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Home My Public Portal About5019 SANTA ANITA AVE_Plumbing__ JRKERS' ffirm.ha COMPENSATION DECLARATION APPLICATION F®® Pj UMBIN PERMIT / 120-0026 DPW 4/87 �'1 9� l� ® h7 R [� f}irm.ihat Ihave a,certificate of consent to self in- 76A667A ,LJI ✓} �.certificate of Workers'Compensation Insurance,or a .CE 817(REV. 8/86) certified copy thereof(Sec. 3800, Lab. C.) I Policy No. Company COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS � E• Certified copy is hereby furnished. , FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 4 Certified copy is filed with the county building inspection ADDRESS `d/ department.- NUMBER FIXTURE OR ITEM @ FEE _ LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST C/ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB /, CROSS ST. � N COMPENSATION INSURANCE SHOWER OWNER J 7, (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) - LAVATORY ADDRESS Q1 I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person in any manner so SINK CITY lip /� TEL. NO. as to become subject to the Workers'Co pensation Laws. DISHWASHER C• � Pr ` CONTRACTOR Date ^ r Applicant of ECLOTHES WASHER ADDRESS rtif9 NOTICE TO APPLICANT: If, after making this Ceicate x- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITYTEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROC ED BY I hereby affirm that I:am licensed under provisions of-Chapter GAS SYSTEM OUTLETS V d s 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER •' CJ fed Professions Code; and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION a DATE 3 O License Number Lic. Class V FINAL Contractor Date BY O 0 I am exempt under Sec. W B.$P.C. for this reason Val Plan check fee � ; � Date: PLUMBING PERMIT ISSUING FEE$ Signature �� • TOTAL FEE SINGLE FAMILY 0 4 5 3 A HOME OWNER-BUILDER DECLARATION Plan check applicant S # 0 0 0,0 0 5 I hereby affirm that I am exempt from the Contractor's License Name1 0 0 3 4 5 0 Law for the following reason (Section 7031.5, Business'and :0%o o 3.4,5 0 25 Prof sions Code): Address as owner of the property, will do the work and the I Cityifi cec Tel. No. 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.). t. Lender's Name Lender's Address , I certify that Ihave. 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-me tionedpro rty for inspectionpurposes. I O_/i_t SEE REVERSE FOR EXPLANATORY LANGUAGE Signa ure of Permittee Date 76A667 f7 B"BO APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY ; COUNTY OF LOS ANGELES . PLUMBING 1 WILLIAM J. FOX. CHIEF ENGINEER FORAPPLICANTTO FILL IN DIsTIRs!qxNO. GROUP �PERMITNO. PLUMBER �✓ - ( �� RECE2E. Y READY FOR DATE ISSU D FIRST INSPECTION ADDRESS �/f f( eM I�.ry CITY /e ADDRESS�!� TEL. NO �`Q �S BUILDING s` ® / �° C7 I �T7 COUNTY t 4F LICENSE NO. �'L v EXPIRES '* D LOCALITY Z' NEAREST PERMIT FEES ` CROST. NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER s MAILWATER CLOSET (TOILET) @ .0.50 $ ef7 ADDRESS BATH TUB @ 0.50 6 0 CITY TEL. NO. SHOWER @ 0.50 I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 0 LAVATORY (WASH BASINV @ 0.50 w APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND I KITCHEN SINK @ 0.50 STATE LAWS REGULATING PLUMBING. I 1 CERTIFY' THAT I POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 `� ANGELES COUNTY LICENSE. OR I AM THE LEGAL OWNER GAS SYSTEM OUTLETS @ 0.50 ^ OF THE RESIDENTIAL PRO ERT DESC IBED ABOVE. SIGNATURE OF f WATER HEATER (� 0.50 �w PERMITTEE SLOP.SINK . @ 0.30 INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.5.0 DISHWASHER @ 0.so DRINKING FOUNTAIN @,0.50 �'W 9 `/p— g!2vQ1 URINAL - @ 0.50 /t/&v lo!