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Home My Public Portal About5635 PAL MAL AVE_Plumbing__ 76 A 667 -ICE 617 7-" APPLICATION FOR PLUMBING ERMITC COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING North PaljAvenus JOHN A LAMBIE COUNTY ENGINEER COLEMAN W JENKINS SUPT OF BUILDING mple Cit FOR APPLICANT TO FILL IN PR NT OR TYPE) CROSSNEAREST NUMBER FIXTURE OR ITEM EACH FEE WATER CLOSET 150 tten ROSS BATH TUB 1 50 North Pal SHOWER 1 50 1 LAVATORY 150 JADDRiSS ONTRACTOR Pacific Ins442-7 SINK 1 so 10920 E. GranDISHWASHER 150 ITY CLOTHES WASHER 150 STATE LICENSE NO 211898 LIC SWIMMING POOL RECEPTOR 1 50 DISTRICT NO GROUP ED BYLAWN SPRINKLER SYSTEM 2 00 WATER HEATER 150 INDUSTRIAL G. WASTE APPROVAL. 8 GAS SYSTEM OUTLETS 1 50 QiRPECf'ION RECORD OUTLETS OVER Z 5 PER SYSTEM 30 0 I�u Plan check fee 25' of above See reverse PLUMBING PFRN11T ISSIJING FEE 8 2 00 i PO PAL FEE APPROVALS DATE INSPECTOR S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING _ Address GAS PIPING r GAS VENT City Pel No HOT WATER HEATER - 1 NERCBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND srAn TNAT THE ABOVE a CORRECT AND AaR[E co PLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCE[ AND STATE LAW/ COU INa GA$TEST PLUMBING I HERBBY CERT IrY THAT I AM ROP[RLY RESIST q[O A1� oR UTILITY CO NOTIFIED _ LICENBED A/ R[OUIR[D BY LO GELCB COUNTY / ATE F CALIFORNIA OR TNAT 1 AM TH OWN[ ND INTCNO O RE¢IO[ IN THE ABOVE DEECR [HYI P RrY FINAL Q SIGNATURE I IF JACK R ALLEN, 9U PER VISIN ECH ANICAL ENG R OF PERMITTEE PERMIT VALIDATION n M o CASH PLAN CHECK VALIDATION CK M D CASH i Xc 3 4 1 3'1— ,M 2 0 5- D 3.5 0- Q WORKERS'COMPENSATION DECLARATION 74Aa57A 'tel I hereby affirm that 1 have a certificate of consent to self 2117 (2-aa, APPLICATION FOR PLUMBING PERMIT SIu'1 insure or a certificate of Workers ensatio .Insurance r ` , a c c rtten op the eof f�5� 3 L ) COUNTY OF LOS ANGELES�/� BUILDING AND SAFETY Y Certified copy nYhereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING,. A NUMBER FIXTURE OR ITEM • FEE p`D DRESS Aq' fL Certified copy a fled wit a unt bml rnspecLon depar t J CALI WATER CLOSET Date / ,Applicant NEAREST I BATH TUB CROSS ST CERTIFICATE OF 16&TION FROM`WORKERS' COMPENSATION INSURANCESHOWER OWNER r (This section need not be completed If the work invoh'ed / LAVATORY_ ADDRESS 3� /✓` ?L .�-llrG by'the permit is for one hundred dollars (5100) or less) BINKd CITY TEL NO a. I certify, that in the performance of the work for which this DISHWASHER U permit is issued, Lshail not employ any person imany,manner CONTRACTOR / l/ so as to become subject to the Workers Compensation Laws CLOTHES WASHERO ADDRESS . I— De[e Applicant SWIMMING POOL RECEPTOR U NOTICE TO APPLICANT If, after,making this Certificate of CITY �y TEL NO - 1 d Exemption, you should 'become subject 'to the Workers' LAWN SPRINKLER SYSTEM STATE LIC p N Compensation provisions of the Labor Code you must forth- LICENSE NO -] CLASS p Z with comply with such provisions or this permit shall be WATER HEATER deemed revoked GAS SYSTEM OUTLETS DISTRICT NO P ESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER 6�0 Thereby affirm that I am licensed under provisions of Chapter 6 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Buai - FINAL VALIDATION n ness and Professions Code, and my license is in full force and DATE effect - ' License Nu er Lic Class- FINAL � (� BY Z Date Contractor " IaCP((f I xempt from the licensing reclulrements as,l am a Plan Check fee h sed archdect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051 Bus mess and Professions Code) TOTAL FEE ({ Lic or Reg No Date Plan check applicant s HOME OWNER BUILDER DECUARATION Name _ I hereby affum that I am exempt from the Contractor's Address License Law for the following reason (Section,7031 5 Busi City - Tel No r ness and Professions Code) I, as owner of the,property, am exclusively contracting with licensed contractors to construct the project , (Section 7044,Business and Professions Code) i , „ R 2 1 2 0 A CONSTRUCTION LENDING AGENCY _ , ' ° ° a ° 5 I hereby affirm that there is a construction lending agency ' i c 2 G �J 0 for the performance of the work for which this permit