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Home My Public Portal About5029 SERENO DR_Plumbing__ TeAeeT-1L'0111I7 Io-az 509 APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER Jo%DN QGL� SAFETY IFIVLSION N AIDDRESS 5129 Sereno Dr. JO N A M IE COUNTY NaINEER WILLIAM A JENSEN SLIP T OF BUILDING LOCALITY Temple Qtv FOR APPLICANT TO FILL IN CROSS NUMBER FIXTURE OR ITEM EACH FEE WATER closer $12.5 OWNER Harry Vernon Lee Smihh MAIL BATH TOB 175 ADDRESS Same SHOWER 125 CITY TEL NO LAVATORY 175 coNTBACTOa SINK 125 I'll g Blvd. DISHWASHER 175 CITY South Gaty TEL NO SP 32210 LAUNDRY TUB 175 3 STATE REGMTRATION NO 190179 C-53 COUNTY CLOTHES WASHER 1.75 DCT-NQ%, OU Z N ► BY WATER HEATER 150 ♦ 00�/ ISO INDUSTRIAL CAS SYSTEM OUTLETS WASTE APPROVAL OUTLETS OVER S PER 8Y87@4 90 INSPECTION RECORD {J Y C W 6 N Z T APPROVALS DATJZ INSifTdRESIONATUIK PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING 1 NEMBYSTATE THAT TH ABODGE THAT I HAVE READ TNI• LCOMPLY GAS VENT ICATION AND FALL THAT TH[ ROINA I[ LAND S ANO AGF[[ TO COMPLY WITH ALL COUNTY OFOINANC[[ AND STATE LAW[ F[OULATIMp PLuwelXa HOT WATER HEATER I H[RKSY CERTIFY THAT I AM PITOMPILY RKGISTIKWD AND/OF PLUMBING FIXTURES LICENSED AS REQUIRED BY LO[ ANpeLU COUNTY AND [TATE OF GAS TEST GLI FOFNIA OR THAT 1 AM a L[DAL OWNER F D INTKHD TO ..mIN THE ABOVE Ie.O R[e1DENTIA PTY UTILITY CO NOTIFIED SIGNATURE OF PERMITT NAL Z ATION ROBERT A WOOD &7m- D CASH SUPERVISING MECHANICAL ENG R _ LAGO 0 7 4 6 t^o S&26 5 D 4.00- o TSw SST CE#817 E ea TEMPLE CHTY APPLICATION FOR- PLUMBING PERMIT COUNTY OF LOS ANGEUES DU[A�R�pT T OF COUNTY M3IIN0� a 74;0.2 JOTIN A LA E OL. UNTY NGINEER WILLIAM A JENSEN SUP T OF BUILDING FOR APPLICANT TO FELL IN E- q NUMBER FIXTURE OR ITEM EACH FEE D 1.17 WATER CLOSE[ 8I95 BATH TITS 125 DaPSS 'R E'/Y SHOWER 1 25 CT[Y C.n TEL NO LAVATORY 195 CONTRACTOR SINK 195 ADDRESS DISHWASHER 195 CITY TEL NO ATE uoeroaY TUB 125 ATE CONTRACTOR N CLOTHES WASHER 195 DISTRICT N I O OUP Z N¢ P [SSEO BY WATER HEATER 150 / OAS SYSTEM OUTLETS 1 50 URDUSTRIAL WASTE APPROVAL OUTLETS OVER s PER SYSTEM m II PECn 1 RECORD 0 C W d N APPROVALS DATE INSPECTOR E SIGNATURE PERMIT s 2 ]TO UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HERESY wcRNowL[OOL rNAr 1 HAVE READ THIS ARuu AND RAT[ THAT THE AOOv[ I• CORMCT AND AGREE TO COGAS VENT WITH ALL COUNTY ORDINANCES AND STATE L Wll RCGUL PLUMSING HOT WATER HEATER I MEMNY C`WIFY THAT I AM PROPERLY REGISTERED ANPLUMBING FIXTURES LICENSm AS REQUIRED NY LOS ANGELES COUNTY AND STATGAS TEST _ CALIFORNIA OR THAT 1 AM THR LEWL OWNER OF AND IHYIN RESIDE IN THE ASOv[DKSCRISSO RERID[HTIAL PNOPE UTILITY CO NOTIFIED SIGNATURE OF PERM ITTE! FINAL V VALIDATION ROBERT'A WOOD CK M o cAEN SUPERVISING MECHANICAL ENG R LAGp 1 -974t2 OCT 17 5 D 350- Q / 76A667 