HomeMy Public PortalAbout5825 TEMPLE CITY BLVD_Plumbing__ 76A667 17 2SM SETS 7-48 •'APPLICATION FOR PERMIT
DEPARTMENT OF EUILDING AND SAFETY
COUNTY OF LOS ANGELES
WM.J.FOX.CHIEF ENGINEER PLUMBING-- -
NATURE O INSTALLATION ISTRICT NO.- GROUPI-ZONF.
PERMIT No.
ROUGH FIXTURESCOMPLETE
HEATER CESSPOOL H SEPTIC TANK RECEIVED
BYY READY FOR- DATE ISSUED
�J�4 /�.. .
FIRST INSPECTION ,A —.2 _ L!
AS-. MI CELLANEOU /
APPLICANT FILL IN HEAVILY OUTLINED PORTION O Y Af
ME �� JOB
ADDRESS DRESS / LOCALITY�.�qNEAREST
TY • I EL.No. CROSBST.
UNTYCENSE NO. EXPIRES Y NAME /?a
LOCATION OF SEPTIC.T OR CESSPOOL
3 ADDRESS
NORTH O
C17Y TEL.No.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICAF gUALIFIC TON.
M _ t FLuma R
1 AMTHE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
3' OWNER
CORRECTIONS
SOUTH J
DESCRIPTION OF WORK i
ATH TUB FURNACE F,
SHOWER DISHWASHER 13
LAVATORY REFRIGERATOR
.-KITCHEN SINK WATER SOFTENER
FLOOR SINK pAND TRAP
LOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME
'WATER HEATER DENTAL LAVATORY ROUGH.PLUMBING I
ETES GAS SODA FOUNTAIN GAS PIPING I I
OUTL
GAO VENT
CESSPOOL
TOTAL NUMBER OR FIXTURSB SEPTIC TANK I I
—CESSPOO, ¢EPTICTANK 'J SEWERZan I
S UTILITY CO:NOTIFIED I
TOTAL FEE sd'
7SA667-CEBSI7 4-64
APPLICATION FOR PLUMBING PERMI
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER BUILDING
BUILDING•AND SAFETY DIVISION ADDRESS r,
JOHN A. LAMBIE, COUNTY ENGINEER
WILLIAM A:JENSEN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN' NEAREST
CROSS.ST.
Adaad
NUMBER FIXTURE OR ITEM EACH FEE OWNER
s
WATER CLOSET 81.25 MAIL
BATH TUR 1.25 ADDRESS n.
SHOWER 1.25 CITY TE . NO."
Ir
LAVATORY 1.25 CONTAACTO
SINS 1,25 ADDRESS
DISHWASHER 1.25 CITY TEL. NO.
RESTC STATE
LAUNDRYTUB 1.25 REGISTRATION COU
TY
CLOTHES WASHER 1.25 DISTRICT NO. I GROUP I ZONE PROC SED B.Y
WATER HEATER 1.50 X61 Q r I zj
GAS SYSTEM[ OUTLETS 0.
1.50 WASTE�APROVAL O
OUTLETS OVER 5 PER SYSTEM .80 INSPECTION-RECO)ID V
V
W
d
H
Z
APPROVALS DATE INSPECTOR'S SIGNATURE
PERMIT S 2 00 UNDER SLAB WORK
ROUGH PLUMBING
TOTAL FEE GAS PIPING
1 HEREBY ACKNOWLEDGE THAT I 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 HOT WATER HEATER
PLUMBING.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED 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 DEBCRIBED RESIDENTIAL PROPERTY. UTILITY CO.NOTIFIED
SIGNATURE
OF PERMITTEE FINAL
LIDATION ROBERT A. WOOD
(
CK. M.0. CASH SUPERVISING MECHANICAL ENG'R
_ _ . LA[;o 6'5 6 OZO DEC 310 .. 5 0 3.5 0— 1
D.B.S.-17 25M SETS 12-46' APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY
COUNTY OF LOS ANGELES `� ' '
WM.J. FOX.CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO. GROUPf ZONE PERMIT NO.-
ROUGH FIXTURES_ MPLETE
REG IVSD BY READY•FOR DA E ISSUED
HEATER CESSPOOL 1:�:lC:T:A::N:K:j_ � � FIRST INBPECTdON
AS MISCELLANEOUS
APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY
NAME {�A`j� /e a ADDRESS
X ADDRESS � �''� `f LOCALITY ! if
��y9 T
CITY PAA22,42,./i TEL.NO.f4a JJ �I CROS S .
