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HomeMy Public PortalAbout5532 PERSIMMON AVE_Plumbing__ i 76A667 (CE-817)-8-71 ,J - APPLICATIONPPLICATION J06 U 9LN6ERMIT COUNTY OF LOS ANGELES LJ DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION BUILDING ADDRESS 33 - ire i LOCALITY /e eli& at; a i FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST. OWNER r. An ( Q i^/ C• l/f�Ct WATER CLOSET 1.75 75 MAIL BATH TUB 1.75 ADDRESS,6-3e�• �,y/h+h'►Oh SHOWER 1.75 CITY C/-' TEL. NO. LAVATORY 1.75 CONTRACTTR SINK 1.75 ADDRESS DISHWASHER 1.75 CITY TEL. NO. CLOTHES WASHER 1.75 STATE LIC LICENSE NO. CLASS SWIMMING POOL RECEPTOR 1.75 DST ICT NO. GROUPNE P OCESSED BY LAWN SPRINKLER SYSTEM 1.75 C)� �� WATER HEATER 1.75 INDUSTRIAL WASTE APPROVAL GAS SYSTEM OUTLETS 1.75 INSPECTION RECORD OUTLETS OVER 30 Z 5 PER SYSTEM 639 N z 0 Plan check fee See reverse. ' PLUMBING PERMIT ISSUING FEE $ 00 TOTAL FEE 1 APPROVALS D TE IN PECTO R'S IGNATURE Plan check applicant UNDER SLAB WORK Name t ROUGH PLUMBING Address GAS PIPING CityTel. IVo: � GAS VENT S m HOT WATER HEATER IHEREBY ACKNOWLEDGE THAT I HAVE. READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST f 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ' UTILITY CO. NOTIFIED LICENSEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIYPE'RTY. FINAL SIGNATURE �pJ OF PERMITTEE r2'�' PERMIT VALIDATIO CI(. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH IACo6 9 1-2 9- -qLa. 1 5 'D 825- a WORKER'S COMPENSATION DECLARATION Bog gPWsfas APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self Insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.'C.) Poli No. Policy fq—W-J5'1FZ Company _ l�T QW 1 J COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑' Certified copy is hereby furnished. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS �j Z VY2,S1 Ilii 144 0 Certified copy Is filed with the county building inspection department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date Applicant WATER CLOSET NEAREST CROSS ST. CERTIFICATE OF EXEMPTION FR WORKERS' BATH TUB COMPENSATION INSURANCE ASSESSOR (This section need not be completed If the work Involved by the SHOWER MAP BOOK I PAGED IDT I PARCEL0I L/ permit is for one hundred dollars($100)or less.) OWNER Q N 18ertify that in the performance of the work for which this permit LAVATORY C7 is Issued, I shall not employ any person in any manner so as to SINK ADDRESS 15- become subject to the Workers'Compensation Laws. DISWASHER CITY TEL.NO.�(�7�z� Date Applicant CLOTHES WASHER ✓✓ NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR p ` ,.' CD Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code,you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER cr'E �` YEL'C•NO. y"77 S IL I hereby affirm that I am licensed under provisions of Chapter 9 (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. J9??!� CLASS Professions Code,and my license is in full force and effect. Im OUTLETS OVER DISTRICT NO. PROCESSED BY Im A 5 PER SYSTEM1�� License Number -5009 S8 Lic.Class 1J' FINAL DATE VALIDATION W �(^ Contractor Date `(+ cc ❑ Ir FINAL Z I am exempt under Sec. BY e B.&P.C.for this reason Date: Plan check fee ► _ Si nature PLUMBING PERMIT ISSUING FEE$ 02� ' it44TeA 9 ❑ TOTAL FEE 13 Q 3307 39.30 SINGLE FAMILY Plan check applica rr —c c 1 ITEMS HOME OWNER-BUILDER DECLARATION Name ( I"F EYL I hereby affirm that I am exempt from the Contractor's License Law TOTAL 39 .310 for the following reason (Section 7031.5, Business and Professions Address �♦� ���—�(,F)�© - Code): GE+V% 39.30 �p� 1 EL t�++.UA�r ❑ I,as owner of the property,will do the work and the structure City � Tel.Not fir�0(00 tv .013 is not Intended or offered for sale(Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY =-OWI 1/ 5f93 I hereby affirm that there Is a construction lending agency for the 7434 1 M104-32 performance of the work for which this permit is Issued(Sec.3097, Grid.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 ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE t natureof Pennittee� Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0306030027 • BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: -LEGAL ID: FEES PAID BUILDING-ADDRESS: TR: 13613 LT: 26 5332 PERSIMMON AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802801 ASSESSOR FO 0 NEAREST CROSS STREET: 8573-005-014 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 25 LAVATORIES/SINKS 1.00 FIX 16.20 ySSUED ON: PROCESSEDBY: -PLANEXPIRES 0 : 45 WATER CLOSET/URINAL 1.00 FIX 16.20 06/03/03 JK 11/30/03 TOTAL FEES 92.55 OWNER: TEL. N0: FINA D 1 A B CODE: ALBUERA;JENNIFER & ROLANDO (626) 533-4266- 5332 PERSIMMON AV Z� TEMPLE CITY 91780 C 0N 0 WORK PLUMBING FOR BATHROOM REMODEL PPL TEL. NO: ELISA DEMBSKY (818) 674-6034- 5440 OAK PARK LN#244 SPECIAL CONDITIONS: OAK PARK, CA 91377 CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE RENAISSANCE CONSTRUCTION (818) 609-7880- 12400 VENTURA BLVD #618 LIC. NO UNDER SLAB WORK STUDIO CITY CA 91604 801590 B WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING S VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY O I D CWV GRAY WATER SYSTEM z o.3 REPORT ID: DPR263 ROUTE TO: BS0508