HomeMy Public PortalAbout4935 RYLAND AVE_Plumbing__ 7GA667 17 11-49 APPLICATION FOR PERMIT
DEPARTMENT-OF BUILDING AND SAFETY PLUMBING
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
P OPERMIT N13.—
FOR APPLICANT TO FILL IN DIS R NO. IRI n
/� 40-,12-Ir
PLUMBER //��1�/ RECEIVED BY READY FOR ' DATE 188UED
FIRST INSPECTION
�y BUILDING
CITY _(1� TEL Nt>�3v G�(p ADDRESS
COUNTYTY
LOCALI
LICENSE NO. L �� EXPIRES D
NEAREST
PERMIT FEES CROSS ST.
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER •/ ®® ./ d%!;Q'��t?i
MAIL
I WATER CLOSET(TOILET) Cat 0.50 $ ADDRESS G
/ BATH TUB @ 0.50 CITY /1.11.& TEL. No.
SHOWER @ 0.50 1 HERE90Y ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE 18 CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
I CERTIFY THAT i POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY 0 0.50 ANGELES COUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL DE9`CI� E,D,JASM.
�4
GAS SYSTEM OUTLETS @ 0.50 '
SIGNATURE OF
WATER HEATER a 0.50 PERMITTE
SLOP SINK @ 0.5o I INSPECTION RECORD
FLOOR SINK @ 0.501
FLOOR DRAIN @ 0.50
DISHWASHER @ 0:5OI
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50 J
Q
HOUSE SEWER @ 0.50 ?
MISCELLANEOUS 0
I O
APPROVALS
DATE INSPECTOR-B NAME
1 ROUGH PLUMBING '
!;
I _ 6A9 PIPING f.L
1 GAS VENT ! 7
CESSPOOL @ 1.00 CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ) PIT ( ) @ 1.001 SEWER /
PERMIT I 1.Do GAS TEST A K. L
UTILITY CO.NOTIFIE - / �.•�f
TOTAL FEE S �/�
v FINAL �
d./ ,I
�IyoRKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
1'hereby-Affirm that I -have a certificate of consent to self 76A667A l
insure, or a certificate of Workers'Compensation Insurance, ;CE 817(REV. 10/81) IL
or a certified copy thereof(Sec. 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) BUILDING
Certified copy is filed with the county building inspec- ADDRESS 7 L DJ
tion department, NUMBER FIXTURE OR ITEM. @ FEE LOCALITY
WATER CLOSET
Date Appligant NEAREST
NEARE ST, L)S bq'
CERTIFICATE OF EXEMPTION FROM WORKERS' I BATH TUB
COMPENSATION INSURANCE OWNER
(This section need not be completed if the work involved by �t SHOWER.
MAIL
the permit is for one hundred dollars($.100)or less.) LAVATORY 0o,ADDRESS Je L/
I certify that in the performance of the work for which this
permit is.issued',,I shall not.employ any person in any manner SINK CITY TEL.NO. i-
so as to become subject to the Workers'Compensation Laws. DISHWASHER.
CONTRACTOR
i
DateApplicant. CLOTHES WASHER ADDRESS t�
NOTICE TOAPPLICANT: If, after making this Certificate of
you Exemption; should become sub•ect to the Workers' SWIMMING POOL RECEPTOR
P Y I CITY �. TEL.NO..
Compensation.provisions of the Labor Code, .you must forth-; LAWN-SPRINKLER SYSTEM
with comply with such provisions or this... permit shall .be STATE LIC:
deemed revoked. WATER.HEATER LICENSE NO. CLASS.
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PR D BY
I hereby affirm that I am licensed under provisions of..Chapter 9 x GAS SYSTEM OUTLETS 1 '
(commencing with Section 7000)of Division.3 of the Business OUTLETS OVER
and Professions Code;,and my license is in full force and effect. 5 PER SYSTEM FINAL
r
r VALID. TION O
•
License Number Lic.Class DATE'
FINAL
Contractor Date BY G
❑ I am exempt under Sec: MR
to
B.BP.C. for this reason ►
Plan check fee
Date:
PLUMBING PERMIT ISSUING FEE$ Q Sv
Signature
TOTAL FEE d I 3 5 GO A
Plan check applicant # o o o 0 0 5
SINGLE FAMILY
HOME OWNER-BUILDER'DECIARATION Name I o 0 3 k.5 0
I hereby affirm that I am exempt from the Con.tra.ctor's License Add
Law for the following reason (Section 7031.5, BAddress.
usiness and o. o o 3 4.5 0;'-
Professions Code): City Tel. No.
fL/�`J1 I, as owner of the property, will do the work.and the ( 1. 19-85
structure is not intended. or offered for sale (Section
7044, Business and Professions Code). ,
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
I certify that 1 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
above-mentioned property for Inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Apuw
1(A�
Signature of Permittee Dare
76A667-CE#617 2-66
CITYIOF TEMPLE CITY
APPLICATION FOR PLUMBING PERMIT .
COUNTY OF LOS ANGELES -B 24.8
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY IN
JOHN A. LAMBIE, COUNTY DIVISION
EER AD RESSS 4935 No. Ryland
COLEMAN W. JENKINS. SUPT. OF BUILDING
JLOCALITY Temple City
FOR APPLICANT TO FILL IN
NEAREST T. Temple Blvd.
NUMBER FIXTURE OR ITEM EACH FEE
OWNER R. Klebba
• WATER CLOSET 11.25 -
BATH TUR 1.25 ADDRESS same
SHOWER 1.25 CITY TEL. NO.
LAVATORY 1,25 CONTRACTOR General Installation Co.
SINK 1,2 ADDRESS 6558 West Blvd.
DISHWASHER 1.25 CITY Los Angeles TEL.NO.• PL 3-2541
STATE LAUNDRY TUB 1.25 LICENSE NO. ('i-36 151839_ CLASS
CLOTHES WASHER 1.25 DISTRICT NO. GROUP ZONE PROCESSED BY
WATER HEATER 1.50 �®
}
GAS SYSTEM OUTLETS 1.50 INDUSTRIALWASTE APPROVAL o
OUTL R 5 PER SYSTEM .30 INSPECTION RECORD
ATSR SOFTEN
1 1 .50 Reaciv f r Inspection Now CD
r. W
fn
Z
APPROVALS DATE INSPECTOWS-SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL.FEE 3 .' 50 GAS PIPING
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ. THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE. LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF LASTEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DESCRIBED REST FIZRiny. UTILITY CO.NOTIFIED
SIGNATURE
�, ` 41 it
OF PERMITTEE FINAL J
VVALIDATION
JACK R.ALLEN
M.O. CASH SUPERVISING MECHANICAL ENG'R.
- r8 '1 5 ,� -F827 -5 D 3500
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