HomeMy Public PortalAbout5003 RYLAND AVE_Plumbing__ 76AGW7 17 11-49 - :,. APPLICATION FOR PERMIT
DEPAaTMlfNT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER
D R C O. G O P ZOPERMIT NO
FpOR APPLICANT TO FILL IN 00 ?F-1 '
of
PLUMBERJy( • // ¢ ,(SIR RECEIVED BY READY FOR DATE ISSUED
A
//��//�� FIRST INSPECTION
DDREBS:90-
�,�,, BUILDING
CITY Q� �/�i TEL.NR7 ADDRESS ®d �c(J
m-d6
COUNTY NLOCALITY �t
LICENSE O. 0 EXPIRES & U—
NEAREST.
PERMIT FEES CROSS ST.
NUMBER -TYPE OF FIXTURE OR ITEM FEE OWNER
11 WATER CLOSET(TOILET) 0.50 $ ADDRESS 07 !
d BATH TUB @ 0.50 CIT_YGol2bof-/ j TEL. No.
SHOWER @ 0.50- 1 HEREBY ACKNOWLE E THAT 1 HAVE READ THIS
LAVATORY (WASH BASIN) @ 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
1 KITCHEN SINK @ 0.50 AND STATE LAWS REGULATING PLUMBING.
® 1- CERTIFY THAT I POSSESS THE ABOVE VALID LOS
LAUNDRY TUB OR TRAY @ 0.50 ANGELESBOUNTY LICENSE, OR I AM THE LEGAL OWNER
OF THE RESIDENTIAL P OPE Y EBC BED OVE.
._ GAS SYSTEMOUTLETS 0:50
/ SIGNATURE OF� .4-.
WATER HEATER @ 0.50 PERMITTEE
SLOP SINK @ 0.50 INSPECTION RECORD
FLOOR SINK O.50I
FLOOR DRAIN @ 0.50
DISHWASHER @ O.'50I
DRINKING FOUNTAIN @ 0.50
URINAL @ 0.50, J
Q
HOUSE SEWER @ 0.50 Z
MISCELLANEOUS [7
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
GAS PIPING I
//
�1JnivA_Yl a'
GAS VENT
f
CESSPOOL @ 1.00' CESSPOOL
SEPTIC TANK: SEPTIC TANK
DRAIN ( ) PIT ( ) @ 1.111131 SEWER
PERMIT I 1.00' GAS-TEST
UTILITY CO.NOTIFIED
TOTAL FEE Gf �� FINAL
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERM '
I hereby affirm that I have a certificate of consNnt to scat 76A6E7A' t
insure, or a certificate of Workers'Compensation Insurance, CE 817(REV. 10/81)
or a certified copy thereof(Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES y BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. 'ADDRESS Q0(BUILDING -/� !'A A�1V` AVE.VE.
!
❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE)
Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM @. FEE �
tion department. LOCALITY •rt'ENtP LC— CITY
� WATER CLOSET nn
Date Applicant NEAREST
CROSS ST. ® S T1
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB
COMPENSATION INSURANCE OWNER O LORE
I (This section need not be completed if the work involved by SHOWER p g
MAIL — S
the permit is for one hundred dollars.($100)or less.) LAVATORY ADDRESS 65 ,0_3 S AN v l^"
I certify that in the performance of the work for which this ! .�
SS ( ,
' permit is issued, I shall not employ any person iri any manner ��PL� `t TEL.NO. '�, 7 e
SINK CITY` i{vZ�
so as to-become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
yp� (�Mr4� �L6t2 $pplicant CLOTHES WASHER ADDRESS ,
NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR
Exemption, you should become subject to the Workers' CITY TEL. NO.
Compensation provisions of the Labor Code., you must forth- LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATER LICENSE.NO. CLASS
LICENSED CONTRACTORS DECLARATION Z DISTRICT NO. P ESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ,.�
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER — O�
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION 0
DATE
License Number Lic. Class
FINAL. 0
Contractor Date BY uJ
I am exempt under Seca y
B.BP.C. for this reason p
Plan check fee � w •"";+�';�,, .*-•�
Date: PLUMBING PERMIT ISSUING FEE$ An PP
Signature t+
TOTAL FEE ' 4
n
i Plan check applicant
SINGLE FAMILY �.✓ y �
HOME OWNER-BUILDER DECLARATION j Name �����•✓✓✓✓ C 1 7. 1 A
I hereby affirm that I am exempt from the Contractor's License Address o o c
Law for the.following reason (Section 7031.5, Business and
Professions Code): City Tel. No. '
❑ I, 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).
CONSTRUCTION LENDING AGENCY r �• -' _ �'
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 )
i
Lender's Address
;1 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
above-mentioned•property for inspection purposes.
,�,�n'' SEE REVERSE FOR EXPLANATORY LANGUAGE f
Signature of Perini Date !
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0310210007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL
TR: LT: 20 FES PA BUILDING S:
5003 RYLAND AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804039
ASS5SSOR OR B R: NEAREST CROSS STREET: LA ROSA
8585-010-016 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: 84 LOCALITY: TEMPLE CITY
13 DISHWASHERS) 1.00 FIX 16.20
TEN-ANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED 0 PRO S D : PLAN EXPIRES
TOTAL FEES 60.15 10/21/03 JK 04/18/04 .
OWNER: TE 0: FINAL BY: CODE:
MURO PETER;SHERI (626) 579-6628-
5003 RYLAND AV
Fr-
TEMP 917804039 MDF'SgrRTPMTI'O 0ORK
PLUMBING FOR KITCHEN REMODEL
APPLICANT: p:
SAME AS OWNER -
SPECIAL CONDITIONS:
CONTRACTOR: TE 0: �f' / S ' V Zl� '�
,,,,��++ /� ���.`� APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER - o�f.4 y ►r
LIC. NO j rr✓';.� °' �`. UNDER SLAB WORK
WATER SERVICE
ARCHITECT 0 ENGINEER: p; t�' "-i, �rj_- �', \ , PLASTIC Y/N METAL Y/N
- /I '_-� ROUGHP B I G
LIC. N0:" ,---
GAS PIPING
�i - —---------- -- - - -- ---- -- --I�
GAS VENT
HOT WATER R
- -- -- -- - - --- ----- PLUMBING FIXTURS
LAN SPRINKLERS
GAS TEST
��, A
UTILITY PNOTIFIED
CW
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508