HomeMy Public PortalAbout4959 PERSIMMON AVE_Plumbing__ 7BA887-CE817 8 / ®uN �G l� /�/� C/
APPLICATION FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION• BUMDDFG
rrOF1Pi A. LAMBIH, County er ADDRESS L
CASSATT D. GRIFFibi,Sup t of Dufidiag LOCALITY
FOR APPLICANT TO FILL IN NEARESTR . �8
NUMBE FIXTURE OR ITEM
OWNER
WATER CLOSET MAIL
BATH.TQB ADDRESS
CITY TEL NO.
SHOWER '
LAVATORY CONTRACTOEFONTANA PLUMOINr, CON
SIIm ADDRESS ' 1a329 E. E,-'o- S
DISHWASHEB CITY ify. OF IR'4.f. - %
CONTRALAUNDRY TUB REGISTAACTION NO.#96496 comvTY ❑
CLOTHES WASHER DISTRICT NO. GROUP ZONE PR ESSED BY
WATER HEATEB
GAS SYSTEM MDUSTRISL
WASTE APPROVAL
XNSPECTION RECORD
is OdSE E/d1 oo
-Fea p ;0j4j&.
Cal:11.61L 4?Xv -0",p to
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
TOTAL.FEE , ROUGH PLUMBING 'Y > L-7a-eY.a ry
GAS PIPING {
I HEREBY ACKNOWLEDGE THAT I HAVE READ- THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY GAS VENT
WITH ALL COUNTY ORDINANCES AND STATE LAWS• REGULATINGLAST
ATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT I AN 'PROPERLY REGISTERED AND/ORBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND 3�gTE OFESTCALIFORNIA OR THAT I AM THE LEGAL OW R OF THEA ABOVEDESCRIBED REBID IAL P OPER Y CO.NOTIFIED
SIGNATURE
OF PERMIT FINAL
1�I'TALIDATION ROBERT AAWOOD, y
SUPERVISING MECHANICAL.ENG'R
1 D.? 6 5 !y a MAR `5 A 1 '.d 0 10 =
I!1 WORKERS'COMPENSATION DECLARATION Ysaes7A
hereby affirm that I have ir certificate of consent to self cE a,7(:-ae) APPLICATION 01R PLUMBING PERMIT
insure,or a'certificate of Workers.'Compensation Insurance,or
a'certified coy thereo (Sec.38 ,Lab.C,)
/ � � ,.�� �� �• COUNTY OF LOS.ANGELES ` BUILDING AND SAFETY
olicy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL.IN (PRINT OR TYPE) BUILDING
�Eef[1 led co 'NUMBER FIXTURE OR ITEM • FEE ADDRESS
copy is filed with the county building inspection
departmen . ��_J� ` WATER CLOSET LOCALITY
s Date Applicant. O/ �= NEAREST
BATH-TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
RY MAIL
'
(This section need not be completed if the work involved LAADDRESS d' to-0 }
by the permit is for one hundred dollars ($.100) or less.)
SINK CITY � ��` TEL.NO o
I certify that in the.performance of the work for which this DISHWASHER U
permit is issued, I shall not employ any person in any manner. CONTRACTOR
so as to become subject to the Workers'Compensation.Laws. CLOTHES WASHER lee
ADDRESS
Date' Applicant SWIMMING POOL RECEPTOR
NOTICE TO APPLICANT; If, after making this Certificate of CITY , TEL:NO. IJJ
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC.Compensation provisions of.the Labor Code;you must forth-
LICENSE NO. CLASS'
with comply with such provisions or this permit•shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BY
�• R
LICENSED CONTRACTORS DECLARATION. OUTLETS OVER
I hereby affirm that I am licensed under provisions of Chapter •5.PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- ��� FINAL VALIDATION
ness and Professions Code,and my license is in full force and DATE
effect.
���1�� FINAL
License Number-3 Lic.Class Z: W BY',
Contractor r Eei' ! Date
F1 I am exempt,from the licensing requirements as I am a Plan check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051., Bus-
iness and Professions Code). TOTAL FEE / To
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-.BU!ILDER DECLARATION Name
I hereby affirm that I am exempt from the 'Contractor's '
Aadrens 726527A
License Law for the following reason (Section,7031.5, Busi- City Tel.No. $.o o a o o 5
ness and Professions Code):
I, as owner of the property, am exclusively contracting
2'0 0 1. 250
with licensed contractors to construct the project
(Section 70.44,Business and Professions Code). o 0 0 "1 2 5 0,5
CONSTRUCTION LENDING AGENCY .0-9,2 9—8 2'
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
above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-mentioned property for inspection purposes.
ignatu 1 of Per ' ee Date ,
i n COUNTY OF LOS ANGELES ' TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9709080016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
GL ID: FEESP D BUILDING ES :
TR: 4902 LT: 35 BL: F 4959 PERSIMMON AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804105
ASSESSOR IWFM14ATION R: NEAREST CROSS STREET:
8574-025-038 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.35
TENANT: TOTAL FEES 44.10 ISS E.D ON.—PROCESSED EXPIRES ON:
09/08/97 UT 09/08/98
OWNER: TEL. NO: FINAL- DATE FIN B ODE:
MCNIEL RICHARD A CO TR (818) 444-5256- .-
4959 PERSIMMON AV
TEMP 917804105 DESCRIPTION OF WURK
GAS LINE FOR NEW HEATING AND AIR COND. SYSTEM
APPLICANT: TEL.
JORDANAIR (626) 963-3313-
SPECI'AL CONDITIONS:
CONTRACTOR: TEL. N0: Ha`: "�:: _ _ "' f ,ti .,� APPROVALS DATE INSPECTOR SIGNATURE
JORDANAIR (818) 963-3313-
129 S. HACIENDA AVENUE LIC. NOUNDER SLAB WOR
GLENDORA, CA 91741 560429 B
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH MB G
LIC. NO:
- - - GAS PIPING
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRIN L
GAS fgS-T-
IMPANTINUTIFIED
C V
GRAYIWATER SYSTEM
i
I
* ADDITIONAL DATA ON FILE
REPORT ID: DPR263 ROUTE TO: BS0508