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HomeMy Public PortalAbout5603 ROSEMEAD BLVD_Plumbing__ 9eAM7A - I fff A t P IYl V�/Y�1 ®A APPLICATION FOR PLUMBING PERMIT , COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN I PRINT OR TYPE) BUILDING Z6 O ov NUMBER FIXTURE OR ITEM 0 FEE ADDRESS WATERCLOSET d O O LOCALITY 0 _ �� NEAREST BATH TUB { CROSSST CLO �'"�• di SHOWER OWNER LAVATORY MAIL / pp ADDRESS777 S 9 ✓ 1 L7 SINKa p GTYLA, TEL NO If DISHWASHER - 3 CONTRALTO ` `.j AA CLOTHES WASHER ADDRESS SWIMMING POOL RECEPTOR CITY �j T TEL NO.2 LAWN SPRINKLER SYSTEM iTATE LIC ,�ER WATERHEATER LICENSE NO 2 Is CCLASSE, —a GAS SYSTEM OUTLETS. 3 APPROVALS DATE INSPECTOR 5 SIGNATURE OPER�STEMR UNDER SLAB WORK 71--k-7 ROUGH PLUMBING L D9 GAS PIPING 3 00 GASVENT V D #FINAL WATER HEATER b �G MBING FIXTURES G GAS PIOE1 Check fee ITY CO NOTIFIED Z PLUMBING PERMIT ISSUING FEE$ TOTAL FEE Plan ceck applicant PLAN CHECK VALIDATION Name Address I City Tel No LREBW REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE R 5 Q 5 A BOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES UINS REGUUTING PLUMBING PERMIT VALIDATION # * * * 5 EBY CERTSY TIUT I AY PROPERLY REGISTERED AND/On LN:[NSEO AS , BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA ON THAT I AM THE 2 •4 9 4 2 5 ER OF AND INTEND TO BESIDE IM THE ABOVE DESCRIBED RESIDENTIAL T I ,E/� ' • a 1, 9 9,255 RE /////N M I1.100r-78 DISTRICT NO D BY INDUSTRIAL ' WASTE APPROVAL'A(' (E d , WORKERS'ih eI haveSATIONDECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affum Iha41 have a certificate of convent to self 200028 DPW 8/87 insur9 or a certificate of Workers' Compensation Insurance 78A887A ty �ky h l t er C(Sec 38M C ) BOr 1 COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS Certified dopy is hereby furnished ❑ APRICANT TO FILL 14(PRINT OR TYPE) BUILDING Certified copy n filed with the county building irnpec- ADDRESS ©,3 WF) depar ent p��/�/,//A,��,.�y�� Fr FIXTURE OR ITEM ® FEE LOCALITY G Date �� Applicant". �'_'/Ntis 4 WATERCLOSET NEAREST r CERTIFICATE OF EXEMPTION FROM WORKERS' B x 57 COMPENSATION INSURANCE SHOWER OWNER S (This settlors nerd not be miripksted If the work Involved by the permit Is for one hundred dollars ({100)or less ) LAVATORY DDRESS r 0 O 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 CITY TEL NO w os to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR � T Date Applicant CLOTHES WASHER NOTICE TO APPLICANT If, after making this Certificate of ADDRESS �� 3 Set^ `A!C - Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR � L� � ) Compensation provision of the Labor Code you must forth- CRY QA/7�^' LAWN SPRINKLER SYSTEM cfflc�l PVN with comply with such provisions or this permit shall be STATE uC deemed revoked WATER HEATER LICENSE 140 CLASS LICENSED CONTRACTORS DECLARATION 01 I¢ D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS U (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER yy and Professlorq Code,and my license is In full force and effect 5 PER SYSTEM FINALLIDATION O: LicenseNumbe Lic ClClau DATE I U FINAL — a Contractor Dateq14 12e BY 0 ❑ I am exempt under Sec V �++ B 8P C for this reason ' Plan check fee Pol Z 3 Date PLUMBING PERMIT ISSUING FEE S Signature r TOTAL FEE o , SINGLE FAMILY Plan check applicant r HOME OWNER BUILDER DECLARATION Name e !V - ACCT.i 1 hereby affirm that I am exempt from the Contractor's License Add4 Address Law for the following reason (Section 7031 5 Business and 3307 20ry0 Professions Code) City Tel Nk ❑ I, as owner of the property, will do the work and the 1 ITM structure is not intended or offered for wle (Section , TOTAL 20.50 704, Business and Professions Code) CONSTRUCTION LENDING AGENCY DECY` 20.50 1 hereby offum that there is a construction lending agency for (. ,DIT the performance of the work for which this permit is issued (Sec 3097, C,v C ) Lender s Name ODOO-0001 +/26190 Lender s Address 1 AM 8:37 1 certify that I have read this application and state that the poll.obove mformation is correct I agree to comply with all County ordinances and State jaws regulating Plumbing and hereby - authorize reprellentotives of this County to enter upon the above-mentioned property for inspection purposes ' A - �1 SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of ParrrmmiilteeJ/" p to v i WORKERS'COMPENSATION DECLARATION 7•A617A I hereby affirm that I have a certificate ofcoment to self eaear (2-ae) APPLICATION FOR PLUMBING PERMIT insure or a certificate of Workers'Compensation Insurance,or ' a certified copy thereof(Sac 3800,Lab C) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company ' Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILD I NO fppss Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM 0 FEE ADDRESS department WATER CLOSET LOCALITY Date Applicant NEAREST BATH TUB CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER (Thu season need not be completed if the work involved LAVATORY �� ADDRESS i by the permit u [or one hundred dollars ($I00) or less) SINK CITY TEL NO CO U 1 certify that in the performance of the work for which this DISHWASHER Q permit is issued, I shall not employ any person m any manner CONTRACTOR ^� 0 so as to becomesubjectto the e ' Comp CLOTHES WASHER ADDRESS n Dete6_�GR Npplicant SWIMMING POOL RECEPTOR NOTICE TO APPLICANT If, after making this Certificataro' CITY U TEL NO h Exemption, you should become subject to the Wor LAWN SPRINKLER SYSTEM STATE LIC Z Compensation provisions of the Labor Code, you must forth WATER HEATER LICENSE NO CLASS with comply with such provisions or this permit shall be deemed revoked OAS SYSTEM OUTLETS DISTRICT NO PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER i I hereby affirm that 1 em licensed under provisions of Chapter a PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Bust _� FINAL / 7 / �!� VALIDATION nese and Professions Code, and my license is in full force and R Sµ�'C DATE G o effect By License NumbeP� E-7 Lie Class G FINAL 04 Contractor Date /J1 6&� /,/Jj , El I am exempt from the licensing requirements es I am a Plan Check fee v' O,;? licensed architect or a repstered professional engineer PLUMBING PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Butti mess and Professions Code) TOTAL FEE -A, Lic or Reg No Date Plan check applicant :2l6 6 9 6 A HOME OWNER BUILDER DECLARATION Nama # • • • • • 5 1 hereby affirm that I am exempt from the C4itractor's Addreaa License Law for the following reason (Section 7031 5, Bust City To] No 2 • • 4 0 5 0 ness and Professions Code) 1, as owner of the property, am exclusively contracting • • • 4 0 5 0 , with licensed contractors to construct the project (Section 7044,Business and Professions Code) 1006-82 'CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the performance of the work for which this permit m tuned(Sec 3097,Civ C) , Lender's Name I Lender's Address I certify that 1 have read this application and state that the above information is correct I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing and hereby authorize representatives of this County to enter-upon the ebo an conedr c o inspection purposes -Signature of Permittea Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508IiT DEPARTMENT OF PUBLIC {ARKS 9701 LAS TUNAS BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT LEGAL 10 FEES PAID BUILDING ADDRESS BK 105 PG 86 PC 3 5603 ROSEMEAD BL FEE DESCRIPTION QUANTITY UAM AMOUNT TEMP CA 917801804 ASSESSOR INFORMATION • NEAREST CROSS STREET LAS TUNAS 5387-031-063 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H4 LOCALITY TEMPLE CITY 17 FLOOR DRAIN(S) 2 00 FIX 32 40 TENANT 25 LAVATORIES/SINKS 4 00 FIX 64 80 ISSUED ON PROCESSED BY PLAN BY Exffffn�� 45 NATER CLOSET/URINAL 6 DO FIX 97 20 05/07/99 VG 1199 TOTAL FEES 222 15 OWNER TEL NO FINAL DATE F UAL BY CODE ELTINGE GRAZIADIO;SAMPSON DEV 00 - C 2 _( 1 DESCRIPTION OF WMK PLUMBING FOR MINOR TENANT IMPROVEMENT APPLICANT TEL NO FRED COM ARCHITECTS (714) 966-1415- 3184-B AIRWAY AVE SPECIAL CONDITIONS COSTA MESA, CA PNGELES Co CONTRACTOR TEL NO OroAPPROVALS DATE INSPECTOR SIGNATURE GREISEN CONSTRUCTION, INC. (818) 248-1291- \1 1901 BROADVIEW DR LIC NO GLENDALE, CA 91208 352551/8 / PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER. TFL NU FRED COM ARCHITECTS (714) 966-141 ROUGH PLUMBING 3184-8 AIRWAY AVE LIC NO 1111111 COSTA MESA, CA 92626 NONE GAS VENT PUBLIC WORKS HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS fib/ �e CWV Se�vMce That REPORT ID DPR263 ROUTE TO BS0508