HomeMy Public PortalAbout5826 SULTANA AVE_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 NG-PERM-IT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS P"508-9903P0019
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES PAI LLD. G DDR S!n
TR: 5905 LT: 103 5826-SUL-T-ANA--AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801838
ASSESSOR INFORMATION NUM ER: NEAREST CROSS STREET: LAS TUNAS DR.
5387-015-019 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20
TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN EXP ES ON:
03/31/99 UT 03/31/ 0
• OWNER: TEL. NO: FINAL DATE FINAL BY CODE:
WONG SHEK F;KAM M (626) 286-6019-
5826 SULTANA AV 0-16-15 917801838 bES—CRIPTION OF WORK
GAS LINE FOR NEW HVAC SYSTEM
APPLICANT: EL.
ALAN LEE SERVICE (626) 369-2546-
1672 CLAY HILL AVE. SPECIAL CONDITIONS:
HAC. HGTS., CA
IES C®
CONTRACTOR: TEL. NO: �5 ��/'. APPROVALS DATE INSPECTOR SIGNATURE
ALAN LEE SERVICE (818) 369-2546- V y
1672 CLAY HILL AVENUE LIC. NO UNDER SLAB WORK
HACIENDA HEIGHTS, CA 91745 635793/C20
WATER
/i PLASTIC EY/NCEMETAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
ROUGH PLUMBING
LIC. N0� lllllll
5 PIPING
GAS E
�)U L) LC ����Fro--RKS HOT WATER-HEATER
5 oFEUMBING FIXTURES
QQ Inl`• AWN SPRINKLE—RS
Z7
El 4p
S TEST0 -1
UTILITY C P N OT I F I D
LJ �
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c Service'fha
GRAY WATER SYSTEM
REPORT ID: DPR263 ROUTE TO: BS0508
1
76AG67 (C6-817) - 1/75
• APPLICATION FOR PLUMBING PERMIT
•1e. COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER '
BUILDING AND SAFETY DIVISION BUILDING
MAKE CHECKS PAYABLE TO: ADDRESS S SUS
HARVEY T. BRANDT, COUNTY ENGINEER
LocALIrY 7`7r P6/�
FOR APPLICANT TO FILL IN (PRINT OR TYPE) [NEAREST
CROSS ST. A#N TUN19S
NUMBER FIXTURE OR ITEM @ FEE OWNER
WATER CLOSET 2.00
MAIL
BATH TUB 2.00 ADDRESS 3 (7
SHOWER 2.00 CITY eomojiwiq TEL. NO.a 13 7-
LAVATORY 2.00 CONTRACTOR MQR O Li "ej d2cm#N
SINK 2.00 ADDRESS S-Z)Q V4 �„j7XO
DISHWASHER 2.00 CITYSC)Ur6 /v r�b� TEL. No-77,;;P-3/is
CLOTHES WASHER 2.00 STATELIC
LIG ENSENO.JJ915F-laS CLASS SC 20
SWIMMING POOL RECEPTOR 2.00 DISTRICT NO.GRO ZONE ROCES$ED BY
LAWN SPRINKLER SYSTEM 2.00 •� .��
WATER HEATER 2.00 INDUSTRIAL
WA TE APPROVAL
GAS SYSTEM OUTLETS 2.00C
I INSPECTION RECORD
OUTLETS OVER ,30 v
5 PER SYSTEM I'1_7G 5n / /-"!. 0 rVA` x
r, Pr ¢G U j 3 0 0 W
CL
N
I �
Plan check fee See Reverse
PLUMBING PERMIT ISSUING FEE $
TOTAL FEE
APPROVALS DATE INSPECTOR'S SIGNATURE
Plan check applicant UNDER SLAB WORK
Name ROUGH PLUMBING
Address GAS PIPING
City Tel. NO. GAS VENT
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION HOT WATER HEATER
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST
PLUMBING.
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED
LICEN SEDAS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM E LEGAL OWNER OF, AIM FNTEND TO
RESIDE IN THE ABOVE DES I ED RESIDENTIA60A0 PERTY. FINAL Y-13-Ad
r�
SIGNATU RE
OF PERMITTEE
PERMIT VALIDATION cK M.O. CASH
PLAN-CHECK VALIDATION CK. M.O. CASH
0 2 1 _')U 5 0 .0 0 413
% vORKERs'yCOMPENSATION DECLARATION - I FOR PLUMBING PERMIT '
r �' .20-0026DP1/V4/B7 APPLICATION
I h�reb�:, affirm fiat I have a certificate of consent to self in- 76A667A
' sure,or a certificate of Workers'Compensation Insurance;or a .CE 817.(REV:8/86)
certified copy thereof(Sec. 3800, Lab. C.) I,
COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. Company.
0 Certified.copy':is hereby furnished. BUILDING
FOR APPLICANT TO FILL IN(PRINT OR TYPE)
❑ Certified copy is filed with the county building inspection. 'ADDRESS e002K /J, 7-4
department. i. NUMBER FIXTURE OR ITEM @ FEE LOCALITY6,4°!t✓/L e-1,
Date Applicant WATER CLOSET(TOILET) NEAREST
BATH TUB a CROSS ST. 44S7 i7JN4�?
CERTIFICATE,OF EXEMPTION FROM WORKERS' (/
COMPENSATION INSURANCESHOWER OWNER )„f,1Me
(This section need not be completed'if the work involved by MAIL
the permit Is for one hundred dollars($100)or less.) LAVATORY ADDRESS �' isvC'.T.Q/d�fl
I certify that in the performaAce of the work for which this per
mit is issued, I shall not employ any person in any 'manner so, SINK CITY its Cly TEL. NO...100/ p jlj
as to becomesubjectto the Workers'Compensation Laws. II DISHWASHER '
oRd/ Q A - CONTRACTOR S�����►
Date Applicant pp' CLOTHES WASHER 'ADDRESS
NOTICE TO APPLICANT: If, after making this Cerfificate'of Ex- SWIMMING POOL RECEPTOR
eruption,you should become subject fo.the Workers''.Compen- CITY �y�NcA TEL. NO.?4 x•373 y
sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE (f LIC. "�
ed. WATER HEATER 'LICENSE NO. �G���7 CLASS C"13b
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby affirm that I am licenied under provisions of Chapter GAS SYSTEM. ' OUTLETS
9(commencing with Section 7000)of Division 3 of the Business, OUTLETS OVER V U
and Professions Code, and my license is in full force and ef- 5 PER.SYSTEM FINAL _ v VALIDATI a
fect. DATE
License Number 3�74a7 Lic. Class
b ; FINA Q
Contractor �uM7 Date �� �d 'BY O
H
❑ I,am exempt under'Sec. W
B.&P.C. for this reason ® U)
Plan check fee -
Date:- PLUMBING PERMIT ISSUING FEE$ z 1 2•Q 0 A
Signature.
TOTAL FEE �y
SINGLE FAMILY $ 8 JP O
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I.am exempt from the Contractor's License, Name d 0 a 3 4L 5 035
Law for the following reason (Section 7031.5, Business and
Professions Code):' Address ( 1.2 8- 8 8
I, as owner of the property, will do the work and the' City _ Tel, No.
structure is not intended-or offered for•sale'(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 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.
(J" ��� � •. ��/a�� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date '