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APPLICATION FOR I?LU 414G PERMIT
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
JOHN A. AAMBIE COUNTTY ENTY GINEER ADDRESS 6L02 Ne Sultana.
WILLIAM A.JENSEN, SUPT OF BUILDING
LOCALITY Sar rTphriel
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. �.� • --"Y�--
NUMBER FIXTURE OR ITEM EACH FEE
WATER CLOSET $1.25 OWNER W.
. Sickel
BATH TUB 1.25 ADDRESS S ame
SHOWER 1.25 CITY TEL. NO. A t 7 2 q
LAVATORY 1.25 CONTRACTOR Pacific Installers
SINS 1.25 ADDRESS q r
DISHWASHER 1.25 CITY Temple ci-tv TEL.NO. 442-1234
LAUNDRY TUB 1.25 CONTRATOR'S STATE
EGISTRACTION NO. 211898 COUNTY
CLOTHES WASHER 1.25 DIST R NO. GROUPZO'E P SSED BY }
1 WATER HEATER 1.50 F t/C
GAS SYSTEMOUTLETS 1.50 WASTE APPROVAL 0
OUTLETS OVER 5 PER SYSTEM .90 INSPECTION RECORD
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APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 21 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE 0 GAS PIPING
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION GAS VENT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING. HOT WATER HEATER
I HEREBY CERTIFY THAT I AM PROPERLY REGISTEREb AND/OR PLUMBING FIXTURES
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF GAS TEST
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF,AND INTEND TO
RESIDE IN,THE ABOVE DEED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE ���JJJ
FINAL
,�LIDATION ROBERT A.WOOD
cK.J M.O. CASH SUPERVISING MECHANICAL ENG'R
LjiUo 5 4 0 6 FEB -10 5 D 3.50-
D.1141—,ll 25M SM s-" APPLICATION FOR PENT
DEPARTMENT OF BUILDING AND SAFETY;COUNTY COUNTY OF LOS•ANGELES PLU"n I N G ,
W.M.J.FOX.CH1w:ENGINEER
A
_WRE OF MET-MATIONI 7O P .-
ROUGH, FIX' COMP B
. READY.FOR
R �iVtE�.BY DATE ISSUED•
HBATER CESSPOOL SEPTIC TANK -FIRST IN$PECTIOIV
APPLICANT FILL-IN HEAVILY :OUTLINED PORTION ONLY
fjob
NAM E ylt�tief _ .rrl/� ADDRESS:
m
ADDRESS f Y AM'RT r s LOCALITY 4'. r'r�
' �. ..... �. .. �rV• - 'NEAREST � P
CITY .�.. - TEL.No. CROSS ST.
COUNTY
CERT:NO. SEPTIC
AMCN
LOCATION OF SEPTICS TANK, Olt CESSPOOL MAtL
ADDRBOB
NORTH O
CITY, TEL.•NO.
I .AM.,THE LEGAL PO$8E880R OF THE- ABOVE LOS
ANGEL C LINTY CERTIFi TE,�i FQU IFICATION,
• r PLUMB=
I AM THE L&AL OWNER OF THE PROPERTY DESCRIBED .
_ ABQVE.,
OWNER
• CORRECTIONS -
SOUTH _ J
DESCRIPTION OF WORK. z
` BATH TUB FURNACE
_SHOWER 1318HWA$HER 13
_LAVATORY REFRIGERATOR''
J KITCHEN SINK WATER SOFTENER
FLOOR-BINK, SAND TRAP
GLOP SINK FLOOR DRAIN
WASH TRAY -,_- URINAL APPROVALS ,
WATER CLOSET RINKING FOUNTAIN. DATE tNsr+ECTOR's NwME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING.
Ergo rsAS .'SODA FOUNTAIN
OUTL-
GAS PIPING !
GAS VENT
CESSPOOL_
TOTAL NWMSER.OF FIXTURBB SESMIC TANK 4
r .�CESSPOOt *=EPTtCTANK _I SEWER 7
S UTILITY CO.NOTIFIED.
TOTAL FEE FIN Z` ° 14? .
7GA667 DBB 17 7-s1 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES
WILLIAM J. FOX, CHIEF ENGINEER PLUMBING 1
ERMIT N13.
FOR APPLICANT TO FILL,IN••
DISTRI NO. GROUP O
leNE g .95
PLUMB IA I J d A RECEI Y READY FOR DAT 1 SUED
o _¢ FIRST INSPECTION
` Jam'
ADDRESS _ o ^^ `r!
