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Home My Public Portal About5538 PAL MAL AVE_Plumbing__ 76MV CE917 12139 TEMPLE CITY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEP OFCOUNTY F;R,2 M BUILDING BJ IE. OUNY ENMOISNIeEN ADDRESS .S—.5 WILLIAM A JENSEN $UP T OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEA= 12 CROSS ST NUMBER FIXTURE OR ITEM OWITER WATER CLOSET BE" BATH TOB ADDRESS ®owEa No -O LAVA70HT CONTRACTOR HQ7[ ADDS DISHWASHER CRY TEL NO. ONTRACTORB RrAtl ❑ LAUNDRY TOR REGMTRATION NO COUNTS CLOTHES WASHER DI RI NO OR ZONE PR CESSED BY WATER FITTER a OAS UTSTENI INDUSTRIAL WASTE APEROVAL nmmPEcrloN RECORD S O U PI O A • Rl RAS s / �1 HBD FIBTUBE 4 v APPROVALS DATE INSPECTOR SSIONATURE PERMIT s 1 00 UNDER SLAB WORK TOTAL FEEROUGH PLUMBING 6-6 OAS PIPING 1 HEREBY ACERONLeDO[ THAT i HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IB CORRECT AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS R[OUIRRD BY LOS ANGELES KTr AND STAT[ OF GAS TEST CALIFORNIA OR TH P AN LEGAL RR OF THE ARM DESCRIBRD R[SID ILITY NOTIFIED HIGNATUREfl- ' OF PQTLMI FINAL Q m. MMATION ROBERT A WOOD C[ ■ 0. Gad SUPERVISING MECHANICAL ENG R M9266—� MV 30 5 D 3.00 R 'veds-oz " 7aMV-=17 B-W APPLICATIO FOR PL MBING PERMIT DI?[A�p%�p �{{►�Spp ��J8{�'�'yy M Bio JOAN IA LffllE��.�Ou Y EN6INEOERN ll DDLR WILLIAM A JENBEN SUPT OF BUILDING FOCALITY FOR APPIXANT TO FILL IN NEAREST NUMBER FIXTURE OR ITEM OW1M® WATER CLOSET . BATH TDB ADDRESS SHOWER CRY TBL H0. LRVATORT CONTRACTOR STNS ADDB= DIR WASHER CRY TEL NO. O LRONDRY TDB REGI8TRATFON NO COUNTY CLOffiS WASHER DISTRICT NO GROUP P 6D BY WATER HEATER , —' GA8 SYSTEM INDUSTRIAL WASTE APPROVAL INSP=ON RECORD PI APPROVALS DATE INSPECTOR 3t1GMATUR6 PERMIT f E OO UNDER SLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING 1 HERE" ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER 1 HERESY CERTIFY THAT 1 AN PROPERLY REGISTERED AMO/01 PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS AN GELD COUNTY AND RATE OF GAS TEST CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTII L PROPERTY UTILITY CO NOTIFIED SIGNATURE ' OF PERMI PENAL k-77—, � �MMATIONa0. 0 Ee F3ROBRTN WOOD,w CASE MECHANICAL ENG R is0 -10o OCT 25 5 D 300 7M%7-M17 12159 APPLICATION F R PLU BtNG PERMIT DEEP co ANGjNEEH »» C>�ipMM33IION soD.Dsro � 1 UNTY NGINEER aD WILLIAM A JENSEN, GUI'T 0P BUILDIHQ LOCALITY 1 FOR APPLICANT TO PDB. IN NXABEffT NUMBER FIXTURE OR ITEM CR011s BY CWMlID WATIM CLOHg MAIL RA'!8 TDB ADDIM SHOWER CTR TE. NO -LAVATORY CONTRACTOR BI1'R ADDREBB DISEEWASIM CTR h — TEL NO CONMCTOVS PFSSIEDBY LAUNDRY TOB REGISTRATION NO G m CLOlB�WARREN DIETRIIC[JO OR ZONE WATER IMTEB J~—^ OBJOAS SYSTEM INDDBTBULLWASTE APPROVAL UfSPECTIo RECORD s� o O U m /yam • 00 PER ITEM APPROVALS DATE INSPEGIOR 9 SIGNATURE PERMIT S E 00 UNDER WORK TOTAL FEE ! Lie ROUGH PLUMBING GAS PIPING LI 1 HEREBY ACKNOWLEDGE THAT I RAYS READ THIS APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND ADM TO COMPLY GAS VENT WITH ALL COUNTY ORDINANCES AND STATE LAPS REGULATING PLUMBING HOT WATER NEATER 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANWOR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS AROSLSS COUNTY AND RATE OF GAB TEST .h A CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ADM DESCRIBED RESIDENTIAL PROPS UTILITYCO NOTIFIED SIGNATURE OF PERMIrrEE.10 /-� FINAL ®T 1 VALIDATION ROBERT A WOOD CE M 0 CAS SUPERVISING MECHANICAL ENG R U{G62682 SEP12 5 D 1100 -0� WORKERS'COMPENSATION DECLARATION 76As67A I hereby affirm that I have a certificate of consent to self enarr (r-ice) APPLICATION FOR PLUMBING PERMIT Insure or a certificate of Workers'Com nation Insurance,or s rC ed co thereof See 800 Y �Jc�L COU TY ANGE S BUILDING AND SAFETY Policy 110 Company } p' DD Certified copy u hereby furnish /� /f-- FOR APPLICANT TO FILL IN (PRI OR TYPE) DI LDI IV ORESS Certified copy u filed with the co ty building inspection NUMBER FIXTURE OR ITEM • FEE department LOCALITY WATER CLOSET Date Applicant NEAREST CERTIFICATE EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER MAIL (This section need not be Completed If the work tmohRLAVATORY d ADDRESS by the permit Is for one hundred doUm ($I00) or leas) $INK } CITY TEL NO d O 1 certify that in the performance of the work for which this DISHWASHERU permit n issued, I shall not employ any person in any manner CONTgAC70 2 so as to become subject to the Workers' Compensation Lam CLOTHES WASHER /-j _ O ADORE S 1' Date Applicant SWIMMING POOL RECEPTOR .