permit is issued, ,I shall not employ any person in any manner t SINK CITY �<n j�, C TEL.NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR 4 Date applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should- become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. R with comply with such-provisions or this permit shall be � LAWN SPRINKLESYSTEM STATE LIC. ' deemed revoked: y WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION, DISTRICT NO. PROCESSED BY I hereby off irm-that I am licensed under provisions of Chapter 9 Ck GAS SYSTEM OUTLETS D (commencing with Section 7000)of Division 3.of the Business OUTLETS OVER � and Professions Code,and my license is In full force and effect. 5 PER SYSTEM FINAL L I,, VALIDATION C C3� S _ ISS License Number Lic. Class •f DATE FINAL G Contractor Date BY 1 L O aI am exempt under Sec. ' Lei. B.&P.C. for this reason ► G Plan.check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature - TOTAL FEE " Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name .3313 58aGO I hereby affirm that I am exempt from the Contractor's License Address �)�f`f'C� Law for the following reason (Section 7031.5, Business•and Professions Code): t City Tel. No.• ' {� � 1, as owner of the property, will do the work and the f K c; - structure is not intended or offered for sale (Section NBCJ'S7sl.I:i 7044, Business and Professions Code). CHANGE CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for, the performance of the work [ICI�► _ .for which this permit is issued ! r1 7/�,�f5. (Sec.,3092, Civ. C.•). ' IJ (IQIIs 8158 fid'! .8-'55 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 ordinances and State laws regulating Plumbing, and hereby authorize represehtatives of this County to enter upon the above-mentioned'property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE - a S na ure of Permitteeate