CU17 12159 TEMPLE CITY APPLICATION FOR PLUMBING PERMIT UNTY ELES D ]C��N OF Cj{O[J'NjlyY Him `e ]STATE UILDING NIEOERN ADDRDRESS A l /C EllyWILLIAM A JENSEN SUP T OF BUILDING LOCALITY tyFOR APPLICANT TO FDS IN • yCROSS er C.a/NUMBER PIXTURB OR ITEM OWN®WATER CLOSES MTB TBD ADDRESSRATH 7UCITE eN / CTEL NOER LAVATORY COXTBACiOBHQ� ADDRESS DUIHWASHER crrr Ti . NO CONTRACTORS LAUNDRY TUB REGISTRATION x0. CLOTHES WARNER DISTRICTNO GROUP ZONE PjpqESSED BY WATER HUM GAD Snmm INDUSTRIAL WA37E APPROVAL nISeecTION RECORD 6/70 6 ( UAX— a( �fp ° T,-; txf- lire 0 Lv9PETP A)or11ccEP7A3LG ! . AfS 7 0.i/ '� �/ //U 0 �_[ �� CIOE Ci APPROVALS DATE INSPECTO 3 SIGNATURE PERMIT S E 00 UNDER BLAB WORK TOTAL FEE ROUGH PLUMBING GAS PIPING 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ TRIS APPLICATION GAS VENT AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY KPLUMBING ITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATIRO HOT WATER HEATER I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR PLUMBING FIXTURES LICEN BED AS REQUIRED BY LOB ANGELES COUNTY AND MATE OF GAS TEST CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ARM DESCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED n i SIGNATURE OF PERMITTER FINAL Of VALIDATION ROBERT A WOOD / CB / N 0 C,W SUPERVISING MECHANICAL ENG R l\�'fLj�o 6 8 8 2 I lAy 11 5 D 400 D • 17 "M Em fl I APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY COUNTY OF LOS ANGELES P`u��'�� Wm .1 FOX. CHIEF ENGINEOI rH7ffAY=' T INSTALLATION— PERMIT . S �'7 ) a CESSPOOL OTIC TANK READY FOR DATE 98MIM ° � PIR[T INYPx=ONAPPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY AooRSEE[ LOCALITYNEAREST •` TEL1CROLD ET EXPIRES t NAM[OF SEPTIC TANS, OR CESSPOOL, MAn. ADDRESS NORTH O CT1Y TEL No I AM THE LEGAL POSSESSOR OF TH[ ABOVE LOS ANGELES COUNTT CERTIFICATE OF QUAL PICATION PLY 1 AM THE LEGAL OWNER OF THE PROP' DESCRIItm ABOVE OIYMDI CORRECTIONS BOUTx DESCRIPTION OF WORK LH TUE rURNACK O BIi ^IBHWASXOI TOItY �UPRIGERATOR EN BINK ,WATIMI SOPTEH01 ' RBINK ��D TRAP BINK DRAINO TRAY URINAL APPROVALSCLOSET ^RINKINGFOUNTAIN DA,EII�PECIOR'E KueJI R NEATER DENTAL LAVATORY ROUGH PLUMBING RBAB BODA FOUNTAINGAB PIPING OUTLa"VONTcESEPOGLLNUMBEROPPIXTURES SEPTIC TANK POO, Z EPTIC TANK / VLJ BEwER E UTILITY CO NOTIFIED TOTAL FEE PIN -,R R� OB 17 asm� 1s w APPLICATION FOR PERMIT r DEPARTMENT OF RUELDING AND SAFETY COUNTY �N� PLUMBING T NATURE OF INSTALLAT[ONP ROUGH FIXTURESCOMPLETE HEATER CESSPOOL SEPTIC TANK RECETV=W READY FOR DAT[MBUM FIRST INSPECTION A� p O CYC GA e I� i APPLICANT FILL. INHEAVILY OUTLINED QPO�{RTION ONLY Q NAY[ 1 ..TEES ✓ '�/ e/1'�h D • ADDRESS LOCALITY a jm NEAREST B CTEL No CROSS ST COUNTY R CERT No EKPIRES NAM[ LOCATION OF SEPTIC TANS, OR CESSPOOL = MAR 3ADDRESS NORTH O em 1414411-� TEL