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Home My Public Portal About6102-6104 TEMPLE CITY BLVD_Plumbing__ 76 A 667—CE 817 B/68 APPLICATION FOR PLUMBING PERM I T COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS COLEMAN W. JENKINS. SUPT. OF BUILDING LOCAL FOR APPLICANT TO RILL IN(PR NT OR TYPE) NEAREST CROSS ST. NUMBER FIXTURE OR ITEM EACH FEE OWNER WATER CLOSET 1.50 NAIL BATH TUB 1.50 ADD SHOWER 1.50 CL. NO.,V,? LAVATORY 1.50 4CEONTRAOR SINK 1.50 ADDRESS a DISHWASHER 1.50 C TEL. NO. CLOTHES WASHER 1.50 STATE O -LIC LICENSE O. O CLASS SWIMMING POOL RECEPTOR 1.50 DISTRICT NOGR P ZONE PR CE,SSED BY LAWN SPRINKLER SYSTEM 2.00 '-6 � , 2C WATER HEATER 1.50 INDUSTRIAL f v WASTE APPROVAL Z GAS SYSTEM OUTLETS 1.50 INSPECTION RECORD 2 OUTLETS OVER v 5 PER SYSTEM .30 a N Plan check fee 25% of. above. See reverse. PLUMBING PERMIT ISSUING FEE 8 2 00 TOTAL FEE APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING GAS VENT City Tel, No. HOT WATER HEATER 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GAS TEST PLUMBING. 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO.NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF,AND INTEND TO ,y RESIDE IN.THE ABOVE SCRI RESIDENT L PROPERTY. FINAL Q SIGNATURE JACK R. ALLEN, SUPERVISINGnK ' HANICAL EN'G'R. OF PERMITTE PERMIT VALIDATION O. CASH PLAN CHECK VALIDATION CK. M.O. CASH (',�7-O 8 30-D OCT 8 5 D 3.50- Q 76xOW 17 5-50 APPLICATION FOR PERMIT DEPARTMENT OF BUILDING AND SAFETY 1 COUNTY OF LOS ANGELES WILLIAM J. FOX, CHIEF ENGINEER FOR APPLICANT TO FILL IN DISTRICT NO. GROUP ZONE PERMIT NO. y-- f ir-33 9 PLUMBER Belvedere Plumbing Co. RECEIVED BY READY FOR DATE ISSUED L �t {� FIRST INSPECTION ADDRESS 136 S. Palm Ave. CITY Alhambra TEL. NoAT95025 ADDRESS ®r BUILDING N Temple Cit Blvd COUNTY LICENSE NO. 80$M EXPIRES 6/30/51 LOCALITY Temple City Zn/ o - I NEAREST PERMIT FEES CROSS ST. t7. T LOturco NUMBER TYPE OF FIXTURE OR ITEM FEE C OWNER MAIL WATER CLOSET (TOILET) @ 0.50 $ 1 00 ADDRESS 2 BATH TUB @ O.50 1 00 CITY TEL. NO. SHOWER @ 0.501 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS 2 LAVATORY (WASH BASIN) @ 0.50fll000 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND 2-- -KITCHEN SINK -' "" " 0.5000 - 1 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER 2 GAS SYSTEM OUTLETS .@ 0.50OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. WATER HEATER o50 SIGNATURE OF PERMITTEE ./11.et1 �t //w7V1s t�/Yw�iy SLOPSINK @ 0.50INSPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN @ 0.50 DISHWASHER @ 0.501 DRINKING FOUNTAIN @ 0.50 URINAL @ 0.501 {.� /l J HOUSE SEWER @ 0.50 C �•Z_5 f_ �•� /�''1"� 6!a t^ ? MISCELLANEOUS wr-(--r t+-p-r . a-K //_o-rd-co%r. 1-1" 7P Dd(,P c— A A7' L..v vreco /A/;�L AL R 6. lid?-EJ i1/1� "s 2- 'APPROVALS `'APPROVALS 1 DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS VENT �Z• C! Ger, )1. CESSPOOL @ 1.001 CESSPOOL SEPTIC TANK: SEPTIC TANK 1 DRAIN ( ) PIT ( ) @ 1.00 SEWER n PERMIT . 1.00 GAS TEST r/NR's �R$T� v G z 9-�`�xr UTILITY CO. NOTIFIED 1 TOTAL FEE $10.0 ` �G� O.0 FINAL 2`s l—'' / 152 M �` g•'�* APPLICATION.FOR PERMIT DEPARTMENT.QF BUILDING AND"SAFETY COUIgTY OF LOS ANGELES PLUMBING 1 WILLIAM J. FOX. CHIEF ENGINEER- FOR NGINEERFOR APPLICANT TO ALL IN' DISTR15P;NO. GROUP I ZONE PERMIT NO. PLUMBER61 RECEIVED BY READY FOR. DATE ISSUJkD FIRST INSPECTION BUILDING h CITY 1 TEL. 14y. Ae bDDRESS ® v 6't �/ LICENSE NO. EXPIRES LOCALITY a PERNIIT FEES CR0S8 s.. NUMBER TYPE OF FIXTURE OR.ITEM FEE OWNER -- MAIL WATER CLOSET (TOILET) 0.50 S ADDRESS BATH TUB @ 0.50 CITY TEL. NO. SHOWER rrh O.SOI 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS LAVATORY (WASH BASIN) 0.50 APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH .ALL COUNTY ORDINANCES AND KITCHEN SINK Q 0.5.0 STATE LAWS REGULATING PLUMBING. 