HomeMy Public PortalAbout5753 ROWLAND AVE_Plumbing__ 76A667 'EBY!"12/.59
TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT �
COUNTY OF LOS ANGELES :
DEPARTMENT OF COUNTY ENGINEER BUILDINGB NTGLABDIE.CTNYTYNIVGILSNEON• ADDRESS a
WILLIAM A.JENSEN,SUPT OF BUILDING LOCALTPI!
FOR APPLICANT TO FZL IN NEAREST
CROSS ST.
NUMBER FIXTURE OR ITEM OWNES
WATER CLOSET MAn
RATE TUBADDRESS
-
SHOWER �s TEL NO a
CO OR
LAVATOBY
sum ADDRESS t
DISHWASM CITY TEL. NO. �
CONTRAq R'S STATE
LAUNMY TUB REGISTRATION NO. Cl Q COUNTY ❑
CLOTHES WASHER DISTRICT No ZbNR' P D BY
WATER HEATERa �1 Vim/ el
GAS SYSTEM IMMUSTR(IAL/
WASTE APPROVAL
INSPECTION RECORD
O
V
O
�i
w
- a
lice PER ITEM
OR FEMUBE $ I /i 00 APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT $ 2100 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING
GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY GAS VENT
I y� .. �,
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER 7 I U
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES /
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF G TEST 1
CALIFORNIA OR THAT I AM E LEGAL OW�TEDESCRIBED RESIDENTI PR ERTY. TILITY CO.NOTIFIED
SIGNATURE .�", .4
OF PERMITTE FINAL •'�f��1�r�S�{ �s7
DF VALIDATI. ROBERT A. . OOD,
6K. m.o. cA38 SUPERVISING MECHANICAL ENG'R
�.'Ss8% JM16 5D 3.50N4
„%WORKERS'COMPENSATIQN DECLARAtTION APPLICATION FOR PLUMBING PERMIT
I hereby affi*h that I ho0e,a certificate of consent to self 76A667A
Insure, r a.certificate'of Workers''Cbmpensati6n Insurance, CE 817(REV. 10/81)
;ior.t"ce copy thereof(Sec. 3800,kab C.) I COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No.-Company-
Certified
o. CompanyCertified copy is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 5,,745-J f, j L.A AJ t
❑ Certified copy is filed with the county building insect- NUMBER FIXTURE OR ITEM � FEE
tion department. LOCALITY
Date Appli4ant NEAREST
WATER CLOSET dQ 15 f I
14
CERTIFICATE OF EXEMPTION FROM WORKERS' / BATH TUB 61V CROSS ST. L/C.
COMPENSATION INSURANCE OWNER y
(This section need not be completed If the work Involved by SHOWER C G�✓
the permit is for one hundred dollars($100)or less.). LAVATORY 111 �MAILADDRESS S /V / W D
I certify that in the.performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TE7m 1 IC TEL.NO.
so as to become subject To the WIrrs'Cagmensation Laws. DISHWASHER G
r CONTRACTOR, S�
Date �' Applicant CLOTHES WASHER ADDRESS
NOTICE O APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers' CITY TEL.NO.
Compensation provisions of the Labor Code, you must forth- LAWN SPRINkLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROLE D BY
I hereby affirm that I am licensed under provisions of Chapter 9
GAS SYSTEM OUTLETS �rO
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER ='
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL 0
DATE � Y IDATION 0
License Number Lic. Class
FIN A O
Contractor Date BY
I am exempt under Sec. �
B.&P.C. for this reason
Date:
Plan check fee ►Signature PLUMBING PERMIT ISSUING FEE$ O �®
TOTAL FEE Qff
Plan check.applicant
SINGLE FAMILY PER 3 2 7 4 8
HOME OWNER-BUILDER.DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License # o 0 0 0 0 5
Law for the following reason (Section 7031.5; Business and Address
Professions Code)171-T : City Tel. No. ° ° 4 Q 5 0
f� I, as owner of the property, will do the work and the 0 0 o 4 Q 5 0 v
structure is not intended or offered for sale (Section
7044, Business and Professions Code).
IQ24-85
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
1 certify that I have read this application and state that the
above information is correct. Iagree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
ob. mentioned proQa.,
r inspection�rpos ss.
U 7-LI SEE REVERSE FOR EXPLANATORY LANGUAGE
ignature of Permittee ate
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0103060010
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 6561 LT: 406 5753 ROWLAND AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802617
ASSESSOR INFORMATION NUM NEAREST CROSS STREET: WORKMAN
8587-029-011 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20
T TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES 0 :
03/06/01 LS 09/02/01
OWNER: TEL. 0: FINAL DATE FI OQ Y: CODE:
BROWN GLENN R;ELAINE M (626) 286-8224-
5753 ROWLAND AV �'✓ 2� r
TEMP 917802617 DESCRIPTION OF WORK
GAS LINE FOR FIREPL E
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO UNDER SLAB WORK
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR NEER: EL. 0:
ROUGH PLUMBING
LIC. NO:
GAS PIPING g.fl
I �
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
C V
GRAY WATER S S
REPORT ID: DPR263 ROUTE TO: SS0508