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Home My Public Portal About5126 TEMPLE CITY BLVD_Plumbing__ TeAea�_a#elTa na TEMPLE COTY APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGELES DEPARTMENT�TO�TF� COUNTY ENGINEER ADDRESS BUIIIHIIVG MH SAFETY DIVISION JOH A LA IE COUNTY ENGINEERAU WILLIAM A JENSEN WP T OF BUILDING LDCAI.ITT �_ r FOR APPLICANT TO FELL IN CRNEAREST OSS ST NUMBER FIXTURE OR ITEM EACH FEE OWN IL WATER CLOSET 31 25 - - - - - - - -MA -- BATT{TOB 125 ADDRESS -- - - - SHOWSR 115 CITY�`, y TEL NO LAVATORY 125 CONTRACTOR SINL 12S 'ADDRESS /(�',5-'U- - a DISHWASHER _125 AfE LAUNDRY TOB 19 REOISTRAYRI NO :?-bJF3 COUNTY CLOTHES WASHER I'6 DISTRICT NO GR UP WATER HEATER 150 ZONE SBa[zoD BY BY OAS SYSTEM OUTLETS ISO IMOUSTRIAL WASTE APPROVAL OUTLETS OVER S PER SYSTEM m INSPECTION RECORD d O u O ! 6 N Z APPROVALS DATE INSPECTOR n SIGNATURE PERMIT S 2IGAS NDER SLAB WORK OUI PLUMBING TOTAL FEE / AS PIPING I HERESY ACKMOWLEOGE THAT 1 HAVE READ THIS ARLIAS VENT AND STAT[ THAT THE ABOVE IS CORRECT AND AORSE TO C WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULOT WATER HEATER PLUMBING I N!N®Y CERTIFY THAT I AM M LY REGISTERED ALUMBING FIXTURES LIC[NSSD AS R[OUIRm eY LOn AMG COVMY ANO STATEST CALIFORNIA OR THAT I AM TN O L O N[R OFAND IMCRESIDE tN THE [oTILITY CO NOTIFIEDSIGNATUREOFPlRMITT INAL ATION ROBERT W WOOD cK M D GEN SUPERVISING MECHANICAL ENO R /) �� UtC09720G JAN16 5 0 3.75- a TBABBT CEZ17 x 62 TEMPLE CLT 7( APPLICATION FOR PLUMBING PERMIT COUNTY OF LOS ANGEIFS A . DEPARTMENT OF COUNTY ENGINEER B BUILDING e �LENGINEER wPie WILLIAM A JENBEN YUP T OF BUILDING LOCALITY FOR APPLICANT TO FILL. IN Ceo0 53TATE NUMBER FIXTURE OR ITEM EACH FfiE OWNERWATER CLOSET— _ _ __ $125 _ — _ MAIL /.Z 6 e L BATH TUB 125 ADDRESSaxDWES 125 STT TELNOLAVATORY 125 CONTBACTOSM[ 125 ADDRESS DISHWASHER 125 CITY OLAUNDRY TUB 125 REGIS RATION TIO CLOTHE$ WASHER 125DISTRICT NO GROUPZONA WATER HEATER I SS 0 g A-- GAS SYSTEM OUTLETS 150 INDUSTE APuaaovAL OUTLETS OVER 5 PER SYSTEM 20 DBPE=ON RECORD T 6 0 ri W CL N Z APPROVALS DATE INEPELTOR•EIGNATUM PERMIT f 2 OO UNDER SLAB WORK d ROUGH PLUMBING TOTAL FEE GAS PIPING THEREBY ACKNOWLEDGE THAT 1 HAV[ READ THIS APPLICATION GAS VENT AMD STATE THAT THE ABOVE IR CORR[LT AND AGIMS TO COMPLY .TTMWM ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING r HOT WATER HEATER I MER<oEPS Y CERTIFY THAT 1 AM PNORLY REOISTERED AND/OR PLUMBING FIXTURES CE LINSED AS REQUIRED eY LOS ANGELES COUNTY AND STATE OF GAS TEST GLIFORMIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN TME ABOVE OSSCRIBED RESIDENTIAL PROPERTY UTILITY CO NOTIFIED SIGNATURE OF PERM ITTQ FINAL VAMATIROBERT A WOOD CK M O kCASH SUPERVISING MECHANICAL ENG R Lj&0 5 7 1G FEB 4 5 D 3.50" �6h2Z2Gii+'ry WORKER BCOMPENSATION DECLARATION , °""°'09 APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self Insure or a certificate of Worker a Compensation Insurance or a certified copy thereof(Seo 3800 Lab C) An Percy No �r �K/ �u,L�,j) COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS - F ,,DEPT OF PUBLIC WORKS DIV ^ , ❑ Certllgd lehedd fJ` FOR APPLICANT TO FILL°I(PRINT OR TYPE) U� I^//J, f I u /(,/ ❑ Cerblled copy is flied with the ui M n 7 �V IV 9 tlepartrrrerrt NUMBER FIXTURE OR ITEM O FEE LOCALITY Date-y ADWkem t / WATER CLOSET O NEAREST Q,C, CERTIFICA OF EXEMPTION FROM WORKERS / BATH TUB �a CROSSST COMPENSATION INSURANCE ASSESSOR _ " '•_ _ a_ (This section need not be completed If the work Involved by the SHOWER - QV MAP 8001( PAGE PARCEi permit Is for one hundred dollars($100)or bp) / LAVATORY �0 OWNER NJ I certify that In the performance of the work for which this permit ) Is issued I shell not employ any person In any manner so as to SINK ='REf>s BC. become subject to the Workers Compeneetio we DISWASHER CRY s 4 TEL NO �laRaiff CLOTHES WASHER NOTI E TAPIf after making t le Certificate of CONTRACTOR Exemption you Should become subject to the Workers Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code you must forthwith comply with such. ADDRESS mQ , provisions or this permit shall be domed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER CITY 0 TEL NO a I hereby affirm that I am licensed under provisions of Chapter S 8 (commencing with Section 7000)of Division 3 of the Business and STATE NO MAW LIC Professions Code and my license is in full force and effect GAB SYSTEM OUTLETS OUTLETS OVER DISTRICT NO Cc � fi PER SYSTEM O Q License Number_ / rt Clw r_-7— I FINAL 30 VALIDATION DATEContactor L Date Elam exempt under Sac -- BY Z B aP C for this reason t/�ro Plan check fee , /sow. - PLUMBING PERMIT ISSUING FEE$ ❑✓ TOTAL FEE (7 0 A! N SINGLE FAMILY Plan _ - ACCT.T HONE OWNER BUILDER DECLARATION Name - LrK,UUW �c� I hereby affirm that I am exempt from the Contractor• License Law r 33077 U for the following reason (Section 7031 S Business and Professions Address T rM Code) 1 ITEM5 ❑ I as owner of the property will do the work and the structure CIry Tel No T13TAL 100 - 65 Is not Intended or offered for sale(Section 7044 Business I - c ala Professions Code) _ Poo. CHECK iDD.b! CONSTRUCTION LENDING AGENCY CHANGE .OWI I hereby affirm that there is a construction lending agency for the performance of the work for which this permit le Issued(Sac 3097 - CIv C) p000—OODL 4� 6/93, Lerwar a Name 9033 1 AM 11:21 i Lender s Address I certify that I have read this apps cation and slats 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 Inspecilon purposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Data 91