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HomeMy Public PortalAbout5632 PERSIMMON AVE_Plumbing__ 76AS67-CENG27 12-54 10814 ' City of Temple City APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIMION Ann�ss �' JOHN A. LAMBIE. COUNTY ENGINEER p - L� COLEMAN W. JENKINS,SUPT OF BUILDING, LOCALITY Temple City FOR APPLICANT TO FILL IN NEAREST. CROSS ST. T NUMBER FIXTURE OR ITEM EACH FEE OWNER Joon Sta lnley ' WATER CLOSET $1.25 MAIL BATH TUB 1.25 ADDRESS Same SHOWER 1.25 CITY TEL. NO. LAVATORY 1, CONTRACTOR General Installation Co. SINS 1.25 ADDRESS 6558 West Blvd. DISHWASHER 1.25 CITY Los Angeles TEL. NO. PL 3-2541 LAUNDRY TUB 1.2S REGIS�TRAATION NO. C-36 151839 787cOUTNATY M CLOTHES WASHER 1.25 DISTRICT G UP ZO EP OCESSE ��BY��//JJ WATER HEATER 1.50 �D [/�L A. GGC� GAS SYSTEM OUTLETS 1.50 WAS S APPROVAL IL OUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD v 1 Softener 1 50 RegLdy for Inspection Now c IS n W ca ' Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT S 2 OO UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE 3 50 GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING .HOT WATER HEATER PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY .REGISTERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED .BY LOS ANGELES COUNTY AND STATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO RESIDE IN,THE ABOVE DESCRIBED RESIDE AL PROPERTY. UTILITY CO.NOTIFIED SIGNATURE OF PERMITTEE FINAL /-'AALIDATION ROBERT A.WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENG'R - LC60 3 6.1 9 JUL 13 5 D 3.5 0`" '� 78A867-CE#8175 4-54 - r APPLICATION FOR PLUMBING PERMI COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUII.DING AND SAFETY DIVISION TNEAREST DINGJOHN A:LAMBIE. COUNTY ENGINEERRESSWILLIAM A.JENSEN.SUPT OF BUILDINGALITYFOR APPLICANT TO FILL IN SS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET Si• MAIL �+ HATH TUB 1.25 ADD CITY L. O. SHOWER 1.25 LAVATORY 1.25 CONTRACTOR SINE 1.S5 ADDRESS ;:�;, DISHWASHER1.25 CITY jv. NO. LAUNDRY TVH 1.25 CONTRACTOR'S STATE REGISTRATION NO. a LINTY CLOTHES WASHER 1.25 "DISTRICT NO ,63RQUP . Z PR BBg3�Y WATER HEATER 1.50 -GAS SYSTEM-OUTLETS- 1'� INDU S A AOVAL OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD V it Ica—I 60L. . P1. P/AIG. Oe(!C O " .� 17116r- TV-N'p. APPROVALS DATE INSPECTOR'S BIGNATURE PERMIT S !STATE 00 WILDER SLAB WORK OUGH PLUMBING TOTAL FEE GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION Ga►S VENT AND STATE THAT THE ABOVE IB CORRECT AND AGREEPLY WITH ALL COUNTY ORDINANCES AND STATE LAWING HOT WATER HEATER PLUMBING. 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGIS /OR PLUMBING FIXTURES ( f LICENSED AB REQUIRED BY LOS ANGELES''COUNTY OFCALIFORNIA OR THAT I AM THE LEGAL OWNER OF ATO GAS TEST'RESIDE IN.THE ABOVE DESCRIBED RESIDENTIAL PROPEUTILITY CO.NOTIFIED SIGNATURE + t< v 1( ►rte' OF PERMITTE c � l FINAL 1.�' LIDATION ROBERT A.WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENG-R, X -7 Lnuu 7.� w i':A 3 S D ✓w 5 N V 1haRKER'SCOMPENSATION DECLARATION 20-0026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT I hev5by affirm that I have a certificate of consent to self insure, 78A867A or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company ❑ Certified copy is hereby furnished. BUILDING F1ADDRESS APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 5 Z Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY 77 G Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Gl[le' COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK 1� I PAGE_ 1 PARCEL permit is for one hundred dollars($100)or less.) LAVATORY OWNER I certify that in the performance of the work for which this permit MAIL „/ Is issued, I shall not employ any person in any manner so as to SINK DRESS „•5 632- become subject to the Workers'Compensati n , / �/ DISWASHER CITY T v T . e17g&Sy Date Applicant CLOTHES WASHER CONTRACTOR /1 T NOTIC TO PPLICANT: If. after making this C r ificate of t�/9L!/ . eZ, re Exemptprovisions lon,yu should become ofo othe Labor Code,youect to the Worker.'must forthwith Comply w thssuion ch SWIMMING POOL RECEPTOR ADDRESS :Z 7D o0c /W G2e-e-A, provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM �/ LICENSED CONTRACTORS DECLARATION CITY �2G19©1• aD4 TE / v '' I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER -y D. (commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSTASE NO. / CLASS '�� Professions Code,and my license Is In full force and effect. / V OUTLETS OVER DISTRICT NO. PROCESSED BY cc Lj 5 PER SYSTEM License Number / Lic.Class ` y� r/t /� �t FINAL ' VALIDATION LU y/ /��/.i��O7� late t? � DATE rr Contractor FINAL AL'4 T°S Z ❑ I am exempt under Sec. BY `;1 60 ,,jj,� u BAP.C.for this reason Date: t- Plan check fee ' I I{EI PLUMBING PERMIT ISSUING FEE$ TOTAL AL 4 _ 60 Signature rl TOTAL FEE VA; /p D CHECK 42.0= E] Plan check applicant CHANGE .1310 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's License Law for the following reason(Section 7031.5, Business and Professions Address =}/M/TJ Code): City Tel.No. `}�e?