HomeMy Public PortalAbout5114 SERENO DR_Plumbing__ 6AG07 •CE#en O 61 r C
APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANG
DEPARTTME�T NT OFAff�7(COOXII {P�YTy�ENeN
BU
A C. G:OUNTY ENa1 it! ADD�HEpBB° / Ii D
SHOWER '
WILLIAM A JENSEN, BUTT OF BUILDING IALocumLocumqcwoum
FOR APPLICANT TO FILL IN se
FIXTURE OR ITaITEMCROSS ST 'jea
OWNm
WATER CLOSCT NAD.
BATH TOB ADDRW
CRT YEL NO.
LAVATORY CONTRACTOR J
amADDRZSS
DIBHWASM CITY TEL NO
LAUNDRY TOR RZ°IDTRATION NO
CLOTHES WASHY DISTRICT NO GROUP I ZONE BY
WATER HATER O I
INDUSTRIAL
GAS SYSTEM WASTE APPROVAL 09
uopz=R RRcoBD O
01A ri
d
PZ� d
r
' OR FA 9m s Ki
APPROVALS PAT9INs►SCTOR SSIONATUR[
PERMIT E 2 00 UNDER SLAB WORK
TOTAL FEE ROUGH PLUMBING G
GAS PIPING
1 HRRZBY ACKNOWLSDOS THAT I HAVS READ THIS LIGATION
AND STATE THAT TNS AROVS It CORRSCT AND AOSSR TO COYRT GAS VENT
WITH ALL COUNTY ORDINANCIR AND STATS LAWS MODUTINO
P W YRINO HOT WATER HEATER
1 NSRUY =RTIFY THAT I AN rADflALY ma1STSIS[o ANO/OR PLUMBING FIXTURES
LICENSED " RROUIRSD BY LOS ANDSLSS CO NTY AND RATE Of
CAGAB TEST
LIFORNIA OR THAT 1 t Or TNS ABCNT
D[�CRIR[u RESIDSNTUL UTILITY CO NOTIFIED
SIGNATURE
OF PER TTEIZ FINAL
VALIDATION///^^���ROBERT A WOOD
CR Y O SUPERVISING MECHANICAL ENO R `
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APPLICATION FOR PLUMBING PERMIT
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN(PRINT OR TYPE( BUILDING �„ /
T
NUMBER FIXTURE OR ITEM 9 FEE ADDRESS
WATER CLOSET LOCALITY
NEAREST
BATH TUB CROSS ST
SHOWER OWNER )
LAVATORY Wzl_L
ADDRESS -
SINK CITY - , TEL NO
DISHWASHER -369-0 CONTRACTOR li
CLOTHES WASHER ADDRESS
SWIMMING POOL RECEPTOR
CITY TEL NO
LAWN SPRINKLER SYSTEM STATE LIC
WATER HEATER LICENSE NO CLA55 NINE
pGUATSSYSTEEM OUTLETS APPROVALS DATE INSPECTOR S SIGNATURE
5 PER TS VER
UNDER SLAB WORK
ROUGH PLUMBING
GAS PIPING O
GAS VENT U
d
HOT WATER HEATER 1 F0
PLUMBING FIXTURES u
GAS TEST v1�1
Plan check fee UTILITY CO NOTIFIED Z
PLUMBING PERMIT ISSUING FEE E
TOTAL FEE 3 FINAL �7
Plan check applKant PLAN CHECK VALIDATION
Name
Address
City Tel No @ 3 0 d 8 A
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APhN:ATION AND STATE M E E • C
THAT THE ABOVE B CORRECT AND ACRE E TO COMPLY WITH ALL COUNTY ORDINANCES M J
AND STATE LAW'S REGUTAnNG PLUMBING PERMIT VALIDATION , Z s. 1300
I HEREBY CERTRY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS
REQUIRED In LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE
LEGAL OWNER Of AND WEND TO RE51DE IN THE ABOVE DESCRIBED RESIDENTIAL B A R ' 3006
PROPERTY
SIGNATURE 0302-79
OF PERMITTEE 1
NN I
DISTRICT NO D BY
o I
INDUSTRIAL
WASTE APPROVAL
,
f
OGo°;7 1055 APPLICATION FOR PLUMBING PERMIT 1
DIVISION OF BUILDING AND SAFETY
DepmTTneat of County EnglneeP
COYaty of Los Angel" BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADORE:SB
CASSATT O GRIFFIN,SUP TOP BUILDING
LouuTv
FOR APPLICANT TO FILL IN NEAREST