BUILDING �
CITY d A TEL.NO. A ADD REBS -
r °
COUNTYLOCALITY
(CENSE NO. EXPIRES
+pp'���rS� NEAREST
PE30M FEES DROSS ST. ( s�
NUMBER TYPE OF FIXTURE OR ITEM FEE OWNER A/ *lJ f�.�r 2 A _
MAIL vv
WATER CLOBET(TOILET) Q O.SO JEi ADDRESS
BATH TUB @ 0.50 CITY TEL NO.
SHOWER 0.50 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT
AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES
KITCHEN BINK 0.50 AND STATE LAWS REGULATING PLUMBING.
1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS
LAUNDRY TUB DR TRAY 0.50 ANGELES COUNTY LICENSE; OR I AM THE LEGAL OWNER
GAB SYSTEM OUTLETS 49 0.50 OF THE REBIDENTI PROPERTY DEQ R ED OVE.
NATURE WATER HEATER O.SO SIG61 '� ff�
SLOP BINK (11 0.50 INSPECTION RECORD
FLOOR BINK O.SO
FLOOR DRAIN 0.90
DISHWASHER 0.50
DRINKING FOUNTAIN 0.50
'URINAL 0.50 J
Q
HOUSE SEWER 0.313 Z_
MISCELLANEOUS O
lz
O
APPROVALS
DATE INSPECTOR'S NAME
ROUGH PLUMBING
BAB PIPING
BAS VENT
CESSPOOL @ 1.'00 CESSPOOL
SEPTIC TANKS BE*—
DRAIN ) PIT ) 1.00 SEWER
PERMIT I 1.00 GAS TEST
Cl ® UTILITY CO.NOTIFIED
TOTAL FEE
FINAL ^Z� 7.. �p7/►y .
i
D.B.S.=17 86M SETS 8-48
APPLICATION FOR PEiW1ii1
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES �`u�B� �
WM.J.FOX.CHIEF ENGINEER
NATURE OF INSTALLATION DISTR1GROUPI Z NE PERMIT-NO.
ROUGHFIXTURES , _COMPLETE 7
7
HEATER CESSPOOL I-I SEP,;1'IC TANK PM;q
D BY - RBADY FOR DATE ISSUED
FIRST INSPECTIONISCELLAN UB -I- C=%==�-
APPLICANT FILL IN HEAVILY OUTLINED PORTION 'ONLY.
SSSSSSBSSSS
NAME C -/,d A Q JOB f /
ADDRESS. (R �'!" p 8 (,f rAQ
id
g --ADDRESS I ��� Lt- A (/�+ � i-' -LOCALITY f C C A4 //�. p
NEARZBT
d CITY � Al TEL.NO.<A--11,rld CROSS ST. 1 OX � fW � �r
CERT.NO. EXPIRES.9, it=
'41 NAME
LOCATION OF SEPTIC TANK, OR CESSPOOL 3 ADDRESS
J021 1�t
NORTH O
CITY TEL.NO:
1 AM THE -LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICA E OF 0 ALIFICATION.
PLUMBER
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBE
ABOVE. z
" a
3 OWNER
CORRECTIONS
SOUTH
J
DESCRIPTION OF WORK - a
z
ATH TUB FURNACE - V'
H.OWER DISHWASHER p
—LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
p .LOP SINK
OUTL FLOOR DRAIN
s WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTO NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I
METES L GAD SODA FOUNTAIN GAS PIPING I
GAB VENT rr
CESSPOOL 1
TOTAL NUMBER OF FIXTURES SEPTIC TANK I I
CESSPOOL SEPTIC TANK SEWER I
S UTILITY CO.NOTIFIED I
TOTAL FEE. C
FINAL.
ON
affirm° ORIKER'hav�eMa c'ertif cls a of
S7DPW 91as APPLICATION FOR PLUMBING PERMIT
I herebyt f con nt to self Insure, ,
or a certificate of Worker's Compensation Insurance,or a certified
copy therbof(Sec.3800 Lab C.) ,
COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV.
Policy No Company
❑ Op
Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING t `
ertified copy to filed with the county buildi
� ni ADDRESS. �/ ddZ
department. l NUMBER FIXTURE OR ITEM 4f FEE LOCALITY fir.
Dater` '` ! pplicent WATER CLOSET NEARE
CERTIFICATE'OF EXEMPTION FROM ERS' CROSS ST.
