HomeMy Public PortalAbout5043 SULTANA AVE_Plumbing__ T°A°°° Y
oee n APPLICATION FOR PLUMBING PERMIT
�IVISION OF BUILDING AND SAFETY
DaPormunl of County Engineer
County of LOB Angeles ' BUILDING �y CC0
JOHN A LAMBIE. COUNTY ENGINEER ADDRESS y ✓ N U
CASSATT D GRIFFIN,SUP TOP BUILDING /
LOCALITY
FOR APPLICANT TO FILL IN "AR`ss Po f47-I nl d
OWNER N M, � r DISTRICT NO GROUP ZONE I READY FOR IMPPICTION
MAIL
ADDRESSIV A
n INDUSTRIAL
CITY C TEL NO WASTE APPROVAL
PLUMBER 1r `INSPECTION RECORD
ADDRESS Ii' Irl �fCe
C 1 �L
CITY TEL NO J
LICENSE NO /
NUMB" TMP[OP FIXTURK OR RIM PEI
WATER CLOSET (TOILET) $100 E
✓< BATH TUB $1 00 O
SHOWER s1 00
Y
LAVATORY (WASH BASIN) @ s100 C
KITCHEN SINK $100 b
DISHWASHER •1 00
I LAUNDRYTU13 OR TRAY 100 O
CLOTHES WASHER $t OD
/ WATER HEATER $1 DO ID
GAS SYSTEM 1100 / Od
APPROVALS
A..TppE INS CTOR q SIGNATURE
UNDER SLAB WORK p
PERMIT $ 1 00 ROUGH PLUMBING
GAS PIPING
TOTAL FEE LO 00 GAB VENT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 71
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING PLUMBING FIXTURES
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR OAS TEST
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 Y T L AL OWNER OF THE ABOVE UTILITYCO NOTIFIED
DESCRIBED RESIDENTIAL ROP
SIGNATURE
OF PERM ITTHE FINAL
JOHN A LAMBIE COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
O 'JT83613A JUL 1$3 3 10.00 in
c e, I't
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TeAeeT•CERSIT M/e] vww � , C l �
APPLICATION FOR • PLUMBING PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COlWW ENGINEER
��p D soNLDlxa
B1 IfAGLAFt"�I OUNTY Fn'ON xaaa�s Q
WILLIAM A JENSEN SUR T OF BUILDING
LOCALITY 4AJI, of
BY
FOR APPLICANT TO FILL INHEAREBIT CROSS ET
GRE
NUMBER FTRTURE OR ITEM EACH FEE OWI
WATER CLOSET iER
t 7a KAM
BATH TUB 115 ADDBESB
SHOWER 125 2.3
CRT TEL NO O H
LAVATORY 115 CONTRACTOR
BDR 115 ADDRESS
DISHWASidR 115 CRY CONTRACTOR 8STATE NO M7
LAUNDRY TOB 115 REGISTRATION NO , Q 3 STATE
COWTT
CLOTHES WAS}® 115 DIETRI�'f NO 0P 20NE PROCESSED BY
WATER HEATER 150
Y
-GAS SYSTEM( OUTLETS a
I50 A� OVAL O
OUTLETS OVER 5 PER SYSTEM 10 INSPECTION RECORD V
O[
O
d
N
Z
APPROVALS T IHSMC OR R[IGNAr
PERMIT f 2 OO UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE
GAS PIPING
I H[R[LY ACI(MOWLCOG[ THAT I NAV[ RGO THIS AfFLICATIOM GAS VENT
ANO RAT[ THAT THE A[OV[ I[ CORR[CT AND AOIM[ TO COMELY /�
wITH ALL couMTY oROINANCIs AND nAr[ uw[ R[GuuTIMG HOT WATER HEATER (,�'/
FLU MRINO
I H[RmT CERTIFY THAT I AM FROF[RLY R[G."ll 0 ANG/OR PLUMBING FIXTURES
LICCN"D A[ R[OUIR[O RY LOS ANG[L[[ COUNTY AND STAT[ OF GAS TEST
CALIFORNIA OR THAT 1 AM (Ne "GAL OWN[ OF NT[MO TO
"SIM IM TH[Aso p[[eR a R[RIu�TIA UTILITY CO NOTIFIED
SIGNATURE IP-I/V!1
OF PERMITTEE
FINAL Y
%ADATION ROBERT A WOOD I
cR M O CASH SUPERVISING MECHANICAL ENG R
LAC0 7 0 0 8;2 DEC 21 5 D 8.75-
IN
VrCOMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
I hyt•eby affirm um that I have o certificate o1 consent to self ZO 0026 DPW 8/87
insure or a certificate of Workers Compensation Insurance, 7SA887A
or Q_C dl�coop�Zof(Se 38DO�Lob C ) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS
PoIII(Ic m n laww'r p—
❑ Certified copy Is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADS '
Certified copy t L
WATER CLOSET filed with the county bmldi g Inspec OORE55
d
tion department NUMBER FIXTURE OR ITEM ®/ �' FEE LOCALITY
Date�ApphSa NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB l( CROSS ST
COMPENSATION INSURANCE OWNER MAIL
(This section need net be cornpfeted R the wSHOWER OWNork Imnsf!"d by
the permit M for am hundred dotter,($100)or leu) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is Issued, I shall not employ any person in any manner SINK , CITY TEL NO
so as to become subject to the Workers Compensation Laws DISHWASHER
CONTRACTOR
Date Applicant CLOTHES WASHER
AOOaE55
NOTICE TO APPLICANT If after making this Certificate of
Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR T�
Compensation provisions of the Labor Code you must forth CITY TEL NO�?�-Q(Q�
with comply with such provisions or this permit shat[ be LAWN SPRINKLER SYSTEM STATE
deemed revoked WATER HEATER n
LICENSE NO CLASS 3
LICENSED CONTRACTORS DECLARATION /T DISTRICT NO Br
I hereby off um that I am licensed under provisions of Chapter V GAS SYSTEM OUTLETS S' 0
0.