CROSS ST
OWNER DISTRICT NO GROUP ZONE RRAUY PoR INSPECTION
MAIL
ADDRESS
INDUSTRIAL
CITY EL NO WASTEAPPROVAL
PLUMBER INSPECTION RECORD
ADDRESS -�3
CITY AdzTEL NO
LICENSE NO
NUYBRR TYPE OP FIXTURE OR RRM PRR
WATER CLOSET (TOILET) @ et 00 S ry
BATH TUB @ $100 �^'E
i
SHOWER @ STOO
LAVATORY (WASH BASIN) Q $100
KITCHEN SINK @ tt100
DISHWASHER jl 00
LAUNDRY TUB OR TRAY til 00
CLOTHES WASHER v Do
WATER HEATER @ 11o0
GAS SYSTEM v DO
APPROVALS
ATH INSPECTOR S ME
TUBE
UNDER SLAB WORK S lq
PERMIT S 1 00 ROUGH PLUMBING iI
GAS PIPING
TOTAL FEE 1716GAS VENT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APP (CATION HOT WATER HEATER
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR LASTEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE UTILITY CO NOTIFIED
DESCRIBED RESIDENTIAL PROPERTY
SIGNATUREc
OF PERMITTER FINAL _G�L J ✓'�`�
JOHN A LAMBIE COUNTY ENGINEER VALIDATION_, ROBERT A WOOD CHIEF PLBG INCPHcToR
CR ■ • GEN
LAC05 wR 6 3 700 tD
DdW FSH 9� 2-.7 ., r APPLICATION FOR PERffiT
EPARTMENT OF BUILDING AND SAFETY ����®���
COUNTY OF LOS ANGELES
�
WN J. FOX,CHIEF ENGINEER F •
ROUGH NATURE FIII'fURO
HEATER COSPOOL I SEPTIC TANK _ ( �,�v ►IRST I�READY�FOR IOU DATE ISSUED
_ LLA 7/
APPLICANT
,� FILL IN'HEAVILY/OUTLINED PORTION/ONLY
NAME �Tyrvy1/ ISI` , n ✓ =..
ADDREYt A
=1 / �_ Jul ._fin ( .nrl LOCALITY r,�]^,.��, -•/1'Y1./[Q,�• /L/l.
EAREST
CM TEL No CROSS BY. �!�/�'-/�'�'l ll'd 9 /✓2✓`-�� y
Q[RT vXPIREB 1 I NAME �v YV1'L �'•� /(JG'i7 L GiY✓ ,
LOCATION OF SEPTIC TANS, OR CESSPOOL' I "AA.l. V 9
NORTH CM (Y�.d.GL LL'✓)t�V G TEL No
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOE
ANGELES COUNTY CERTIFICATE OF quALIFIcAT10N.
_ FLurFOt
I AM THE LEGAL OWNER O►THE PROPERTY DESCRIBED
ABOVE /
V j OWN"
CORRECTIONS
SOUTH
DESCRIPTION OF WORK
X ATH TUB -----FURNACE °
rc
MOWER ^IBHWASHER O
f v VATORY` RE►RIOERATOR
ITCHEN SINK ✓ WATER SOFTENER
R SINK n" DTRAP '
LOP SINK ^^R DRAIN
WASH TRAY URINAL APPROVALS
!WA CLOSET � ^RINKINa FOUNTAIN p DATE �Iw•Psa'mwY IurE
\t WATER HEATER DENTAL LAVATORY ROUGH PLUMBING
•,y mm,2�AB SODA FOUNTAIN a"PIPING
OLITL
GAS VENT
CESSPOOL
' TOTAL NUMBER OF FIXTUREB
SEPTIC TANK
CESSPOOL NEPTIC TANK SEWER
S UT1LM CO NOTIFIED
TOTAL FEE
TOTAL i D 0
'DRA IT ITEM IIIRB T•., APPLICATION FOR PERMIT
EPARTMENT OF BUILDING AND SAFM '
COUNTY OF LOS ANGELIC ��������
L WM J FOX.CHIMP ENGINEER
NATURE dTMRMZjffON---j 1319TRICTNO, PER
-1 (3110UP1 ZONE I RR
t •ROUON FIXTURES COMPLETE jRRA
`�
NEATER CESSPOOL S�TIC TAMK RECEN BY FOR DAT[ISSUED
RN
RAI
�! o-.t6-5�P
APPLICANT FILL IN HEAVILY OUTLINED POY
JOB ,
NAME ADDRESS
APR
LOCALITY iNGRECT• O CROSSETCOUNTYC[IR Ne0[PIREDZ�LOCATION OF SEPTIC TAN$ OR CESSPOOL 03MAILaADDRESSNORTH OCmTEL ND S
1 AM THE LEGAL POSBEDSOR OF THE AYOVE LOU
ANO�[e COUNTY CERTI PIGTE OF QUALIFICATION
- FI.WeQ
I AM THE LEGAL /�' �UECR
ABOVE Jr7J,'
I�toUD
owNa
CORRECTIONS
SOUTH J
DESCRIPTION OF WORK i
