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Home My Public Portal About6243 TEMPLE CITY BLVD_Plumbing__ o e.v-ry veN arra"rrre APPLICATION FOR PRRMT DEPARTMENT OFF IM AG AND SAFETY ��'�� ' COUNTY OF LOS ANGELES WM J FOX.CHIS ENGINEER NATURE 019 _ G 2� ROUGH rOcruRss eoMrLETr< HEATER COM-00L SEPTIC TANK ITEC[ BY Fl READY FOR DATE m 40 APPLICANT FILL IN HEAVILY OUTLINE�Dj PORTION ONLY y. NAME--�ee. . /d�� 11 � ice ADDRESS a ADDRINIGA 344 0004W Q4I I e. LOCALITYWE e-KARIMIT � CT'Tq�ft TEL 1 CROSS Sr �O COUNTY _� _ I C[Rr NO Z EKrIR �' NAM[ LOCATION OF SEPTIC TANK, OR CEMPOOL MAILADORS a $ t NORTH O }� C �I / TEL NO 1 AM THE'L[AAL FOBS DR OP [ ABOVE LOS ANGELES COUNTY C L I ION l 1 urvGa 1 AM THE L[OAL OWN P THE PROPURTY DES Rmm ABOV[- OWNOr CORRECTIONS 5i -I-Y-Y9 SOUTH J LT.TAL ESCRH'TION OF WORK _i Tun PURNACE D rc fY DISHWASHER O ORY evvRIOERATOR N SINK WATER SOFTENER SINK NANO TRAP INK FLOOR DRAIN , TRAY URINAL APPROVALS CLOSET RINKINO FOUNTAIN /� DATE IMNYGTOR•NArr H[ATOFT' { ENTAL LAVATORY ROUGH PLUMBING OAB r^^A FOUNTAIN GAS PIPING OUTL GAS VENT CESSPOOL I NUMBER OF FlKTURES SEPTIC TANK COr REPTICTANK B[WRR S UTILITY CO NQTlrlm f_ 1 DEPARTMEUNT OY OF LOS AINNGAND SA Y PLICATION FOR PERMIT PLUMBING WM J FOX CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO I IROUP I ZONE PERMIT No ROUGH 5 2-9 Z PLUMBING FIXTURES COY PLLT[ RECEIVED B� 1 READY FOR DAT[ ISSUED HEATER Cl[HSIOOL SEPTIC TANK 'LN1 FIRST INSPECTION APPLICANT FELL IN HEAVILY OUTLINED PORTION ONLY JOB NAM[ ADDRESSBlvd, ° ADDRESS 810 South Flower Street LOCALITY Temple City x CITY Loa Angeles Tea. NO mi 5181 cN=sE eTS o Duarte Rd.(�� CHRTN NO 1 E%PIRES 11- W NAME ®• •�61ph Breiv CATION OF SEPTIC TANK, OR CESSPOOL woowese 835 N. Sunset Blvd. NORTH CITY Temple City TKL No 1 AM THE LEGAL POSSESSOR THE ABOVE LOB ANGELES COUNTY CERTIP C Z UALIFICATION R 1 AM THE LEGAL OWNER OF THE PROF e[D[sCRIBHD ABOVE OWMKR CORRECTIONS SOUTH J DESCRIPTION OF WORK z TRI Tun FURNACE u C ROWER ..,�� DISHWASHER 0 LAVATORY SW201 REFRIGERATOR KITCHEN SINK WATER SOFTENER R BINK RAND TRA! SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET ^SINKING FOUNTAIN DATE NAIo WATER NEATER DENTAL LAVATORY ROUGH PLUMBING METER-GAS SODA FOUNTAIN GAB PIPING OUTL GAB VENT CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK SEWER �ESSPOOL SEPTIC TANK Is UTILITYCO NOTIFIED L.0 TOTAL FEE 1 FINAL y 1 DEPARTMENT OF BUILDING APPLICATION FOR PERMIT COUNTY OF LOS ANGELES PLUMBING NAMURE OF INSTALLATION DIST/{RICT No GROUP 1* PERMIT No ROUGH PLUMBING FIXTURES GOM E .2 HEATER CESSPOOL I Bfi READY FOR RECEIVED BY DATE ISSUED FI�NB�ON .^ _ AS MISC[l NOUS Q/y I�—\ � OUTLANED PORTION ONLY JOB [ NAM6 ADDRESS Y B xc ADDRESS LOCALITY I jCROSSBT 6 CITY CROSS 8T STATE CW NTY LICENSE NO R[O NO It NAME LOCATION OF SEPTIC TANK, OR CESS POO z MAIL f� 3 ADDREBB V221—. NORTH D CITY TR NO C RRECTIO S Ay Po✓J � i z SOUTH DESCRIPTION OF WORK o BATH TUB FURNACE \ ----SHOWER DISHWASHER LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR BINK RAND TRAP ------SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE IXSP n• NAME WATER MEATIER DENTAL LAVATORY ROUGH PLUMBING METER—GATE GASA^DA FOUNTAIN GAS PIPING OAS VENT q� CESSPOOL TOTAL NUMBER FIXTURES SEPTIC TANK SEPTIC TANK ji �{.HBSPOOL .� SEWER 1 PERMIT FEE I I OO UTILITY CO NOTIFIED 1 TOT VIN ' —3 ` WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that 1 have a certificate of cement to self 76W6e7A insure or a certificate of Workers Compensation Insurance CE 817(REV 10/81) or a certified copy thereof (Sec 3800 Lab C ) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No Company Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRIM OR TYPE) ADDRESS ✓ Ccopy n fled with the county buildingmspec tion on dclop epartment NUMBER FIXTURE OR ITEM ® FEE LOCALITYDate Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB CROSS COMPENSATION INSURANCE SHOWER (This section need not be completed If the work Involved by the permit Is for one hundred dollars(5100)W I LAVATORY AD I certify that m the performo o work i ich this permit is issued, 1 shall nate oy a person manner BINK CITY TEL N as to become subject to a War Com ion Laws DISHWASHER CONTRACTOR i Dot pli CLOTHES WASHER ADDRESS NOTICE TO APPLI should at making a Cer to of SWIMMING POOL RECEPTOR Exemption you should ome subject to orkers' CITY TEL NO Compensation provisions the Labor Code,�u ust forth- 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 DISTRICT NO SSED By I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code and m Imense is in full force and effect 5 PER SYSTEM d 0. Y FI / _/d yp� VALIDATION Q License Number Uc Closs V 7 O T V FINAL "0 Contractor Date BY U OO ❑ I am exempt under Sec G 4 B 8P C for this reason sir Plan check fee = Date PLUMBING PERMIT ISSUING FEE S Signature TOTAL FEE lj Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name -967. 1 A I hereby affirm that I am exempt from the Contractors License Address Low for the following reason (Section 7031 5 Business and Professions Code) Gry Tel No 1 •r• • 05 ❑ 1, as owner of the property, will do the work and the 5 0 structure is not intended or offered for sale (Section 7044 Business and Professions Code) popr• •'• 34506 CONSTRUCTION LENDING AGENCY 0 3 13-84 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Ctv C ) Lender s Name Lender's Address 1 that I have read this application and state that the ► eve in anon omect I agree to comply with all County ordmonces nd to I= regulating Plumbing and hereby authorize reptt rves of this County to enter upon the ab mentio p operry for inspection purposes p SEE REVERSE FOR EXPLANATORY LANGUAGE y nature mm to Date