� NOTICE TO APPLICANT If, after making this Certificate of CITY TEL N a Exemption you should become subject to the Workers' LAWN SPRINKLER SYSTEM CI E LIC f/1 Compensation provisions of the Labor Code, you must forth �7 _ Z with comply with such provisions or this permit shall be WATER HEATER LICENSE NO CL �� deemed revoked GAS SYSTEM OUTLETS D TRICT NO CESSED LICENSED CONTRACTORS DECLARATION OUTLETS OVER r 4If I hereby affirm that I em licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000)of Division 3 of the Bust FINAL nems and Professions Code, and my license is in full force and DATE J � LID N effect . C ^ej � n AL License Numbe£�� 374 Lie Clan By 4. Contract Skike Date L 2- d 1 am exempt from the licensing requirements as I em a Plan Check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE S acting in my professional capacity (Section 7051, Bus inem and Professions Code) TOTAL FEE Lie or Reg No Date Plan check applicant HOMEOWNER BUILDER DECLARATION Name I hereby affirm that I em exempt from the Contractor's Addran License Law for the following reason (Section 7031 5, Bwt City Tel No news and Professions Cade) I, as owner of the property, em exclusively contracting with licensed contractors an Pr construct sions C the project w�17 •`,"� p�(�j (� $ 1 3 6 A (Section 7044, Bwmess and Professions Code) ' # • • • • • 5 CONSTRUCTION LENDING AGENCY I hereby affirm that there u a construction lending agency 2 • • 1 6 0 0 for the performance of the work for which this permit ra issued(Sec 3097,Civ C) • - . 16005 Lender's Name Lender's Address 0722-80 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 ordinonc and State laws regulating Plumbing and hereby euthori epresentatives f this County to enter upon the abov a tion f r inspection purpo a Mf0r Daft o 'WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT h hereby affirm that I have a certificate of consent to self 76p067p insure, or a ce Jihcote of Workers Compensation Insurance CE 617(REV 10/81) or o cernii c�op�y t/heerreapf(Sec 3600 LpIs.C I r� COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No�1 1 NI-ompony rIe-��"VO IV rm Certified copy is hereby fushedEV 10-jq— FOR APPLICANT 70 FILL IN(PRINT OR TYPE) BUILDING C� Certified copy Is filed with the county building Impec- "an _ rtJDKyI/�t �l jam/ NUMBER FIXTURE OR ITEM ® FEE LOVWTY !WWLF GIT4 Date_._I�Applisant ` c , WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST COMPENSATION INSURANCE SHOWER OWNER(This section need not M completed If the work Inrolred by MAIL � t the permit is for one hundred dollars($1I OD)or Ins) LAVATORY ADDRESS I certify that in the Performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL NO so as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR i:, _��T�/ �—,; ne Dale Applicant CLOTHES WASHER ` yL • , NOTICE TO APPLICANT If after making this Certificate of ADDRESS 1r�� wt`Zf{}yv �]OQ-TV+ Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR .� tt'y Compensation provisions of the Labor Code you must forth CITY W k7�p1 �Vj� TEL NO W".�� with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATELIC deemed revoked WATER HEATER LICENSE NO ��Qb� CLASS Q LICENSED CONTRACTORS DECLARATION DISTRICT NO D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS )c, (commencing with Section 7000) of Division 3 of the Busiro OUTLETS OVER _ '6 d and Professions Code L�J my/license is In full force and effect 5 PER SYSTEM FFIIANAL Z VALID ION V License Number— �(.'S/Lu�s`�L,(S)/^.s'3IIII�c�Closs�y .� 0 �/ pc Conhr=Ior W ss�"sg6;y USLn'tl� �s-,`�' FI L Q ❑ V 1 am exempt under Sec d y B 8P C for this reason plan check fee ? Dote PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE @377.2A Plan check applicant # e s e is • 55 SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name 1 31150 1 hereby affirm that I am exempt from the Contractor's License Address • . • 3 Q 5 0 tT3 Law for the following reason (Section 7031 5 Business and Professions Code) City Tel No 01, 07-86 ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , 7044, Business and Professions Cade) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work far 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 ► above information is correct I ogre to comply with all County ordi antes Arid Sate lows ulo i g Plumbing, and hereby auth nze represenlcil of his unry to enter upon the abov mentioned pro ly r In ion purp SEE REVERSE FOR EXPLANATORY LANGUAGE l=(- W. Signature of Perminee Date