No I AM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION pwm I AM THE LG EAL OWN PROFoITr ISED wsovs. � owlet CORRECTIONS SOUTH DESCRIPTION OF WORK LTCO)TAAL TUB FURNACEER DIexwwaHEw TORY REFRIGERATORNEN SINK WAYER SOFTOT01R SINK SA DTRAP .00 SINK ^^R DRAIN TRAY •URINAL iAPPROVALSR CLOSET DRINKIMGFOUMTAIN DATE ER HEAT01 DENTAL LAVATORY �1//�1�� ROVGX PLUYSING kaR.7_GAS �^DA FOUNTAIN OAS PIPINGOUTL GAS VENT CESSPOOL L NUMBER OF FUTURES SEPTIC TANK P001 ftEPi1GTANK /� EWER S y � UTILm CO NOTIFIED - FINAL s .! •/ B - ','WORKERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PE1 41T ecutl0priby off rm that I hpv*a certificate of consent to self 7~A rnsure or a certif.wte'of Workers Compensation Insurance, CE 817(REV 10/81) or a certified copy thereof(Sec 3800, Lob C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Cemfied copy is hereby furnished ❑ FOR APPLICANT TO FILL W(PRINT OR TYPE) BUILDING Certified copy fled with the county building inspec ADDRESS tion ds tion department NUMBER FIXTURE OR ITEM ® FEE LOCALITY Dale Appli4ant WATER CLOSET T NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB Q D CROSS ST COMPENSATION INSURANCE SHOWER OWNER (This section need not he completed If the work Invohvd by I A the permit Is for one hundred dollars($100)or less ) LAVATORY O(' ADDRESS 1 certify that in the performance of the work for which the permit is issued, I shall not employ any person in any manner SINK CITY lEL No so as to become sublect to the Workers'Compensation Laws DISHWASHER ' CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption you should become subject to the Workers Compensation provisions of the Labor Code you must forth- CITY TEL NO with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRI L(J y SSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS U (commenting with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and m license s in full force and effect 5 PER SYSTEM 0 r FINAL VALIDAT O DATE V License Number Uc Class00 FINAt7 FOF Contractor Dote BY U d I am exempt under Sec yt B 8P C for this reason - Z Plan check fee0111. Dale PLUMBING PERMIT ISSUING FEE$ # I • ��7 8 Signature TOTAL FEE ( 2 $ Plan check applicant • 812 G J pp Ft SINGLE FAMILY p 1. 14—, 8 5 HOME OWNER BUILDER DECLARATIONName I hereby affirm that I am exempt from the Contractor s License Address 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 sole (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 I have read this application and state that the ► above mfomtation is correct I agree to comply with all County ordinances and Stale jaws regulating Plumbing and hereby authorize representatives of this County to enter upon the above phoned property or inspection purposes , s �A SEE REVERSE FOR EXPLANATORY LANGUAGE Date