*Acm „I HOUSESEWER @ 0.50 a Z MISCELLANEOUS ' a 0 APPROVALS DATE INSPECTOR'S NAME r ROUGH PLUMBING GAS PIPING GAS.VENT CESSPOOL @ 1.00 CESSPOOL , SEPTIC TANK: SEPTIC TANK. DRAIN ( ) PIT ( ) @ 1.001 SEWER PERMIT 1.00 GAS TEST �. . UTILITY CO. NOTIFIED rSr� TOTAL FEE FINAL • r 76A867-CE*817 4-64 / APPLICATION FOR PLUMBING PER T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER �/� BjRl G AND SAFETY DMSION �D�ss JOHN A. LAMBIE. COUNTY ENGINEER WILLIAM A.JENSEN,SUP'T OF BUILDING LOCALITY 71 FOR APPLICANT TO FILL IN NEARESder v CROSR sT . e' 1 NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 31.25 MAIL BATH TUR 1.25 ADDRESS SHOWER - CITY TEL. LAVATORY OJ 1.a5 CONTRACT $INK 1.25 ADDRESS DISHWASHER 1.25 CITY TEL.NO LAUNDRY TUB 1.a5 REGffil�'RATI H NO. COUATE NTY CLOTHES WASHER 1.25 DISTRICT Nq� G O B WATER HEATER 1.50 0 fv")vX GAJ . r 1 V GAS SYSTEM OUTLETS 1'50 INDUSTRIAL STE AAPPROVAL O ---fOUTLETS OVER 5 PER SYSTEM .30 INSPECTION RECORD V OC ri W H Z APPROVALS DATE INSPECTOR'S SIGNATURE PERMIT N 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION: GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY L COUNTY ORDINANCES AND STATE LAWS REGULATING HOT WATER HEATER .Y CERTIFY THAT 1 AM PROPERLY REGISTERED' AND/OR PLUMBING FIXTURES AS REQUIRED BY LOS ANGE COUNTY AND STATE OF GAS TEST A OR THAT 1 AMT LEG OWNER OF,AND INTEND TO THE ABOVE DESC ED IDENTIALP GP UTILITY CONOTIFIED REMITTEE FINAL S I/ VALIDATION ROBERT, .WOOD CK. M.o. cnsH SUPERVISING MECHANICAL ENG'R ..t►�.� 3 1 6,I :'U(,' 4 5 D �3.5 0 I ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1012220004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: [LEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 13363 IT: 17 [ [ 5019 SANTA ANITA AV [ IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ TEMP CA 917803618 [ [ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18574-009-018 101 PERMIT ISSUANCE FEE 27.80 [ THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY, Cl I 107 BATHTUBS/SHOWERS 1.00 FIX 16.30 ITENANT: 21 HOSE BIBB(S) 1.00 FIX 16.30 IISSUED ON: PROCESSED BY: PLAN BY: 1 125 LAVATORIES/SINKS 1.00 FIX 16.30 112/22/10 SR 145 WATER CLOSET/URINAL 1.00 FIX 16.30 1 1 IOWNER: TEL. NO: I TOTAL FEES 93.00 [FIN DATE FIN Y: CODE: 1 IYU, ELVIS (626) 945-7818— I I [ 15019 SANTA ANITA AV 1 I I ITEMP 917803618 I IDEStRIPTIO100F WORK 1 I 1 IPLUMBING FOR NEW BATHROOOM 1 [APPLICANT: TEL. NO: IALVAREZ, JOSEPH (323) 273-8896— 1 1 I I ISPECIAL CONDITIONS: 1 I 1 ICONTRACTOR: TEL. NO: 1 [APPROVALS DATE INSPECTOR SIGNATURE 1 ILIN, DAVID (626) 926-4876— 1 1 I 15917 PMB 372 LIC. NO I [UNDER SLAB WORK y� [TEMPLE CITY, CA 91780 NONE I 1 0— 1 IWATER SERVICE I [ I 1 IPLASTIC YIN METAL YIN 1 [ARCHITECT OR ENGINEER: TEL. NO: 1 I I I IALVAREZ, JOSEPH (323) 273-8896— 1 [ROUGH PLUMBING 1628 N. 21ST ST. LIC. NO. 1 I 1 �I MONTEBELLO, CA 90640 NONE 1 IGAS PIPING 1 IGAS VENT I [HOT WATER HEATER I 1 1 I IPLUMBING FIXTURES I I I I I [LAWN SPRINKLERS 1 1 I I I IGAS TEST I 1 1 1 (UTILITY COMPANY NOTIFIED[ 1 1 I I ICWV I I I I I ,+ a ' • IGRAY WATER SYSTEM I I I I I I I I I I I I I I I 1 I I I I 1 I I 1 1 IREPORT ID: DPR263 ROUTE TO: BS0508 I I I 1