HomeMy Public PortalAbout6022-6024 TEMPLE CITY BLVD_Plumbing__ 76A667 1725M SETS 7.48 APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY '.
COUNTY-OF LOS ANGELES PLUMBING
WM.J.FOX.`_CH1EF ENGINEER
NATURE OF INSTALLATION D1STRt . G P o PERMIT
O..
ROUGH FIXTURES COMPLETE
HEATER ��CEBSPOOL SEPTIC TANK RECBI. Eq FIRST INSPECTION
READY PdR/' DATB ISSUED.
GAS- MI CE LANEOU
APPLICANT FILL IN HEAVILY OUTLINED
/PORTION ONLY
NAME e o 04 ADDRESS NaS
Sd l
�
ADDRESS ,Y/' i*�,�� �� �-'�d+�(d LOCALITY
,1 1 NEAREST
CITY �" 4A�' STEL.No. - CROSS ST.
COUNTY
LICENSE No.'+pogP60; EXPIRES
NAMB' A�
LOCATION OF SEPTIC TANNo OR CESSPOOL: X MAIL
NORTH f O ADDRESS
f; CITY TEL.NO.
! AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIRIC&TE OR QUALIFICATION.
PLUMBER
1 AM THE LEGAL OWNER OF THE.PROPERTY DESCRIBED
ABOVE.
3 Z OWNER
CORRECTIONS
SOUTH Zb gyp
DESCRIPTION OF WORK a
• r�.�. Awe
HATH TUB FURNACE /
MOWER DISHWASHER , O
AVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SAND TRAP
SLOP SINK FL!M DRAIN
WASH TRAY _ URINAL APPROVALS
WATER CLOSET DRINKING POUNTAIN DATE INSPBCTOR'B NAME
WATER NEATER DENTAL LAVATORY ROUGH PLUMBING I
ETES GAS *K+DA FOUNTAIN GAS PIPING I I
OUTL l
GAS VENT 1 pp
CESSPOOL
AL NUMBER OF FIXTURES SEPTIC TANK I I
001EPTICTANK SEWER� c �
T_ UTILITY CO.NOTIFIED
�+ I
TOTAL FEE 0 6
FINALD
AL `
76A667 17 25M SETS 7-4B APPLICATION FOR PERMIT
DEPARTMENT OF BUILDING AND SAFETY PLUMBING
�� ' �
COUNTY OF LOS ANGELES '
WM.J. FOX.CHIEF ANGINEER
NATURE OF 110TALLATIUNDISTRICT NO. GROUP ZONE PERMIT-NO.-
ROUGH FIXTURES COMPLETE 54 9
HEATER CESSPOOL 1-1 SEPTIC TANK R J I ED Y READY FOR DATE ISSUED
FIRST INSPECTION J.
ASMISC LANE ® m
�j J� ��ll��
APPLICANT FILL IN HEAVILY OUTLINED pPORTION ONLY
K NA6l<</Q(.LSLJ �oufz JQ4 �-� ,,�'LpplI���2 LI2GJ p ADDRESSId
ADDRESS OO FZ' 9 u�-G!<oC.+ LOCALITY _r
�` NEAREST
0.
CITY. � - �C TEL.No. •—.77l t F CROSS ST. --OOUNTY /
L CENSE NO. EXPIRES �—���T i' 0! NAME 'P�
LOCATION OF SEPTIC TANS, OR CESSPOOL z MAIL.
3 ADDRESS
- NORTH - O
CITY TEL.NO.
1 AM THE LEGAL POSSESSOR OF THE ABOVE LOS
ANGELES COUNTY CERTIFICATE OF QUALIFICATION.
PLYMB
I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
OWNER
CORRECTIONS
• -9-y 1 3_eo � �-
,G7'1_ _
r
y, 1
SOUTH J
/ DESCRIPTION OF WORK _/o. ?,� z
ATH TUB FURNACE � M
ROWER DISHWASHER !w D
�VATORY - REFRIGERATOR —
ITCHEN SINK WATER SOFTENER
FLOOR SINK - SAND TRAP
��pp SLOP SINK FLOOR DRAIN
"Y WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING.FOUNTAIN DATE INSPECTOR'S NAME
—WATER HEATER - DENTAL LAVATORY ROUGH PLUMBING w I
ETElQj—GAS SODA FOUNTAIN' GPS PIPING
OUTL
r
GAS VENT i
CESSPOOL I
TOTAL NUMBER OF FIXTURES o 'SEPTIC TANK I I
CESSPOOL SEPTIC TANK SEWER nT.. I
S too UTILITY CO.NOTIFIED "1`N I _c
TOTAL FEES— r FINAL
WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT
w•I hereaffirm that I have a certificate of consent to self 76A667A
,.finsure,'g ;a certifi4ate of Workers'Compensation Insurance, CE 817(REV. 10/81) �J
or a certified copy;hereof(Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No."' Company
Certified copy is hereby furnished.
❑ .r
Certified copy is filed with the county building inspec-
FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS
el
tion deportment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY dell,s /vnTg AV'X#117
WATER CLOSET
Date Appli4ant NEAREST
CROSS ST 1,� Ns��
y
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB � •
COMPENSATION INSURANCE OWNER
(This section need.not be completed If the work Involved by MAIL
SHOWER
the permit Is for one-hundred dollars($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this � a
permit is issued,I shall not employ any.persomin any manner SINK t?IOCV, CITY; TEL.NO 06:�� 3
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR
Date �� pplica CLOTHES WASHER
NOTICE TO APPLICANT: If, after mgjrA g this Certificate- of ADDRESS
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY TEL.NO.
Compensation provisions of the Laboi Code, you must forth- LAWN SPRINKLER SYSTEM
with comply .with such provisions or this-permit shall be STATE LIC.
deemed revoked. WATER HEATERLICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION �� DISTRICT NO. P. ESSED BY
/�
I.hereby.affirm that I am licensed under.provisions of Chapter 9 GAS SYSTEM OUTLETS C!
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL
ALIDATION
License Number Lic. Class- d
DAT
44 F C
.Contractor Date - 12
❑ I am exempt under Seca H
L
B.BP.C. for this reason 4
Plan check fee polo d
Date: )�{ V
PLUMBING PERMIT ISSUING FEE$ L V Z
• Signature � ,`
TOTAL FEE
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name 5 0 4 5 A
I hereby affirm that I am exempt from the Contractor's License Address # 5
Law for the followingreason Section 7031.5, Business and 0 0 0 o '0
Professions Code): City Tel. No.
I, as owner of the property, will do the work and the o - 5250
structure is not intended or offered for saleSection
7044, Business and Professions Code). ( , 0 0 0 5 5 05
v
CONSTRUCTION LENDING'AGENCY 0 7. 15-;-'8 6 ,
I hereby affirm-that there is a constriiction lending agency for
the performance of the work for which this permit is issued
(Sec. 3097, Civ. C.).
i
Lender's Name
Lender's Address -
I certify that I have read this applicotion and state that the
above information is-correct. I agree to comply with all County
ordinances and State laws regulating Plumbing, and hereby,
authorize rep�esentatives,of this County to-enter upon the
above-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE
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