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code and my license is in full force and effect 5 PER SYSTEM FINAL VAL ON
DATE
p;
� 17,1
License Number 7 Llc Clan C 362 Z 8
FINl 3Q�Z BE
Y
O
Contractor Is s
L ;
❑ 1 am exempt under Sec
B 8P C for thin reason
Plan check fee a
, Dote PLUMBING PERMIT ISSUING FEE$ I �s
Signature
TOTAL FEE 0
Man check applicant1 ITEL+3
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name Ti1TA� .�'
I hereby off irm that I am exempt from the Contractor s LicenseAddress, C FE(K
Low for the following reason (Section 7031 5, Business and - .QQ
Professions Code) City Tel No
❑ 1, as owner of the property, will do the work and the j
structure Is not intended or offered for sale (Section
7064 Business and Professions Code) (•_I��!-f 1(1[11
CONSTRUCTION LENDING AGENCY
I hereby affirm that there in a construction lending agency for
the performance of the work for which this permit Is Issued
(Sec 3W7 Civ C )
Lender's Nome
Lenders Address
I certify that I have rood this application and state that the
above Information s correct I agree to comply with all County
ordinances,and State jaws regulating Plumbing and hereby
a=,Res
this County to enter upon the ,
ar inspection purposes
SEE REVERSE FOR EXPLANATORY LANGUAGE
Z
Date
DEC
TION
WORKERS'that
Ihave COMPENSATION cafe of corse APPLICATION FOR PLUMBING PERMIT
I hereby offrtm that I have a certificate of consent to self 7yb67q ainsure ora certificate of Workers Compensation Insurance CE 817(REV 10/81) ��
or a
AVL
c py thereof(Sec 3800 La ) COUNTY OF LOS ANGELES / / r BUILDING AND SAFETY
P❑ol�cyJnQo _Company
Certified copy is hereby furnished
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BDILDING I, ' d
,may y,isrtified copy is filed with the county budding aispec- ADDRESS s^'✓ ^�
tion department NUMBER FIXTURE OR ITEM FEE
LOCALITYI t.(
Dote AppliSant WATER CLOSET NEAREST
OLE CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST
COMPENSATION INSURANCE 511CIWER OWNER
(This median need not be completed R the work lisvol•ed by MAILI
the permit Is for one hundred dollars ($1100)or Ion) LAVATORY ADDRESS L�V
I certify that in the performance of the work for which this
permit is issued I shall not employ any person in any manner SINK CITYTEL NO
so as to become subject to the Workers Compensation Lows DISHWASHER iqTIg_ CaCONTRACTOR
Date Applicant CLOTHES WASHER W
NOTICE TO APPLICANT If after making this Certificate of ADDRESS
Exemption you should become subject to the Workers SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code you must forthCITY TEL
with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM
STATECL �a .l
LIC
deemed revoked WATER HEATER LICENSE NO CLASS f.i V
LICENSED CONTRACTORS DECLARATION DISTRICT NO PVaEssED BY
I hereby affirm that 1 am licensed under provimons of Chapter 9 / GAS SYSTEM OUTLETS
(commencing with Section 70DD) of Division 3 of the Business OUTLETS OVER s-,Or >
and Professions Code,and my license is in full force and effect 5 PER SYSTEM FINAL /1 _ b
r/ DATE Y' VALIDATION 0
License Number a�� /Y�Lic Class .)-0 ��
--1�. FINAL yr Q
Contractor ��8'� r(L Date •7��_7��f/:+1� B1' LA�s1� U
❑ I am exempt under Sec D G ,, 2
B 8P C for this reason
Plan check fee
Dote
PLUMBING PERMIT ISSUING FEE$ 111
Signature
TOTAL FEE 1f
SINGLE FAMILY Plan check applicant