Y . 5!e4,L
�9
COUNTY' ��y ;� ��
CERT.No. /`� EXPIRES d I NAME N' .-
LOCATION OF SEPTIC TANH, OR CESSPOOL Z MAIL -
3 ADDRESS
NORTH O
CITY TEL.No.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICA OF QUALIFICAT ON.
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
a
OWNER
CORRECTIONS
O
SOUTH
DESCRIPTION OF WORK
ATH TUB FURNACE
ROWER DISHWASHER 0
® —LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
LOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS•
WATER CLOSET DRINKING FOUNTAIN DATE IIISPBCTOR;'S NAME
WATE77-GAS
ER DENTAL LAVATORY ROUGH PLUMBING b I n I AP'l
METE SODA FOUNTAIN GAS PIPING• Vvv./
UTL -
V
' GAS VENT '
CESSPOOL
TOTAL NUMBERLOFFIXTURES d Q SEPTIC TANKESSPOOT TIC TANK SEWER
BEMS
I TOTAL FEE 1 UTILITY CO.NOTIFIED
I FINAL
WORKERS'COMPENSATION DECLARATION 76A667A '
I hereby affirm that I have ir certificate of consent to self Ise 817(2-66) APPLICATION FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or 1
a certified copy thereof(Sec.3800,Lab.AA .) i COUNTY OF LOS ANGELES BUIL I.NG AND SAFETY
,Policy No. Company_ ii.
Certified copy isbereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDIN �s^ J..
mjgCertified copy is filed with t my u'din ADDRESS pf
g inspection NUMBER FIXTURE OR ITEM • FEE i �{•—
de ar Ra��' WATER CLOSET LOCALITY �Qq InQO
Date-� p�Applicant _ NEAREST
BATH TUB CROSS ST.
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE. SHOWER OWNER
LAVATORY MAIL
(This section need not be completed if the work involved ADDRESS OO d d J
by the .permit is for one hundred dollars ($100) or less.) SINK n tL
CITY TEL.NO. & e(� 0
I certify that in the performance of the work for which this DISHWASHER U
permit is issued, I shall not employ any person in any manner CONTRACTOR - cc
so as to b6cojne subject to the liars' en tion Laws. CLOTHESWASHER _ O
'ADDRESS Inzo
CIWG Ur
Date Appliiant SWIMMING POOL RECEPTOR
TEL.NO. YY
NOTICE TO.APPLICANT: If, after ung this Certificate of jCITY tl
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE 1 i C q LIC. / /�Q
Compensation provisions of the Labor Code,you must forth- �, LICENSE NO ' l. J.O 78- CLASS Ifs oC 12
with comply with such provisions or this WATER HEATER
permit shall be _. 3
deemed revoked. GAS SYSTEM OUTLETS DIICT NO. PROCESSED BY
LICENSED CONTRACTORS•DE.CLAR.AT.ION' OUTLETS OVER
I hereby affirm that 19 m licbnsed under provisions of Chapter IS PE R.SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi= FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE ^� -- �
effect.
Q p CS6 FINAL
License Num u�v Lic.Class BY
Contra Date
I am, Xe pt
from-the licensing requirements as I am a Plan check fee .
licensed architect or a• registered professional engineer
acting in my'professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE 0
Lic.or Reg.No. Date LAddress
pplicant z 2 �,5.A
'I
HOME OWNER-BUILDER DECLARATION # 0 0 0 0 o 5
I. hereby affirm that I. -am exempt from the Contractor's. �; 2 0 0' 1 (10 0
License Law for the following reason (Section.1031.8, Busi- Tel.No.
ness and Professions Code): 0'0 0 1.0.0 0
I, as owner of the property, am exclusively contracting
with licensed contractors to -construct the project f i 1'3'0—8
1.
(Section 7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY I
I hereby affirm that thereis a constructionlending agency i.
for the performance of the: work for which this permit is ,
issued(Sec.3097,Civ.C.). �� F+ '
Lender's Name uR FINAL WrnEpqp�a%ULender's
'�1C�Address
I certify that I have read this-application and state that the
above information is correct.I.agree to comply with all County1
ordinances and State laws regulating Plumbing, and hereby SEE REVERSE FOR EXPLANATORY LANGUAGE
authorize epresentatives of this County to enter upon the
above- en ned r arty for'inspectiJon pur 0
Signature ermittee Date I I
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