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Home My Public Portal About5016 RIO HONDO AVE_Plumbing__ 76A6.67—CE 817 Byes C IT Y OF TEMPLE C I TY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS 016 RIO HQNDO AVENUE JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY ijJfpIj',1 CITY FOR APPLICANT TO FILL IN(PR NT O TYPE) CRDsST. SPAMMTT STRUT NUMBER FIXTURE OR ITEM EACH FEE I WATER CLOSET 1.50 OWNER WISEMAN W. BATH TUB 1.50 ADDRESS• 5016 RIO HONDO AVEBNE SHOWER 1.50 CITY TEMPLE. CITY TEL. NO. 286-6786 LAVATORY 1.50 CONTRACTORPACIFIC IN$T UA..ERS SINK 1.50 ADDRESS 10920 EAST GRAND A VMM DISHWASHER 1.50 CITY TWLE CITY TEL.NO. Wr7070 CLOTHES WASHER 1.50 STATE LIC LICENSE NO. 211898 CLASS SWIMMING POOL RECEPTOR 1.50 DISTRI�CT NO. GR P ZONE PR S BY LAWN SPRINKLER SYSTEM 2.00 4 p 1 WATER HEATER 1.50 3.,50INDUSTRIAL v WASTE APPROVAL o GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD 2 OUTLETS OVER 30 5 PER SYSTEM y Plan check fee 25% of above. See reverse. PLUMBING PERMIT ISSUING FEE 8• 2 "00 TOTAL FEE 3#50 APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel. No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT 1 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 GAS TEST PLUMBING. 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER O AND INTIkND TO RESIDE IN.THE ABOVE DESC ED RESIDENTIAL P PERTY. FINAL 009' •Lt SIGNATURE .TACK R. ALLEN, SUP RV ISING MECHANICAL EN'G'R. OF PERMITTEE < 11 1 Emd PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH 1 11-.. 0 3 4 62-- iW1 9 5 D 3,50- c 76A667 OBB 17 11-50 APPLICATION FOR PERMIT J'DEPARTMENT OFNG AND SAFETY COUNTY OFF LOS LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER ! FOR APPLICANT TO FILL IN DISTRICT a. GROUP I ZONE PERMIT NO. 400- a PLUMBER !s qzf, RE EIVED BY READY FOR DATE ISSUADDRESS Z . /-3Let__— E FIRST INSPECTION I? / P�/ a Bu ADDRESS CITY � TEL No. e COUNTY –'S Q- 1 LOCALITY LICENSE NO. Q EXPIRES NEAREBT PERMIT FEES. DROSS ST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER MAIL WATER CLOSET(TOILET) @ 0.50 S ADDRESS. Q J G.r.A-O.d L.)L QsR aA.� BATHTUB 0 0.50 CITY TEL NO 0 SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY 0.50 ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER GAS SYSTEM OUTLETS @ 0.50 OF THE RESIDENTIAL PROPERTY DESCRIBED AB/nOV�–E.�– WATER HEATER 0.50 BIONP PERMITTEE �* •� a `-"" SLOP SINK 0.50 INSPECTION RECORD FLOOR SINK ! 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.50 J Q HOUSE SEWER @ 0.50 Z MISCELLANEOUS e..eJ 0 APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING / / GAB PIPING I Jb4of.a"If I GAS VENTv�l CESSPOOL @ 1:00 CESSPOOL SEPTIC TANK: SEPTIC TANK DRAIN ( ) PIT ( ) @ 1.00 SEWER PERMIT 1.00 GAS TEST UTILITY CO.NOTIFIED TOTAL FEE FINAL f WORKERS'COMIENgA ON DECLARATION APPLICATION FOR PLU ��{�,�� o(�^k � �� I here'iy offirm that f hiertificate of consent to self 76A667A v�I �+ u insure$or a certificate of ZrWdrs'CrBnpensation Insurance, CE 817(REV. 10/81) cy a certif' d cj#p f there�ft(S 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No.�,wnpanyTem Inc Co- �:Corrified co is her ay furnished. PY t FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 5016 Rio Hondo Certified copy�i's file]with the county building inspec- NUMBER FIXTURE OR ITEM FEE LOCALITY tion department. Date 6-24-87. I Ogen Bros. Plba. � WATER CLOSET .00 DO � Apflil igant NEAREST CERTIFICATE OFXIEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPEVwSIATION INSURANCE O OWNER RIs section need not a completed if the involved by SHOWER 1911 the-pDrmit is for one huabrod dollars($100)or less.) LAVATORY ADDRESS 30301D MAIL .center $tteet I certify that in the performance of the work for which this Permit is issued,I shall not employ any person in any manner SINK OD CITY Arcadia TEL.NO. 818-445-19 94 'so as to become subject to,the Workers'Compensation Laws. I DISHWASHER O CONTRACTOR Date �� Ap((Ilicant'-- CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: Jf, after making this Certificate of 4265 N. Baldwin Ave. Exemption;'you should become subject 'to-the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you>rmst forth- CITY El ML7nte TEL.NO. 443-0078 with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC. teemed revoked. WATER HEATER LICENSE NO. 231 741 CLASS C36 20 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PRbCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS N (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ° Q and Professions Code,and my license is in full force and effect. It 5 PER SYSTEM FINAL VALIDATION License Number 231 741 Lic. Class C36 20 DATE a FINAL V Contractor Wen BrOS. Plbg, Date 6-24-87 BY ❑ I am exempt under Sec. I O B.BP.C. for this reason W Plan check fee p, Date: PLUMBING PERMIT ISSUING FEE$ Z Signature TOTAL FEE SINGLE FAMILY Pian check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ff44 CCss nn nn rtrt nn ❑ IvlLrw�d6Uv , 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). 73 � 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 VA+ (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 tinned property for inspection our luposes. SEE REVERSE FOR EXPLANATORY LANGUAGE re of Permittee Date ANORERS':.COMPENSATION D IECLARATION APPLICATION FOR PLUMBING PERMIT Tihereby,Affirm,lthat I have a cer)ificate of consent to self 7SA667A insure, or a certificate of Workers'Comq¢nsotton Insurance, CE 817(REV.8/88) or a certifie d copy thereof(Sec. 3800, Lab,. C.) )(,J COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ❑o iy No.�G�27CompanyC"iris ` Certified copy is hereby furnished. ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / Certified copy is filed with the county build' ' spec- ADDRESS NUMBER FIXTURE OR ITEM @ FEE +^--- tion department. / LOCALITY ��F •�'��,- S 'a A li ant A �_� WATER CLOSET NEAR T, + Dates PPS � CERTIFI E OF EXE M �RANCEO RKERS' BATH TUB CROSS T. COMPENSATION INSJ SHOWER OWNER f (This section need not be completed if the work involved by fMAIL the permit is for one hundred dollars($100)or less.) LAVATORY / ADDRESS I certify that in the performance of the work for which IN permit is issued,I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL.N Compensation.provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. K deemed revoked. WATER HEATER LICENSE NO. ,} C/ CLASS {r 1 LICENSED CONTRACTORS DECLARATION DISTRICT NO. /PROCESSED BY-. I hereby affirm►hat I am licerised under provisions of Chapter 9. GAS SYSTEM OUTLETS r Q (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER J and Professions Code,and my license is in full force and effect. 5.PER SYSTEM FINAL 41 DATE VALIDATION License Number Lic. Class_ _ F � Contractdr�/ ❑ !� I am exempt under Sec. � B.BP.C. for this reason Plan check fee Date: I I PLUMBING PERMIT ISSUING FEE$ Signature ' TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name . ��l I hereby affirm that I am exempt from the Contractor's License Low for.the following reason (Section 7031.5, Business and Address Professions Code): City l Tel. N s G ❑ I, as owner of the property,.will'do the work and the 7 3 2 3 R structure-is not intended or offered for sale (Section # 0 0 0 0 0 5 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY .)' o o 8 a 5 O I hereby affirm that there is a construction lending agency for o o 'o $$5 _ the performance of the work for which this permit is issued C ` (Sec. 3097, Civ. C.). 2 4 $7 Lender's Lender's Address I certify tha, I have read this application and state that the above information is correct. I agree to comply with all County polo ordinances and State laws regulating Plumbing, and hereby authorize representatives of this County to enter upon the above=mentioned property for p insction purposes. L SEE REVERSE FOR EXPLANATORY LANG4JI11CsE ./�5 _S Si atrire ofJe mittee Date