HomeMy Public PortalAbout6102-6104 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