HomeMy Public PortalAbout5945 TEMPLE CITY BLVD_Plumbing__ ,.:WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT. '
' 20-0026 DPW 4/87
1,hereby.. - i �+4have a certificate of consent to self in- 76A667A
sorefror a c yjficate o{Workers'Comperis6tion Insurance,or CE 817(REV:8/86) U
certified copy thereof(Sec. 3800, Lab. C:) '
COUNTY OF'LOS ANGELES- DEPT. OF PUBLIC WORKS
P..olji No..- Company,,.,
0,,Certified copy.'is hereby furnished:
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING {„
Certified copy is filed,with the courity•bdflding'inspection ADDRESS 64 f 1,0_ ;ZV,
department. NUMBER FIXTURE OR ITEM " FEE ''
, LOCALITY X11 ,,LL4
Date.- Applicant WATER CLOSET(TOILET) ,NEAREST. �e/�/�drr. �I T
- ' •, 'CERTIFICATE OF'EXEMPTION FROM WORKERS'
BATH TUB CROSS 5T, o b'PCL F '
'COMPENSATION INSURANCE OWNER
SHOWER
(This section need.hot lie completed-if the work tnvolved'by MAIL
tke permit is for one hundred dolfcs'(S1f00)or.less,) "LAVATORY :..* ADDRESS ZI►'C
9
Icertif that in the performance of the work for which this perm s•—
mit is Issued, I shall not employ any person' any mannr so / SINK �Q'� CITYAm
as to become s�+bjeet to the War n t' n LDISHWASHER CONTRACTOR A
Date 9ifb d - Applie CLOTHES WASHER 7/ e 3
d D I /f/J'd.1/ ��•
NOTICE TO; ADDRESS i
APPLICANT: If; after making'.fhis;Certificate of'Ex- J SWIMMING POOL RECEPTOR
e-.rfiptio.n,you should:become subiect.to the Workers'Ggmpen-. �- CITY 1f TEL. IVO
cation.provisions of the.Labor Code,you'must'forthwith cojrip- LAWN-SPRINKLEk SYSTEM
(y with.such provisions.or Mis permit shall'be deemed revok STATE' , QQ LIC..
ed. a WATER HEATER LICENSE NOf- �v-� CLASS `-3 2a
LICEN$E�.CONTRACTORS DECLARATION ' DIT Nps/ P ESSED BY '
I hereby affirm that 1 am licensed under provisions of.Chapter GAS SYSTEM OUTLETS a �O/
9�(commencing with Section 7000)of Division 3 of the Business- OUTLETS'OVER
and Professions Code,and my license is in full'force'and ef- 5:PER SYSTEM FINAL VAL ATION
`,/ AL
•30'8,3 ' '�.gi' :�0 ` Qta. A:L3 DATE O
License Nurr er Lic. Class
- -J, jjf/ f. ;- �f FINAL 1C
Contiac'tqCiLr fsFKi!/�1X�Date ! �. BY O
19�1 am exempt under Sec. iVj!
Se 'Z 4Pi-e
B.BP.C. for this reason. Plan Check fee` y
e ... . . . z
°te' PLUMBING PERMIT ISSUING FEE$ S
Signature' 1 TOTAL FEE
' SINGLE FAMILY '
HOME OWNER-BUILDER DECLARATION. Plan.check applicant '
I tiereby.affirm that I am•exempt from the Contractor's License Name
Low for the following reason (Section 7031.5, Business and 7 9 Q 0 A
Professions Code.):. Address ti L ,
;I, .as,owner of the property, will do the work and,the City. Tel. No. # o 0 o o ro'5
structbre.is not intended or offered for sale(Section 7044,
1 .0 o 2:8.5.0
Business-and Professions Code).
CONSTRUCTION.LENDING.AGENCY � o 'o o 2 a 5.0-k
I-hereby affirm that there is a construction lending agency for
the performance of the work for which this.permit is issued c.9'11.1 a" 8 7'
(Sec. 3097, Civ.-C.).
Lender's Name / 1F
Ay
Lender's Address
I'certify that I have read this application and state that the
above information ii correct. I agree to comply with all County ,
ordinances and State laws regulating Plumbing, and hereby
aut e r ntati' s of this C my to enter upon the
ove- e.r ' for i purpo es.
!� SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
DEPARTMENT OF BUILDI.NG AND SAFETY APPPLICATION FOR PERMIT
COUNTY OF LOS ANGELES PLUMBING
1
WM. J. FOX, CHIEF ENGINEER
NATURE OF INSTALLATION DISTRICT NO GROUP I ZONE. PERMIT NO
ROUGH FIXTURES COMPLETE _
RECEIVED Y READY FOR- DATE UED
HEATER CESSPOOL SEPTIC TANK FIRST INSPECTION_ / ,,�S
'✓
OAS MISCELLANEOUS
APPLICANT FILL IN HEAVILY
EAVILY OUTLINED PORTION ONLY /Vo s
Fa
_NAME � tf 1 !/77—I V IA 60' JOB/�' ADDRADDRESS I NFA 1 y ? �q -TFn �� I_ �^ //��1��Ai Y�•�� LOCALITF^
NEAREST
CITY s IH A df [7 EL.No c�`T�D CROSS ST.
CERT.No. EXPIRES / Z.COUNTY1 W NAME m
LOCATION OF SEPTIC TANH OR CESSPOOL z MAIL � /�
f 3 ADDRESS m /) .I
NORTH O I
.
• CITY TEL.No.
1 AM THE LEGAL POSE SOR OF THE ABOVE LOS'
ANGELES COUNTY CE C E QJ' ATIGN.
llll ��
PLUMBE +
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
�1
ABOVE.
OWNER
CORRECTIONS
J
SOUTH Q
Z
DESCRIPTION OF WORK — 5
BATH TUB FURNACE
0
I
SHOWER DISHWASHER
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK --------SAND TRAP
SLOP SINK FLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAINDATE IN9PECT011'9 NAME
"WATER HEATER DENTAL LAVATORY. ROUGH PLUMBING
METER GAS SODA FOUNTAIN GAS PIPING ,
OUTL
GAS VENT ` .••:
CESSPOOL 2-z3
TOTAL NUMBER OF FIXTURES SEPTIC TANK �•R
SEPTIC'TANK. �� SEWER
L-LCi ^
R UTILITY CO. NOTIFIED
TOTAL FEE I / /,Z>2- (0''=ell
v��ue�
• e
•
-COUNTY-OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1210310026
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID BUILDING ADDRESS:
ON FILE 5945 TEMPLE CITY BL
IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:1 TEMP CA 91780
ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: WOODRUFF
18587-014-007 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY CAI
125 LAVATORIES/SINKS 1.00 FIX 16.20
TENANT: 145 WATER CLOSET/URINAL 1.00 FIX 16.20 JISSUED ON: PROCESSED BY: PLAN BY:
VISTA IT CONSULTING/TRAINING TOTAL FEES 60.20 110/31/12 SR
OWNER: TEL. NO: IFINAL DATE FINAL BY: CODE:
[TEMPLE CITY PLAZA (626) 289-4088— 1
1238 S. ATLANTIC BLVD I r( I
1ALHAMBRA, CA 91801 I 1DRSMIArION OF WORK 1
IT/I REPLACE LAVATORIE AND WATER CLOSET
(APPLICANT: TEL. NO: I I I
(LAI, BILLY (626) 512-5748— 1
19173 SOUTHVIEW RD I ISPECIAL CONDITIONS: I
(SAN GABRIEL CA 91775 I I 1
I I I
ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE I
IS B L CONSTRUCTION INC (626) 512-5748— 1 I 1
19173 SOUTHVIEW ROAD LIC. NO I (UNDER SLAB WORK I I I
ISAN GABRIEL CA 91775 754301 1 1 I 1
I I IWATER SERVICE I 1 I
I I IPLASTIC YIN METAL YIN I 1
(ARCHITECT OR ENGINEER: TEL. NO: 1 I 1 1
— I IROUGH PLUMBING 1
LIC. NO: 1 I I I I
(GAS PIPING ! i
i 1 1GAS VENT
I IHOT WATER HEATER I I
I I �
1 I IPLUMBING FIXTURES 1 I 1
I I I
1 I ILAWN SPRINKLERS I I I
I I I
1 1 IGAS TEST I 1 I
1 (UTILITY COMPANY NOTIFIED(
I I
a
ICWV I
1 IGRAY WATER SYSTEM I 1
1 I i l
i I I I I I
! ! I ! I !
I IREPORT ID: DPR263 ROUTE TO: BS0508
I I I I I I