HomeMy Public PortalAbout4830 RYLAND AVE_Plumbing__ • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0706080005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: I FEES PAID I BUILDING ADDRESS:
ITR: 17107 LT: 38 I 1 4830 RYLAND AV
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804032
(ASSESSOR INFORMATION NUMBER: I 1 NEAREST CROSS STREET: ROBINHOOD I
8585-011-018 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY, Cl
1 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 I 1
1 TENANT: TOTAL FEES 43.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
106/08/07 SR 12/05/07 1
[OWNER: TEL. NO: I IFINAL DA FIN Y: CODE: I
IHIGA, GARY/TRAGI (626) 443-8774- I I I
14830 RYLAND AVE. I I '+ I
ITEMPLE CITY CA 91780 I (DESCRIPTION OF WORK I
[ I IGAS LINE FOR HVAC SYSTEM I
(APPLICANT: TEL. NO: I I I
1SAM8 AS OWNER 1 ISPECIAL CONDITIONS: I
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(CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1
1SAME AS OWNER - I I I
LIC. NO I (UNDER SLAB WORK I 1 I
1 I 1WATER SERVICE I I
IPLASTIC YIN METAL YIN I I
1ARCHITECT OR ENGINEER: TEL. NO: I I I I I
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[ LIC. NO: I I I I
[ 11GAS PIPING
I 1 GAS VENT Gr�
IHOT WATER HEATER I
IPLUMBING FIXTURES I I
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ILAWN SPRINKLERS I 1 I
[ IGAS TEST I I I
I 1UTILITY COMPANY NOTIFIED( I 1
I 1GRAY WATER SYSTEM 1 [ I
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[ 1REPORT ID: DPR263 ROUTE TO: BS0508 1 I [ [
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76A667 ,� ,,, 9 APPLICATION FOR PERMIT
D}�U'dA RENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER PLUMISIN
—DI5 R C GROUP O E .
A/ FOR APPLICANT TO FILL IN 601-7 - 37
PLUMBERai •I 4' IO hr Ys�''/� 2a�+, 1 i-"-I . RECEIVED BY READY FOR DATE ISSUED
FIRST INSPEdTION cy
L/ ® d.
ADDRESS
BUILDING`
CITY .��'�9 TEL.N P?-der,r ADDRESS
� 1
COUNTY LOCALITY n/ O
LICENSE NO. / EXPIRES 1 — /
NEAREST
PERMIT FEES CROSS 5T.
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A
OWNER`a_;V_L5;4 A O
NUMBER TYPE OF FIXTURE OR ITEM FEE _
WATER CLOSET(TOILET) @ 0.50 Is /lea
BATH TUB @ 0.50 CITY (e TEL. No.
SHOWER @ 0.50v
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE 15 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL PROP TY D CRIBED ABOVE.
GAS SYSTEM OUTLETS @ 0.50 S'+�' ��bv
SIGNATURE OF
/. WATER HEATER @ O.SO PERMITTEE
SLOP SINK @ D.5D INSPECTION RECORD
FLOOR SINK @ 0.50 _
f7'
FLOOR DRAIN @ 0.50
DISHWASHER 0.50 I S.T��T' ►�-G'
DRINKING FOUNTAIN @ 0.50
URINAL 0.511 'J
Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS
o
APPROVALS
. I DATE //INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING
GAS VENT
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK, SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.00 SEWER
PERMIT I 1.00 1GAS TEST
UTILITY CO.NOTIFIED
TOTAL FEE
FINAL
WORKERS'COMPENSATIONDECLARonseN 7:ET PPLICAT�ON FOR PLUMBING PERMIT
I hereby affirm that I have a' certificate of consent to self ,ce r eo
insure, or a certificate of Workers'Compensation Insurance,or
a certified copy thereof(Sec.3800,Lab.C.)
3 �� � J�2id/J1�`�ss, COUNTY OF LOS ANGELES � � BUILDING AND SAFETY
FPolicy No. ompany / _.
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING '7
ADDRESS
PCertified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM O FEE
�e artment. WATER CLOSET LOCALITY
Date plicant �� �y NEAREST
BATH TUB CROSS ST. .— ti C
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER S'
LAVATORY MAI L
(This section need not be completed if the work involved ADDRESS iL
by the permit is for one hundred dollars ($100) or less.) SINK CITY TEL.NO. U
I certify that in the performance of the work for which this DISHWASHER W
permit is issued, I shall not employ any person in any manner CONTRACTOR z g 0
so as to become subject to the Workers'Compensation Laws. CLOTHES WASHER ADDRESS r W
Date Applicant SWIMMING POOL RECEPTOR d
NOTICE TO APPLICANT: If, after making this Certificate of CITY . TEL.NO. y
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. z
Compensation provisions of the Labor Code,you must forth- LICENSE NO. CLASS
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. P CESSED B
LICENSED CONTRACTORS DECLARATION OUTLETS OVERt��
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL
% i VALIDATION
ness and Professions Code, and my license is in full force and ff �s G
effect.
'License Numb
j FINAL
'LLic.Class gy
ar
Contractor ate !t±60—A Z
Plan check fee
I am exempt from the licensing requirements as I am a //70/
f 7�/
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ Se7
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE SO
Lic,or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION LAddress
I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Busi- Tel.No. '4 2.2 7 A
ness and Professions Code):
I, as owner of the property, am exclusively contracting ' o�0 0 0 o 5with licensed contractors to construct the project
(Section 7044,Business and Professions Code). 0 0 2 k 5 0
CONSTRUCTION LENDING AGENCY o 0 0 2 A, 0 cT5
I hereby affirm that there is a construction lending agency
for the performance of the work for which this permit is 1 0-82
issued(Sec.3097,Civ.C.).
Lender's Name
Lender's Address
4 certify that I 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 j1egulating Plumbing, and hereby
authoriz epre nt fives o this ounty to enter upon the
above- do pr petty r in ection purposes.
ig at re f er itt a Dat '