is issued (Sec 3097 Civ C) r' ' Lender's Name i • • ° 2 0 5 O v Lender's Address 1 20 1 —8 1 , 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 all rize present veao this County to enter upon the , a ov a toned arty r mspection purposes , gn_atulKe of Permittee Det ', m WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I Fierekty affirm that I hpve a certificate of consent to self in- 200026 DPW 4190 - sure,or a cdrtificote of Workers Compensation Insurance or a - 76A667A certified copy thereof (Sec 3800 Lab C ) - • fllll Policy No Company COUNTY OF LOS ANGELES DEPT•OF PUBLIC WORKS Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 5 b 5 Pq Certified copy is filed with the county budding inspection NUMBER FIXTURE OR ITEM ADDRESS An I department � FEE LOCALITY T,57-71f pie, ce Dote Applicant WATER CLOSET(TOILETI ✓ NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST ,I✓Q 019,k COMPENSATION INSURANCE SHOWER OWNER 71 In _ ch,Iq K c1to (This stolon need not be completed If the work Involved by MAIL _ the permit is for one hundred dollars($100)or Ism ) LAVATORY ��3 �y� r ADDRESS (> >j s I certify that In the performance of the work for which this per- mit is issued, I shall not employ any person In any manner so Y SINK J i 1 3 rt CITU ,iK I e r TEL NO ft-_)So_a O as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR 0LV71 Dote Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If after making a Workers Co of Ex- SWIMMING POOL RECEPTOR emption you should become subject to the Workers Compen CITY TEL NO - sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- ^� _ STATE LIC ed WATER HEATER • LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM 06LETS -.:5' 9(commencing with Section 70D0)of Division 3 of the Business OUTLETS OVER and Professions Code and my license is in full force and of 5 PER SYSTEM 0"A 3 FINAL VALIDATION fact HOSE BIB DATE �' y License Number Lic Class 4 FINAL O V Contractor Date _ J BY S O ❑ I am exempt under Sec V Wig— B 8P C for this reason Plan check feepop. a Date PLUMBING PERMIT ISSUING FEES O 5 = Signature TOTAL FEE D ACCT.i SINGLE FAMILY 3303 123.90 HOME OWNER-BUILDER DECLARATION `�?;np� Plan check applicant 1 ITEM I hereby affirm that I am exempt from the Contractor's License Name _ Law for the following reason (Section 7031 5 Business and TOTAL 1.i3 {�� Professions Code) Address 1 as owner of the property will do the work and theCrry Tel No CHECK 123.90 structure is not intended or offered for sole(Section 7044 CHAH 7�E .00 Business and Professions Code) Poo.CONSTRUCTION LENDING AGENCY QQQQ-0+101 5 I hereby affirm that there is a construction lending agency for 2156 1 8�9/ b/9 9 the performance of the work for which this permit Is issued16 (Sec 3097, Civ C ) Lender s Name Lender s Address t 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 jaws regulating Plumbing, and hereby t authorize representatives of this County to enter upon the above mentioned property for inspection purposes �-7�-7 , _�_pf SEE REVERSE FOR EXPLANATORY LANGUAGE , 5>I atur f Permitte Dote COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0307290012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS TR 8822 LT 1 BL 001 5635 PAL MAL AV FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917802855 ASSESSOR INFORMATION NLJM13ER NEAREST CROSS STREET LIVE OAK 8586-012-027 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 597 GRID C3 LOCALITY TEMPLE CITY 07 BATHTUBS/SHOWERS 2 00 FIX 32 40 TENANT 25 LAVATORIES/SINKS 4 00 FIX 64 80 ISSUED ON PROCESSED BY PLAN BY EXFflTTTV- 45 WATER CLOSET/URINAL 2 00 FIX 32 40 07/29/03 JK 01/25/04 TOTAL FEES 157 35 OWNER NO FINAL DATE FINAL BY CODE KOU TAI HSIEH 8 YUAN HSIA CHUANG (626)L447-6624- /^1 5635 PAL MAL AV —1— �-0 3 fin/ TEMPLE CITY 91780 U- g"T61' OMO C/O PLL14BING FIXTURES APPLICANT No SAME AS OWNER SPECIAL- CONTRACTOR j4G SAME AS OWNER �i ��C� APPROVALS DATE INSPECTOR SIGNATURE LIC NO _ ��y UNDER SLAB WORK// WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER TEL NO LIC NbillROUGH' GAS VENT 1aGAS PIPING HOT WATER HEATER PLUMBING FIX;,URES GAS TEST = - -- ------ - - - -- � 03 i7 CWVS ry ce s taL- �`-- _rte REPORT ID DPR263 ROUTE TO BS0508