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY @ 0.50 ANGELES COUNTY LICENSE. OR I. AM THE LEGAL OWNER OF THE RESIDENTIAL PROPERTY DESCRIBED ABOVE. GAS SYSTEM OUTLETS 0.50 SIGNATURE OF j WATER HEATER 0.50 PERMITTE SLOP SINK 0.50 I SPECTION RECORD FLOOR SINK @ 0.50 FLOOR DRAIN 0.50 DISHWASHER @ 0.50 DRINKING FOUNTAIN O.SOI . URINAL Q 0.50 J HOUSE SEWER Q 0.50 Z MISCELLANEOUS (� Lr I I 1 - APPROVALS DATE INSPECTOR'S NAME ROUGH PLUMBING GAS PIPING GAS.VENT CESSPOOL 1.001 CESSPOOL SEPTIC TANK: SEPTIC TANK 6 DRAIN ( ) PIT ( ) @ 1.00 I SEWER PERMIT . 1.00 CTAS TEST G TOTAL FEE UTILITY CO. NOTIFIED � � +.� FINAL WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT 's I hereby affirm that I have a certificate of consent to self 76o667A insure,-or a certificate of Workers'Compensation Insurance, CE.817(REV. 10/81) S or a certified copy thereof(Sec. 3800;.Lab,-C.) �} COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy NaR''L.r_p:/YI��`6.1�ny _ 1 , Certified copy is hereby furnished. IIJ Bllll,'DING FOR APPLICANT TO FILL IN(PRINT. R TYPE)' ADDRESS t4 Certified copy is filed with the county building'insPec- M-4 emnip, Oil tion ent. NUMBER FIXTURE OR ITEM FEE LOCALITY ep rim Date A li ant _ WATER CLOSET PP 4 NEAREST CERTIFICATE.OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION.INSURANCE (This section need:not be completed if the work:involved by SHOWER OWNER ' the permit is.for one hundred dollars(.5100)or less.) LAVATORY "" MAILADDRESS I certify that in the performance of the work for which this Ile 104- -To. n JU114iAA 8. 1 . permit is issued, I shall not employ any person in any manner SINK CONTRi4I7Y so as to become subject to.the Workers'Compensation Laws. DISHWASHER u CCT0. DING Date Applicant CLOTHES WASHER ADDRESS 1510 Q�LgY STREET NOTICE TO APPLICANT: If, after making this Certificate of Exemption, .yoy should become subject to the Workers' SWIMMING'POOLRECEPiORA A/+�A-L9603910 i Compensation provisions of the Labor 0-ode, you must forth- I CITY ��r 'vdtEL.gl1y®�® ); LAWN SPRINKLER SYSTEM with comply with such provisions or this;permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION I i DISTRICT. I> i ED BY I hereby.gffirm that]am licensed under provisions of Chapter:9 GAS SYSTEM OUTLETS `,✓��/``(/�) (commencing with Section 7000)of Division 3 of the Business � OUTLETS OVER � OL Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALID IO.N O DATE ` F3 License Number Lic. Class. Y 09 (� /] p FINA Contractor VDL•�'t Ont/►/t�ti• BY y W ❑] I am exempt Under-Sec. B.&P.C. for this reason ► Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE aln Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name ¢4 4 6,6 b A I hereby affirm that I am exempt from the Contractor's License Address G Law for the following reason (Section 7031.5, Business and Professions Code): city Tel. No. # 0 o 0 0 0.5 ❑ I, as owner of the property, will do the work and the I o o 1'6.5 0 structure is not intended or offered for sale (Section I 7044., Business.and Professions Code). I o - 165050 CONSTRUCTION LENDING AGENCY I hereby off irm that there is a construction lending agency for 10 8:86 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 application and state that the above information is correct. I agree to comply with all Countyj Pool ordinances and State laws regulating Plumbing, and hereby, authorize representative..'s of this County to enter upon the' above-men' ed pr p rYor in tion purpose . SEE REVERSE FOR EXPLANATORY LANGUAGE it I Signature of Permittee D e