HomeMy Public PortalAbout9069 RANCHO REAL RD_Plumbing_1956-10-05 76AS67 .•... APPLICATION FOR PLUMBING PERMIT
D13S-17 Id-BB
'-4-DIVISION OF WELDING AND SAFETY
Deportment of County Engineer
County of LOS Angeles BUILDING
JOHN A. L.AMBIE, COUNTY ENGINEER ADDRESS 9069 Rancho Real Rd.
CASS.ATT D.GRIFFINS SUPT OF BUILDING
LOCALITY Temple City
FOR APPLICANT TO FILL IN NEAREST Rosemead
CROSS 8T.
OWNER C o IIa ROC1Ue DISTRICT NO. GROUP I ZONE I READY FOR INSPECT ION
ADDRMAIL
ESS 9069 R2ncho Real Rd. )
'1e City TEL.-NO. INDUSTRIAL
CITYWA TEAPPROVAL
PLUMBEFN^loSZ'TimM ng POOL COO INSPECTION RECORD
ADDRES81715 Sa San Gabriel Blvd.
CITY San-Gebri el TEL.NoAt o 62004
LICENSE NO. 149717 1-% %.
NUMBER TYPE OF FIXTURE OR ITEM FEE
WATER CLOSET (TOILET) @ $i.00 $
BATH TUB @ $1.00
SHOWER @ $1.00
LAVATORY (WASH BASIN) @ $1.00
KITCHEN SINK @ $1.00
DISHWASHER @ $1.00
LAUNDRY TUB OR TRAY @ $1.00
CLOTHES WASHER @ $1.00
WATER HEATER @. $1.00
GAS SYSTEM @ $1.00
Swimming Pool �
APPROVALS
DATE INSPECTOR'S SIGNATURE
UNDER SLAB WORK
PERMIT $ 1 00 ROUGH PLUMBING
' I GAS'PIPING
TOTAL FEE GAS VENT
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS .CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. PLUMBING FIXTURES
[ HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE UTILITY CO.NOTIFIED'
DESCRIBED RESIDENTIAL4 RESIDENTIALPROPERTY.
SIGNATURE
OF PERMITTEE 7 FINAL �. Q
iOHN A.L AMBIE.COUNTY ENGINEER osz,,VALMATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR
AC ' 4 A u UU1 5 3 2.0-Cr -D
WORKERS'COMPENSATION DECLARATION 20.0026 DPW 4/87 APPLICATION FOR PLUMBING PERMIT J�
t I,herebyf affirm that I have a certificate of consent to self in- 76A667A 'fl I
sure,or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) IL JI
certified copy thereof(Sec.3800, Lab. C.)
Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Certified copy is hereby furni d.
E Certified co is filed wi a count building FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDI
py y g inspection ADDR
department. NUMBER FIXTURE OR ITEM Cal FEE
'1 LOCALITY
Date Applicant WATER CLOSET(TOILET) (/ NEAREST
CERTIFICATE OF'EXEMPTION FROM WORKERS' � BATH TUB Vit CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER V, 14
(This section need not be completed if the work involved by MAIL
the permit Is for one hundred dollars($100)or less.) LAVATORY Q ADDRESS
I certify that in the performance of the work for which this per- SINK
mit is issued, I shall.not employ any person in any manner so CITY
aa
subject t the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
DApplicant �G(M CLOTHES WASHER ADDRESS
NPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITY TEL. NO.
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC..
ed. WATER HEATER LICENSE CLASS
NO.
LICENSED CONTRACTORS DECLARATION DISTRICT NO. CLASS SE BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER (f
and Professions Code, and my license i ` full force and ef- 5 PER SYSTEM FINAL VALID N a
DATE ..
License Number Lic..Class O
• FI V
tx
Contractor Date B O
1—
I am exempt u er See. W
B.BP.C. f is reason
Plan check fee A 0 3.1,5 A
Date: PLUMBING PERMIT ISSUING FEE$ # 0 0 oto 0 5
nature
SINGLE FAMILY TOTAL FEE .I o o 3 IL5 0
FfOME OWNER-BUILDER DECLARATION Plan check applicant o 0 0 3 4,5 0 5
I 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
1� Cit Tel. No. 0 7.2 9 8 8
�I I, as owner of the property, will do the work and the Y
structure is not intended or offered for sale(Section 7044,
Business and Professions Code).
CONSTRUCTION LENDING AGENCY PON
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.).
Lerider's Name
Lender's Address
I certify that I have read this application. and state that the
above information is correct. I e to comply with all County
ordinances and State law gul ting Plumbing, and hereby
authorize repress of t County to enter upon the
above-mentione y f pectin urpose`.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Sign r f Permitt Date
i
+ COUNTY OF LOS ANGELES v TEMPLE CITY # 0508 {PLUMBING PERMIT
• DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS --PL 0508 9609100022
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
EGA D: - FEES PAIDI.LDLNG-.ADDRESS:
TR: 11218 LT: 20 BL: B 19069__.RANCHO REAL RD
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803031
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: SULTANA
5388-002-020 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 1.00 FIX 16,35
TENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.35 ISSUED ON: PROCESSED : PL EXPIRES ON:
13 DISHWASHERS) 1.00 FIX 16.35 09/11/96 TC 09/10/97
21 HOSE BIBB(S) 1.00 FIX 16.35
OWNER: TEL. N0: 25 LAVATORIES/SINKS 3.00 FIX 49.05 FINAL DATE FINAL BY: GODE:
WONG KIM H;WING S (818) 286-4036- 45 WATER CLOSET/URINAL 2.00 FIX 32.70
9069 RANCHO REAL RD 47 WATER HEATER(S) 1.00 WTH 16.35
TEMP 917803031 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.35 TE-SCRIPTION OF WORK
TOTAL FEES 207.60 NEW ADDITION AND ALTERATION
APPLICAN E 0:
SAME AS OWNER -
�n � ® SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO UNDER SLAB WORKS 04y
WATER SERVICE
ARCHITECT OR ENGINEER: TEL. NO: �9
G� PLASTIC Y/N METAL Y/N
LIC. N0: ROUGH PLUMBING
r ��J GAS PIPING
V�//0,,l h ll K s GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
< LAWN SPRINKLERS
mit � �7 �] '�,�: �• /� i
• �, �� �/ 1 �j' GAS TEST
d e /
1`0 _�� yx UTILITY COMPANY NOTIFIED
CWV
c e GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508