COMPENSATION INSURAN BATH TUB
ASSESSOR yam' p� ' PARCEL1A93
(This section need not be completed-if-t a work i ved by the SHOWER MAP BOOK PAGE �� /
permit Is for one hundred dollars($100)or Is LAVATORYOWNER / t
i I certify that in the performance of the w r which this permit
Is issued, I shall not employ any per in any manner so as to SINK A DRES 2
become subject to•the Workers'CcMAIL
enation Laws.
DISWASHER CITY " TEL.NO.-
Date pplicant CLOTHES WASHER
NOTICE TO APPL NT: If, after making this Certificate of CONTRACTO
RIP
Exemption,you s Id become subject to-the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS
provisions of a Labor,Code,you must forthwith comply with such
provisions this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM E�
LICENSED CONTRACTORS DECLARATION CITY
WATER HEATER STATE LiC. CL
O
I he y a)firm that I am licensed under provisions of Chapter 9
(commencing with Section 7000)of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO CkASS ()
Professions Code,and my license is in full,force and effect. DISTRICT NO. D BY j=
OUTLETS OVER (�@D3*5
5 PER SYSTEMV i o
License Number \L Lia.Class. 7
FINAL
DATE V
} Date./07-a 3e��/ V����%lf- VALID�47tJ( (L
Contracto " "DOTAL -i1g ��'� Z
❑ " FINAL i+
1 am ex under Sec. // BY CHECY 88.2111 —
B.&P.C.for this reason Co
Plan check fee CHANGE ,tyij
SignatuPLUMBING PERMIT ISSUING FEE III
►
re �
El _FT FEE 0D, [I !'Qt{I.fi
_
FAMILY Plan check applicant 9 837 AM 1 i'44
HOM NER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Law
for the following reason(Section 7031.5, Business and Professions Address
Code):
❑ City Tel.No.
I,as owner of the property,will do the work and the 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.)
}
i
I Lender's Name
i; Lender's Address .
1 certify that I have read this application and state that the above ,
' information is correct. I a tie to comply with all County ordinances
and State laws r lumbing, .and hereby authorize
representative. t s Co to enter upon the above-mentioned
property f pection r as. SEE REVERSE FOR EXPLANATORY'LANGUAGE
Signatyre ermittee Date
4
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0806270003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
]LEGAL ID: I FEES PAID BUILDING ADDRESS: ]
I ON FILE I I 6402 SULTANA AV ]
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:[ SGAB CA 917752034 1
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN
5382-019-023 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
1 51 LOW PRS'GAS *5 OUTLET 1.00 SYS 16.20 ] 1
TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I
I 1 i06/27/O8 SR 12/24/08
[OWNER: TEL. NO: 1 IFINAL DATE FIN BY: CODE: 1
ILIN, ANTONY (626) 287-9898- 1I
16402 SULTANA AV !I
ISGAB 917752034 I IPTION OF WORK 1
] IGAS LINE I
[APPLICANT: TEL. NO: I I
ITSAI (626) 483-2857- I I
179 W. MAGNA VISTA I ISPECIAL CONDITIONS: 1
IARCADIA, CA 91007 1 I I
(1 I I I
CONTRACTOR: TEL. NO: 1 [APPROVALS DATE INSPECTOR SIGNATURE 1
[JAMES TSAI CONSTRUCTION, 6264832857 (626) 483-2857- 1 1 1
179 W. MAGNA VISTA AVE LIC. NO 1 [UNDER SLAB WORK I ] ]
JARCADIA CA 91007 B CIO C20 * 1 I I I I
I IWATER SERVICE 1 I I
] I IPLASTIC Y/N METAL Y/N
(ARCHITECT OR ENGINEER: TEL. NO: ] I ] I I
I - ] [ROUGH PLUMBING
LIC. NO: ] I I I
]GAS PIPING
IGAS VENT [ 1
I [ IHOT WATER HEATER [ I
I I
(PLUMBING FIXTURES I I
[ I (LAWN SPRINKLERS I I I
I I IGAS TEST [ I I
1 I (UTILITY COMPANY NOTIFIED] I [
I I iwv I I I
I I IGRAY WATER SYSTEM I 1
I I I I I
I I I I I
1 I I I I I
I i I I I I
1 1* ADDITIONAL DATA ON FILE [ I I I
] I I I I I
] 19EPORT ID: DPR263 ROUTE TO: BS0508
] I I I I 1