HOME OWNER BUILDER DECLARATION Name
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 O 9 Z 5 Q
structure is not intended or offered for sale (Section , # e • • • • 5
7044, Business and Professions Code)
CONSTRUCTION LENDING AGENCY ;2 '.- 1650
1 hereby affirm that there is a construction lending agency for r
the performance of the work for which this permit is issued ' ' • 1 6 5 0 v
(Sec Som, Civ C ) 04.0 1 —8 3
Lender s Name
Lender's Address
I certify Flat I have read this application and state that the ►
above information m correct 1 agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
ve mentioned p o er for mapacban l re purpo es
!„ SEE REVERSE FOR EXPLANATORY LANGUAGE
Signaof Per dtee A _ ^ Dote (�
L—�Jril.�i
COUNTY OF LOS ANGELES TEMPLE CITY K 0508 PLUMBING PERMIT
•� DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0808140023
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 2B5-0488 EXT _
(LEGAL ID FEES PAID BUILDING ADDRESS
I ON FILE
5043
AV
I FEE DESCRIPTION QUANTITY Dom AMOUNT I TEN@ CA 9178 3046 `
(ASSESSOR INFORMATION NUMBER
NEAREST CROSS STREET ACACIA
5388-020-022 101 PERMIT ISSUANCE FEE 27 75 THOMAS PAGE 596 GRID H5 LOCALITY TEMPLE CITY Cl
TENANT 107 RATHTUBS/SHOWERS 1 00 FIX 16 20
TOTAL FEES 43 95 11SSUED ON PROCESSED BY PIAN BY EXPIRES ON
108/14/08 SR' 02/10/09
(OWNER TEL NO FINAL DA BY CODE
MR HSUL (626) 282-5117- EXPIRED
•N�+�N�/
15043 SULTANA AV
TEMP 917803046 (DESCRIPTION OF WORK 1
(CHANGE TUB TO FIBERGLASS UNIT
I
1APPLI CANT TEL NO 1
DENNIS R STONE (626) 282-5117-
1307 N SAN MARINO
CONDITIONS
(SAN GABRIEL CA 91775 I iSPECt A*.
CONTRACTOR
TEL NOAPPROVALS DATE INSPECTOR 9IGNA14RE
1SPEEDY STONE PLUMBING, INC (626) 282-5117- 1 ` I I
1307 N SAN MARINO AVE LIC NO UNDER SLAB WORK
ISAN GABRIEL CA 91775 285376BC26
(WATER SERVICE '
PLASTIC YIN METAL Y/N
ARCHITECT OR ENGINEER TEL NO
ROUGH PLUMBING
LIC NO
GAS PIPING 1
GAS VENT
HOT NATER HEATER `
(PLUMBING FIXTURES
1 I 1LAWN SPRINKLERS
GAS TEST
1UTILITY COMPANY NOTIFIED
I
I
I
I I
(GRAY WRITER SYSTEM
1 i i I
I I
I
1 I
(REPORT ID DPR263 ROUTE TO SS0508
COUNTY OF IAS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 IAS TUNAS I PL 0508 1203130004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT {
LEGAL ID FEES PAID BUILDING ADDRESS
ON FILE4 5043 SULTANA AV
I
FEE DESCRIPTION QUANTITY ODM AMOUNT 11 TEMP CA 917803046
ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET
5388-020-022 101 PERMIT ISSUANCE FEE 27 80 �� THOMAS PAGE 596 GRID HS LOCALITY TEMPLE CITY Cl
TENANT 163 WATER PIPING BR/PIX 13 00 FIX 88 40
TOTAL FEES 116 20 ISSOED ON PROCESSED BY PLAN BY
1 03/13/12 SR
TOWNER TEL NO iI IP NAL I)AV FINAL BY CODE
(HESS, DOUGLAS (626) 393-6352- 1 ��
15041 SULTANA AV
TEMP 917803046 JEJCSIRIPTION OF WORK
IPEX REPIPE 13 PLUMBING FIXTURES
I L
1AeeLICANT TEL No
1#1 STATE PLUMBING (818) 566-1390- I1
(SPECIAL C1ONDITIONS
Ij
CONTRACTOR TEL-ml (APPROVALS DATE INSPECTOR SIGNATURE
#1 STATE PLUMBING, INC _ (816) 566-9990- I
1607 W BURBANK BLVD LIC NO }I UNDER SLAB WICK
BURBANK, CA 91506 018631 C36 I I
SERVICE
PLASTIC Y/NMETAL Y/N
(ARCHITECT OR ENGINEER TEL NO (I i
R0�H PLUME ING __
LIC NO
GAS PIPING
I GAS VENT
HOTWATER HEATER
i I I I
_ ) • iPLUMBING FIXTURES
ILAWN SPRINKLERS I I I
I I
GAS,TEST
IVTILITY COMPANY NOTIFIBD
Cwy
GRAY WATER SYSTEM I I {
r I I I
I I I I
I REPORT ID DPR263 ROUTE TO BS0508 I I I