ATN TUB FURNACE 0�
MOWER ^ISHWASHER 0
VATORY REFRIGERATOR
ITCHEN SINK WATER SOFTENER
R SINK SANDTRAP
LOP SINK _JLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN _
DATE INN[CiOR O"UK
WATER NEATER ^ENTAL LAVATORY
ROUGH PLUYSING
6T[R.�SAS^ SS ��SODA FOUNTAIN OAS PIPING
OUTL
OAe VENT
CEBGPOOL / • 13 Y
TOTAL NUMBER OF FIXTURES SEPTIC TANK
CESSPOOL__-WrIC TANK BEW ER
E eO, UTILITY CO YO'►IFIED -�
TOTAL FEE •I
23M 6� APPLICATION FOR PERMIT
ENT OF BUnMING AND SAFET
COUNTY OF LOS ANGELES �`������
NAME OF O
WM J FOX.CHIEF ENOINfm
' yT L 01STRI NIL PERMIT .
-ROUGH FIXTURES COMPLETE 1 -� J e S-f
1 RECEIVED BY READY FOR DATE ISSUED
NEATER CESSPOOL SEPTIC TANK � FIRST INSPECTION _��
APPLICANT FILI. IN HEAVILY OUTLINED PORTION ONLY
Joe
y. NAM[ I ADDRESS
ADDRESS ✓lr LOCALTTY 2>7
CITY QJI �� Tp„4.77. u �f CRO"wr
COUNTY L - -fir ''ll
C[ NG QPIRES B` NAME K
LOCATION OF SEPTIC TANS, OR CESSPOOL �y MAI
NORTH 5 ADDNESY
CCw& NO
I AM THE L[OAL OF THC ASOYE LOS
ANG6fS COUNTY CERTIFICATE OF QUALIFICATION.
PWMELQ
1 AY TH6 LEGAL OWN O►TN[PROPERTY DRECROED
ABOVE.
OMNOI
CORRECTIONS
1
1
SOUTH' J
DESCRIPTION OF WORE i
ATH TUS FURNACE O
rc
HowER _ DIs11wwEH[R O
VATORY REFRIGERATOR
ITCHEN SINK WATZRSOFTQIER
00Ii SINK SAND TRAP
LOP SINK F DDR DRAIN
WASH TRAY URINAL 1 APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE IRE'S m•RASE
WATRi HEATER DENTAL LAVATORY ROUGH PLUMBING
AS 9DDA FOUNTAIN GAS PIPING
OUTL
OAS VENT .�1I
CESSPOOL
AL NUMBER OF FIXTURES SEPTIC TANK
ES9POO SIWTIC TANK SEWER
S UTILITY CO NOTIFIED
TOTAL FEE t lo/emIN
WORKERS'COMPFNSATION DECLARATION r•a0)A
1 hereby affirm chat I have a certificate of consent to teff CC 917 [a-•e) APPLICATION FOR PLUMBING PERMIT
Insure or a certificate of Workers'Compensation Insurance,or
e certified copy thereof(Sec goo, b C) COUNTY OF LOS ANGELES LES r �� BUILDING AND SAFETY
-Policy 702lo 1(01 o�mpenY I
Certified copy is hereby furnished FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING fi—/14j �,-�,Z(/t
Certified copy.n filed with ti£'b n b Idmg inspection NUMBER FIXTURE OR ITEM FEE ADDRESS Y Cy'C/"x+
( p LOCALITY 1...G C
Date Applicant WATER CLOSET NEAREST `
CERTIFICATE OF EXEMPTION FROM WOR S' BATH TUB CROSS ST
Ckin
COMPENSATION INSURANCE SHOWER OWNER r^lez,MAIL
��yO��
(Thu section need not be completed If the work Involved LAVATORY ADDREB it/ N r !TP_7�0
by the permit is for One hundred dollars ($100) or less) SINK CI TEL NO 0
1 certify that In the performance of the work for which this DISHWASHERC2� fl
permit u sxsued I shall not employ any person in any manner
CONTRALTO U�
so as to become subject to the Workers'Compensation Laws CLOTHES WASHERADDRES (.) O
Date Applicant SWIMMING POOL RECEPTOR
NOTICE TO APPLICANT If, after making this Certificate of CITY vfq/� TEL N 1 a
Exemption you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATEUj
