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Home My Public Portal About5329 TEMPLE CITY BLVD_Plumbing__ DaS.TF E511 SRD 1� APPLICATION FOR PERffiT DEPARTMENT OFNG AND SAFETY PLUMBING COUNTY OFF LOS LOS ANGELES WM J FOX CHIEF ENGINEERt� •1 A ROUGH FIXTURES COMPLETE I �� ` �� HEATER CESSPOOL BVTIC TANK R W READY FOR DATE ISSUED 1 vs vG D FIRST INSPECTION l d J3� aim mlocmj-Ar4mQ APPLICANT FILL IN HEAVH.Y OUTLINED PORTION ONLY J AMC H E H C ri -P b ADDRESS 523 So Silmost ADDRESS W iBlvd* ,. LOGLITY J NEAREST CRY TEL NO CROSDST COUNTY CERT MR EKPIRES Z�' NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Y AMAIL DDRESS 90 Li Oaks ' NORTH Mgla ltX ANGCRY T 1IF��5/p�Ary�P�p`SE7'Jpy��Slp��J��^TyEE'L��N��D� {�� Log E9& VO�CIi//Jy/A //�ifGe-Q/� FLUSSER 1 ANI THE LEGAL OWNEI of THE PROPERTY DESCRY AEOYG mrNES CORRECTIONS EourH DESCRII'TION OF WORE i [=TCYTAL TUB R•�RNACE rs rc .60 RR DISHWASHER p TORY REFRIGERATOR HEN SINK WATER SOFTENER R SINK SAND TRAP SINK FLOOR DRAIN T TRAY URINAL APPROVALS t CLOSET DRINKING FOUNTAIN DATE 1rMAECIOR E NAYE R HEATER DENTAL LAVATORY ROUGH PLUMBING /- �J' Jy y vif hS WMR---a" SODA FOUNTAIN OAS PIPING OUTL GAS VENT CESSPOOL L N�UM�4cwnES SEPTIC TANK PCICTANK SEWER E UTILITY CO NOTIFIED el APPLICATION FOR PERM DEPARTMENT OF BUILDING AND SAFETY CLOS ANGELES WILLIUAMAMJ FOX. CHIEF ENGINEER PLUMBING 1 FOR APPLICANT TO FILL IN DISTRICTNO GROUP ZONE PERMITNO UMBER RECEIVED BY READY FOR DATE ISSUED' FIRST INSPECTION ADDRESS I� 13 BUILDING CI THL 140 ADDRESS COUNTY LOCALITY LICENSE No EXPIRES NILAREBT PERM FEES CROSS ET NUMB" "m OF FIXTURE OR IT[M FEE OWNER MAIL WATER CLOSET TOILET O BO ADDRESS ' BATH TUB @ 050 CITY TILL NO KNOWER @ O 60 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS LAVATORY WASH BASIN O 60 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND ■ AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND ` KITCHEN SINK w O 6 STATE LAWS REGULATING PLUMBING 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRYTUBORTRAY 060 ANGELES COUNTY LICENSE OR 1 AM THE "GAL OWNER OF THE RESIDENTIAL OPERTY DESCRIBED ABOVE. AS SVST[N OUTLETS ® O SIGNATURE OF WATER NEATER ® 0 59 PERMITTR en B PRINK O INSPECTION RECORD FLOOR BINK ® O SO FLOOR DRAIN O 60 DISHWASHER O SO DRINKING FOUNTAIN O 60 URINAL 0 60 J HOUSESEW[R O 60 Z Z MIB ELLANEOUS U' K O' APPROVALS DATE INSP[ OR• NAM[ ROUGH PLUMBING IX19 f/ OAS PIPING OAS VENT CESSPOOL 100 CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN ( ) PIT ( ) ® 1 00 S[WER PERMIT F 1 00 GAB TEST TOTAL FEE [ UTILITY CO NOTIFIED q o -2,107) FINAL Kf TRAAATte.En z-ee APPLICATION F R PLUM NG PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION EULLDII6 �- JOHN A LAMBIE COUNTY ENGINEER ADDRESS COLEMAN W JENKINS SUPT OF BUILDING LOCALITY v / FOR APPLICANT TO FELL IN NUMBER FIXTURE OR ITEM EACH FEE OTIlfI� WATER CLOSET $175 ¢ LATH TDB 175 ADDAF�B BHOYVEB 125 CITY TEL NO LAVATORY 175 CONTRACTOR SDQ 175 ADDRESS 17 7 DISHWASHER 175 CITY LAUNDRY TOB 175 STATE LIC LICENSE NO CLASS CLOTHES WASHER 175 DINRRICT NO GROUPMM0ZONE P [[ BY WATER HEATER 150 1 O f GAS SYSTEM OUTLETS I® � A87 APPROVAL S OUTLETS OVER PER SYSTEM INSPECTION RECORD 0 APPROVALS DATE INSPECTOR.SIGNATURE PERMIT S 2 00 