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HomeMy Public PortalAbout6216 PRIMROSE AVE_Plumbing__ 78A667 27 WOOIt APPLICATION FOR PERMIT ` DEPARTMENT OF 13 LDIN.G AND SAFETY COUNTY OF LOS ANGELES na- UmMBING . 1 WILLIAM J. FOX. CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRIC NO.. GROUP ZONE PERMIT-NdWIN : OTTON! �R03r,'��IC: ®7-37t,/A a�' PLUMBER RECEIVE FIRST INSPECTION D'4TSSU ER AVE. 7-r ADDRESS ALHA'M.BRA,, ; )RNM BUILDING CITYTEL._NO: ADDRESS. Y 4C t En .jit t.tf LCOUNY LOCALITY E NO. .EXPIRES His e ++�i_521 NEAREST PERMIT FEES °CROSS ST. TYPE OR FIXTURE OR ITEM FEE OWNER k ...... n •�vamm • :av v,. MAIL: WATER CLOSET (TOILET) @ 0.50 S ADDRESS il' R ," vn. i' �. . p a BATHTUB O.50CITY ,ttt, !- n �� rr TEL.'NO. SHOWER Q0.50 I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY WASH BASIN) (� 0.50 APPLICATION AND STATE'THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY'WITH ALL COUNTY. ORDINANCES AND KITCHENSINK O..SO STATE LAWS REGULATING PLUMBING. . I CERTIFY THi4T 1' POSSESS THE ABOVE VALID LOS LAUNDRY TU.B OR TRAY � 0.50 �!� ANGE S CO N L7 NSE. OR I' M T.HE LEGAL' OWNER OF' A OPCRIBED OVE. GAS SYSTEM OUTLETS. (9� O.SO r! SWATER HEATER . Cg? 0.50 y+ PERMI SLOP SI NK 0.50 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN Q 0..50 DISHWASHER 0.50 / 11 DRINKING FOUNTAIN @ O.BO '6 t 1 Ya r=L•Q IN URINAL @ 0.50 .J HOUSE SEWER Q 0.50 a . Z MISCELLANEOUS (� 0 APPROVALS DATE INSPECTOR-13 NAME ROUGH PLUMBING " GAS PIPING GAS VENT CESSPOOL 1.00 CESSPOOL SEPTIC TANK: SEPTIC TANK '•," I DRAIN ( ) PIT ( ) @ 1.00 SEWER {p� 1 PERMIT . 1.00 GAS TEST 1411 A L "ill-A /�-� f"°N � UTILITY CO. NOTIFIED � TOTAL FEE • FINAL WORKERS4 COMPENSATION DECLARATION I APPLICATION FOR PLUMBING PERMIT J 6 H I .hereby affirm that I have a certificate of consent to self 76A667A insure, or a certificate of Workers'Compensation Insurance, ' CE 817(REV. 10/81) or a certified copy thereof(Sec. 3800, Lab. C.) COUNTY O LOS ANGELES/� �, BUILDING AND SAFETY Policy No. Company + �l YL-v'"'016 /.( Certified copy is hereby furnished. i� ) �" BUILDING %�/ ,6�/ A�s� F-1 { FOR APPLICANT TO FILL •(PRINT O PE' ADDRESS e� !% ' Certified copy is filed with the county building inspec- tion i NUMBER FIXTURE OR ITEM /' _ department. @ FEE 'LOCALITY L/ Date Appl'igant WATER CLOSET NEAREST v CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed If the work Involved by the permit is for one hundred dollars($100)or less.) LAVATORY MAIL ' ADDRESS I certify that in the performance of the work for which this I permit is issued, I shall not employ any person in any manner SINK CITY TEL.NO. � so as to be me subject to.the Workers''Compensation Laws: I; i DISHWASHER CONTRACTOR Date pp.lican �'�' CLOTHES WASHER A ADDRESS NOTICE TO PPLICANT: If, after making this Certificate of I 3 Exemption, you should become subject' to the Workers' SWIMMING POOL RECEPTOR P Y I ;I . CITY TEC.NO Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit: shall be ' STATE LIC. deemed revoked. WATER HEATER LICENSE,NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby-affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER e- Joe :0. and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL99' a DATE .�. VALIDATION License Number Lic. Class _ FINAL O Contractor. Date BY 0� U jEDI am exempt under SecC6'. ' , � B.BP:C. for this reason ► z Plan-check fee ate:. PLUMBING PERMIT ISSUING FEE$ .SAO Sianatur TOTAL FEE _06— I Plan.check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from.the Contractor's License Address �• Law for the following reason. (Section 7031:5ess, Business and. z Professions Code),. City Tel.No. ^ 1 29 ` A I, 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). ® [ � c. 1 b 9 0' ` CONSTRUCTION LENDING AGENCY •C .v ` 1 I hereby affirm that there is a.construction lending agency for p . the performance of the work for which this.permit is issued. q IL (Sec. 3097, Civ. C'..). ( _ ' Lenders 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 Boo ordinances and State laws regulating Plumbing, and hereby authorize representatives of this.County to enter upon the abov mentioned property for inspection pu pos SEE REVERSE FOR EXPLANATORY LANGUAGE l Signature of Permittee Da I ! IT COUNTY OF Lt`7S ANGELES TEMPLE CITY # 0508 +�( (PLZ7M87NG-PERM 10 DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS 1p-L 050 0007-170010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL I • FEES PAID BUILDING ADDRESS': TR: 17179 LT: 566216 PRIMROSE-IAV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-CA-9-1-7$01614 ASSESSOR INFOR14ATION NUMBER: NEAREST CROSS STREET: LONGDEN 5385-012-021 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.20 TENANT: - TOTAL FEES 43.95 ISSUED ON: PROCESSED : P EXPI ON: 07/17/00 UT 01/ /01 OWNER: TEL. NO: FINAL DATE FINAL BY; CODE: MURDY BARBARA A TR BARBARA A MURDY 6216 PRIMROSE AV TEMP 917801614 MIC IPTION OF WOR CHAN E OUT OF WATER HEATER APPLICANT: TEL. 0• i ALAP ASSO. (818) 407-1247- 7229 VARNA ST. SPECIAL CONDITIONS: N. HOLLYWOOD, CA CONTELES CO ECTO ALAPASSOCIATES (818)N407-1247- � APPROVALS DATE INSPR E SIGNATUR 7229 VARNA ST LIC. NO UNDER SLAB WORK NORTH HOLLYWOOD CA B/L RHE / WATER SERVICE O! PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. N0: _ 1111111 GAS PIPING GAS VEFT f !I I I I I ' W O I^'I K; OT WATER HEATER- 'U' EATER S LTJ L� JJ LJ 11 U/J V SPLUMBING FIXTURES Q ❑ LAWN SPRINKLERS O ❑ 0 ❑ x r t�' GAS TEST 4r IO ©I,I®C7 UT L T COMPANY NOTIFIED Z�c �O t� , 46CWV Service �haq t GRAY WATER SYSTE i * ADDITIONAL DATA ON FILE i i I REPORT ID: DPR263 ROUTE TO: SS0508