Compensation provisions of the Labor Code, you must forth WATER HEATER LICENSE
NO 1,9&:>37CLASS _ Z
wah comply with such provisions or this permit shall be
deemed revokedOAS SYSTEM OUTLETS 3 DISTRICT yNO PRO ESSEaBV
LICENSED CONTRACTORS DECLARATION OUTLETS OVER Sr a
I hereby affirm that I am licensed under provisions of Chapter 6 P SYSTEM
9 (commencing with Section 7000)of Division 3 of the Blur yy FINAL y/
ness and Professions Code, and my license u In full force and 7 DATE �� CJ VALIDATION
effect
License umber c Class FINAL
BY
Contr U-y Ie X24-a' s-f77
I am exempt from the licensing requirements as I am a Plan Check fee
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting In my professional capacity (Section 7051, Bus
mese and Professions Code) TOTAL FEE (�
Llc or Reg No Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
1 hereby affirm that I am exempt from the Contractor's Address
License Lew for the following reason (Section-7031 5, Bull City Tel No
nese and Professions Code)
1, as owner of the property, em exclusively contracting
with licensed contractors to construct the project 9 0 0 7 9 A
(Section 7044, Busmess and Professions Code)
g . . . . . 5
CONSTRUCTION LENDING AGENCY '
I hereby affirm that there u a construction lending agency 2 • • 1 600
for the performance Ar the worto/ h¢h this permit u
issued(Sec 3097,C v • - 1 6 0 0 5
Lender's Name
Lender's Address
01624 -81
I certify that I have reed this application and Rate that the
above far imetl n u co ect I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances a uta ws regulating Plumbing, and hereby
authorize re ase ten a of this County to enter upon the
above-men n arty for Inspection perp s
Signature of Permittee QDate
COUNTY OF LOS ANGELES TEMPLE CITY Al 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9805190041
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE (818) 285-0488 EXT
LEGAL ID FEES PAID BUILDINU AUUKt:55
ON FILE 5114 SERENO DR
FEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917803039
ASSESSOR INFOR TION NUMBER NEAREST CROSSiSTREET SULTANA
5388-011-036 01 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1 00 SYS 16 35
TOTAL FEES 44 10 ISSUED ON PROCESSED BY PLAN BY EXPIRES ON
05/20/98 VG 05/20/99
OWNER. --Tn—.Tu--- FINAL DATE BY
SOENDJDJO FERRY R;MELANI P (818) 3D9-1287- % n �- CODE:
5114 SERENO DR i (i ov
TEMP 917803039 DEb6RIPTI3NOF WORK
RUN LINE TO HEATER
APPLICANT TEL NO
TOQ(Y'S REFRIGERATION (562) 906-4411-
SPECIAL CONDITIONS
CONTRACTOR TEL NO5 PNGELES Ojj
APPROVALS DATE INSPECTOR SIGNATURE
TOMMY'S REFRIGERATION (562) 906-4411- �.�
10655 INEZ ST LIC NO LINDER SLAB WORK
WHITTIER CA 90605 523477 / WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL NO
- RUU6H PLUMBING
LIC NO 111111
GAS PIPING
� PM o UCS WO[RMS HOT WATER HEATER
O 0
o GAS TEST
G �� �e
`b,1c Ser ice Tha 0
CWV
GRAY WATER SYSTEM
REPORT ID DPR263 ROUTE TO BS0508