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Home My Public Portal About6326-6328 TEMPLE CITY BLVD_Plumbing__ T.AE.;A (CZ BITAPPLICATIO FOR PLUMBING PERMIT BUILDIN D SAFETY DIV FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 6328 R City Blvd. a NUMBER FIXTURE OR ITEM • FEE WATER CLOSET LOCALITY �Is C'lty BATH TUB NEAREST CROSS ST SHOWER OWNER Fal rhaven Development LAVATORY MAIL ADDRESS8656 R- glarrhingtnn rri SINK CITY San Gabriel TEL No 287-9527 DISHWASHER CONTRACTOR wen Bros. P Inc. CLOTHES WASHER O0 ADDRESS 4265 No baldwin Av)e.'q SWIMMING POOL RECEPTOR CIN Sl PSOIIt9 TEL NO 443-0078 LAWN SPRINKLER SYSTEM !� WATER HEATER LICENSE NO 231 `41 CRSS C3� GAS SYSTEM OUTLETS DIST CT NOp G UP �$j�jJNE PROC ED 50PERSYST MR i� O \7L INDUSTRIAL WASTE APPROVAL d' INSPECTION RECORD 8 3o Z 'g o P muT � Plan Check fee PLUMBING PERMIT ISSUING FEE S TOTALFEE Plan check applicant Name APPROVALS ATE cTqp ssw RE - UNDER SLAB WORK ,.F Address ROUGH PLUMBING City Tel No GAS PIPING I HEREBY ACKNOWLEDGE THAT 1 NAV! READ THM A ATION AND STAT! GAS VENT THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY IYTTH ALL COUNTY ORDOMNCES AND STATE LAWS REGULATING PLUMBING HOT WATER HEATER 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR LICENSED M PLUMBING FIXTURES RlOUIgED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE GAS TEST Z� LEGAL OWNER OF An INTEND TO RESIDE IN THE ABOVE DESCRIBED RESIDENTIAL PROPERTY UTLUTYOO NOTIFIED SIGNATURE of PERMITrnE FINAL PERMIT VALIDATION C� No CASH POLICY HOLDER:C'A •-� 9,A?-JUN 22 5 P 7 3P0 0 POLICY NUMBER: • WOVERS COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby,affirm that I have a certificate of consent to self 78AB87A insure a a certificate of Workers Compensation Insurance, CE 817(REV 8/88) or a certified copy thereof (Sec 3800 Lab C ) SEA Al5/1 COUNTY OF LOS ANGELES DEPT OF PUBLIC WORKS �� EAi / Policy No� Company i ❑ Cemhed copy is hereby furnished BUILDItJO FOR APPLICANT TO FILL IN(PRIM OR TYPE) ADDRESS tion department copy n fled with the county building inspec- tion deportment NUMBER FIXTURE OR ITEM ® FEE LOCALITY ' r pp'^"77 _T /� WATER CLOSET !_.G Date Q.lAppllSant v ✓7 �% NEAREST CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB COMPENSATION INSURANCE SHOWER OWNER (This s•efloe no"not be completed R the work Involved by MAR the permit Is for a"huntdred dollars($100)or foss) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is Issued, I shall not employ any person in any manner SINK TEL HO so as to become subject to the Workers'Compensotton Laws DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ADDRESS (� NOTICE TO APPLICANT If after making this Certificate of of Exemption you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY 6qZ5Ae1ZV TEL HD Compensation provisions of the Labor Code you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE ltC deemed revoked / WATER HEATER LICENSE NO CLASS CT LICENSED CONTRACTORS DECLARATION DISTRICT NO Cr er I hereby offum that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ^ D�/ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Profealons Code and my license Is in full force and effect 5 PER SYSTEM FDI VALIDA N 0 3�7�6/ Zo License Number �+I is Class 0c T FI O Contractor Date --I /I?) L V ❑ 1 am exempt under Sec IL 1A B 8P C for this reason Plan check fee = Date PLUMBING PERMIT ISSUING FEE f 2 6 6 8 6 A Signature TOTAL FEE # it • • • • 5 Plan chock applicant I • •,1 650 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License • • • 1 6506 Law for the following reason (Section 7031 5, Business and Address Professloro Cade) City Tel No 0 3 17 8 7 ❑ 1, as owner of the property, will do the work and the structure Is not intended a offered for sale (Section 100704 Business and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there Is a construction lending agency for the performance of the work for which this permit is issued (Sec 3097 Civ C ) Lender's Name Lender's Address 1 certify that I have rood this application and sate that the polo Information is cats rI agree to comply with all County ordinances and State jaws regulating Plumbing, and hereby authorize reprotentotivef of this County to enter upon the above mentioned property fa inspection purposes SEE RlVERfE FOR EXPLANATORY LANGUAGE <�� ✓J/J . /1//t . Signature of Permittee COUNTY OF IAS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1502250025 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 265-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS ITR 33529 UN 6 6328 TEMPLE CITY BL IFEE DESCRIPTION QUANTITY UOM AMOUNT TEMP CA 917801432 (ASSESSOR INFORMATION NUMBER I NEAREST CROSS STREET 15383-015-039 101 PERMIT ISSUANCE FEE 27 80 THOMAS PAGE 596 GRID J2 DOCALITY TEMPLE CITY CAI 147 WATER HEATER(S) 1 00 WTH 16 20 TENANT I TOTAL FEES 44 00 ISSUED ON PROCESSED BY PLAN BY 102/25/15 SR OWNER TEL NO NA WANG, THOMAS (714) 329-2137- FID�Lj^D.- FI ',+yy' CUDE 16328 TEMPLE CITY BL ZT7 � 1 ITEMP 917801432 I IIPTION OF WORK IREPLACED 40 GAL WATER HEATER SAME SIZE/LOCATION GARAGE APPL ICANT TEL NO IMATA, DANIEL (855) 345-9048- 128372 CONSTELLATIAN ISPECIAL CONDITIONS (VALENCIA CA 91355 ) I I 1CONTRACTOR TEL NO 1 1APPROVALS DATE INSPECTOR SIGNATURE 1 (AFFORDABLE WATER HEATER AND PLUMBIN (BEE) 345-9048- ) 128372 CONSTELLATION RD LIC NO UNDER SLAB WORK VALENCIA CA 91355 627368 IWATER SERVICE PLASTIC Y/N METAL Y/N (ARCHITECT OR ENGINEER TEL NO IROUGH PLUMBING LIC NO i (GAS PIPING I I (GAS vFNT I I I I HOT WATER HEATER I (PLUMBING FIXTURES (LAWN SPRINKLERS GAS TDST I (UTILITY COMPANY NOTIFIED( CWV IGRAY NATER SYSTEM I I I I I I I I I I I I I I I I I I I I (REPORT ID DPR263 ROUTE TO 850508 I I