��+�y i �1 ti f El1,as owner of the property,will do the work and the structure Is not Intended or offered for sale(Section 7044, Business and Professions Code). , CONSTRUCTION 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 above , information is correct. I agree to comply with all County ordinances and State laws regulatin Plumbing, and hereby authorize represent ti s of is C nter upon the above-mentioned prop y sp c on a SEE REVERSE FOR EXPLANATORY LANGUAGE 144664 1: 5- n aturra of Parrnittaa Date WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 76A667A sure,or a certificate of Workers'Compensation Insurance,or a q certified copy thereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES c DEPT. OF PUBLIC WORKS Policy No. Company . Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGL/ ?� f�� Certified copy is filed with the county building inspection ADDRESS .J L7 J j department. NUMBER FIXTURE OR ITEM @ FEE f LOCALITY ie G! /I Dote Applicant WATER CLOSET(TOILET) NEAREST __/ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. /�/-5U Ri�3 COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by j MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS 4 P /C'r: ;1MA4CA /41/ I certify that in the performance of the work for which this per- SINK CITYT& TEL.NO. �� mit is issued, I shall not employ any person in any manner so /T&/L.r dtP / as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date• Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL.NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER ` LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE `��((� r -� License Number Lic. Class 4`SO(0 } CL FINAL1 ITErS a Contractor Date BY I am exempt under Sec. TI]TRL - .410 C B.&P.C. for this reason CHECK 43°40 W Plan check fee ► CHANGE °00 a w Date: PLUMBING PERMIT ISSUING FEE$ �'�^ Z Signature i TOTAL FEE SINGLE FAMILY IMM-0001 11/ 6/95 HOME OWNER-BUILDER DECLARATION Plan check applicant 31.519 1 AH W03 1 hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address iIas owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, Business and Professions Code). , CONSTRUCTION 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 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 ab e- ent' R:1 proper y for inspgction purposes. �� SEE REVERSE FOR EXPLANATORY LANGUAGE _ I /l L-- 4: ignature of Permittee Date i WORKERS'COMPENSATION DECLARATINq ' APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1 have a certificate of consent to self 176A667A insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81) or a certified mmcopy thereof(Sec. 3B lob. C.) (� COUNTY OF LOS ANGELES ' e BUILDING AND SAFETY Policy No.C®�Zqo Company L't�,L bCILO` I Certified copy is hereby furnished. BUILDING a I FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS Certified copy is filed with the county building in c- tion department. J NUMBER FIXTURE OR ITEM @ FEE LOCALITY ����Z C I WATER CLOSET Date Appli4ant I NEAREST 14 CERTIFICATE OF EXEMPTION FROM WORKERS' • BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if the work Involved by SHOWER the permit is for one hundred dollars($100)or less.) l LAVATORY MAIL ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner I SINK R.JEPIACE CITY TEL.NO. so as to become subject to the Workers'Compensation Laws. 'I DISHWASHER CONTRACTOR Thtm^\ PS ST-. � Date Applicant CLOTHES WASHER ADDRESS ! NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN.SPRINKLER SYSTEM CITY TEL.NO`W�b0� with comply with such provisions or this permit shall be STATE LIC. �7 deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PRQgESSED BY I hereby affirm that I am licensed under provisions of Chapter'9 GAS SYSTEM OUTLETS �'G r/ (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER d and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALd DATE �' ,j�;, VALIDATION V �Q 2. License Number✓a Lic. Class FINAL Q Contracr Date Tp �— I BY �s ` L 5 41 ❑ I am exempt under Sec. H lwx B'.&P.C. for this reasonZ 1 Plan check fee Ej�.�7� Date: A PLUMBING PERMIT ISSUING FEE$ �o Signature 11110 TOTAL FEE SQ SINGLE FAMILY FI Plan check applicant HOME OWNER-BUILDER DECLARATION Name sa y ^7 4 6 4 A I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address 0O\'> 4, o o*0 0 0 Professions Code): City Tel. No. d�l'� ❑ y �. 0 02,50 I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section , 0 :, n 2(I, 0 cT� 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY 1.0 9-82 1 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.). i Lender's Name I 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 I popordinances and State laws regulating Plumbing, and hereby , authorize representatives of this County to enter upon the a5b9lAf-mentioned property for' pectlon purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Vermittee Date