UNDER SLAB WORK ROUGH PLUMBING TOTAL FEE GAS PIPING I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AMLICATION GAS VENT ANO STATE THAT THE ABOVE lE CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND RATS LAWS REGULATING PLUMBING HOT WATER HEATER IMEREBY CERTIFY THAT 1 AM PROPERLY R[GIERED AND/OR PLUMBING FIXTURES LICENSED AS REQUIRED BY LOS ANGEL" COUNTY AND RATE OF GAS TEST CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF AND INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENT IA PROPERTY UTILITY CO NOTIFIED SIGNATURE -�9 OF PERMITTEIEA FINAL �•"�� y if� � VALIDATION JACK R ALEN, cn M D CASH SUPERVISING MECHANICAL ENG'R - 9 819 1,6 AUs 1 5 D 350-44 p TI WORKERS COMPENSATION DECLARATION I APPLICATION FOR PLUMBING PERMIT' I hereby affirm that I have a certificate of consent to self 76A667A e insure, a a certificate of Workers Compensation Insurance CE 817(REV 10/81) d co or a certified thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Pal icy No Company Certified copy is hereby furnished ID - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy a filed with the county building inspec- ADDRESS 2 tion deportment I NUMBER FIXTURE OR ITEM a FEE LOCALITY Dote AppliSant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS ST C.=)� COMPENSATION INSURANCE OWNER (This section need not be completed H the work Involved by SHOWER the permit Is for one hundred dollars($100)or less ) I LAVATORY MAIL , ADDRESS I certify that in the performance of the work for which this permit is issued I shall not employ any person in any manner VC5 SINK CITY TEL NO so as to become subject to the Worker ompensahon sus DISHWASHER CONTRACTOR Date 10660 4111 CLOTHES WASHER ADDRESS �p , NOTICE TO APPLICANT If, o er making this Certificate oaG Exemption you should become subject to the Works SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code you must forth CITY TEL tip with comply with such provlslons.or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC deemed revoked WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT SSED BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER 0 L and Profession Code,and my license a m full force and effect 5 PER SYSTEM DATE O VALIDATION V License Number Llc Class OC FINAL O Date BY Contractor 4%.?, U ❑ W I am exempt under Sec 6 H B 8P C for this reason Z Plan check fee Date PLUMBING PERMIT ISSUING FEE$ d Signature TOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address ;C9 8 6 2 A Law for the following reason (Section 7031 5, Business and G Professions Code) City Tel No Wis • • • • 5 ❑ I, as owner of the property, will do thework and the '• • structure is not Intended or offered for sole (Section 22850 70" Business and Professlony Code) loop. •f• • 2 8 5 O E CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for I 0216-83 the performance of the work for which this permit is Issued (Sec 3097, Civ C I Lender s Nome Lender's Address 1 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 lows regulating Plumbing and hereby authorize representatives of this County to enter upon the olio entioned proper or Inspection purposes SEE REVERSE FOR EXPLANATORY LANGUAGE ((G r'y`a K3 Signature rmlttee Date