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Home My Public Portal About6424 TEMPLE CITY BLVD_Plumbing__ DEPARnfIMgT OF COUNTY ENGINEER PLUMBING 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES BuI—NG WILLIAM J. FOX, COUNTY ENGINEER ADDRESS 6 1. Or FOR APPLICA T O FILL IN LOCALITY C , BUILDING NEAREST v ADDRESS GROS88T DISTRICT NO GRO P ZONE PERMIT NO v LOCALITY � IA-1 s NEAREST J CROSS ST RECEIVED BY Rudy fp lm0oollon DATE/IoSSUED OWNER S 6- -s MAIL INDUSTRIALEAPP ADDRESS WASTE APPROVAL CITU TEL NO �)... INSPECTION RECORD PLUMBER ADDRESS Mg- CITY TEL NO p STAT LICENSE NO ❑COUNTY J PERMIT FEES z 1lIMnLR TY'[ OI FI% JRL OR OWN FL[ Q WATER CLOSET(TOILET) • 080 1 IZ n BATHTUB 0 080 SHOWER ® 080 LAVATORY(WASH BASIN) ® oto KITCHEN BINK 0 ONO LAUNDRY TUB OR TRAY 0 080 SLOPSINK 0 080 FLOOR BINK ® 080 FLOOR DRAIN ON DISHWASHER 0 080 DRINKING FOUNTAIN 0 080 URINAL 0 080 GASSYSTEM _ _OUTLETS 0 100 WATER HEATER ® 100 MISCELLANEOUS APPROVALS DATE IMBPECTOWB SIGNATURE UNDER SLAB WORK PERMITf 1-�cp 00 ROUGH PLUMBING GAB PIPING TOTAL FEE I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- BASVENT CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE HOT WATER HEATER TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING PLUMBING FIXTURES / 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY OASTEST 7 AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN ER OF THE ABOVE D SIGNATURE _RI ED REFS TIAL PROPERTY UTILITY CO NOTIFIED _ ; L. _ OF PERMITTEE i ddOei OBS 1! (`A, t,.%q COUNTY OF LOS ANGELES APPLICATION FOR PERMIT DSof County Engineer DIVISIONION OF OF BUILDING & SAFETY WILLIAM J FOX County Eppl Reer PLUMBING 1 FOR APPLICANT TO FILL IN DISTR PLUMB R R[ 1 FIRST NBPADY [RION DAT[ IeBU[D ADDRESS l/ BUILDING ADDREHS CITY TEL. N �{ COUNTY LOCALITY /fT_I LICENSENO EXPIRES NCAR PERMIT FEES CWI[eT BT NUMBER wFE Or rixTu r[on ITEM FCC OWNER MAIL 7I WATER OLOBET(TOILET) O O 60 ADDRESS r BATHTUB O 60 CITY TEL No SHOWER as GOO 1 HEREBY AGKNCW EDGE THAT I HAVE READ THIS LAVATORY (WASH BASIN) ® D e0 'J APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES KITCHEN BINK 0513 AND STATE LAWS REGULATING PLUMBING 1 CERTIFY THAT 1 POSSESS THE ABOVE VALID LOS LAUNDRY TUB OR TRAY ® 050 ANGELES COUNTY LICENSE. OR 1 AM THE LEGAL OWNER GAB SYSTEM OUTLETS a 0 60 GF THE RESIDENTIA P OP[ ESCRIBED ABOVE BIONATURE OF C WATER NEATER O O 60 PERMITT[ GLOP BINK • D 6G INSPECTION RE& RD FLOOR BINK Q O 6O FLOOR DRAIN Q O SO DISHWASHER m goo 2--6 e DRINKING FOUNTAIN Q 050 ?ENn O Y JF,aO URINAL a 060 �� /�/ ,� (n(� Q HOUSE SEWER 40 ago _Z MIGCELLANEOUR )E L, A6 r &L Tq / er/ 13 A'P/PROVALS CGWLN' DATE INBPEOTOR E NAM[ ROUGH PLUMBING 'L GAS PIPING SAB VENT I1 CESSPOOL ® LOO CESSPOOL SEPTIC TANK SEPTIC TANK DRAIN I ) PIT ( ) e 100i SEWER PERMIT 1 GD GAB TEST /daL. /- UTILITY CO NOIED FINAL TDTAL FEE L� C� TIF ,I sw r�_'a ' 6� 78&607 DRS#17 &68 WORKER COMPENSATION DECORATION 7a ADPW Yrae APPLICATION FOR PLUMBING PERMIT I hereby affirm that I hhave a certificate of consent to Bell Insure or a Certificate of Worker a Compensation Insurance or a certified copy thereof(Se6c�3t8�00 Lab C) Policy No(i-,bzo6Comppty 6TI4 ARM OF LOS ANGELES DEPT OF PUBLIC WORKS DEPT OF PUBLIC WORKS DIV ❑ Cemf ed copy is hereby furnished FOR APPUCANT TO FILL IN(PAINT OR TYPE) BUT ❑ ODRE3S Certified copy Is filed with the county bundling Inspection AIr depertmem NUMBER FDCTURE OR ITEM LOCAL r Y PLjr_- G Data Applicant WATER CLOSET /!} sZ. I r/ NEAREST ' CROSS ST CERTIFICATE OF EXEMPTION FROM WORKERS BATH TUB ASSESSOR COMPENSATION INSURANCE (This"Cirw roved not be completed H the work Involved by the SHOWER MAP BOOK n t+ PAGE PARCEL permit in for one hundred dollars($100)or leu) Z LAVATORYOWNER I certify that in the performance of the Work for which this permit Lzel l Is Issued I shell not employ any person in any manner so as to SINK ��RE99 692 72 —C� become Subject to the Workers Compensation Laws DISWASHER CITY L' TEL NO Date ApplicantCLOTHES WASHER CONTRACTOR M NOTICE TO APPLICANT It, after making this Csrtilicete o1 FP CpAt_4 Exemption you should become subject to the Workers Compensation SWIMMING POOL RECEPTOR ' + proens of the Labor Code you must forthwith comply with such ADDRESS wb5 La/r,,-I4�. * provisions or this permit shell be deemed revoked OWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION WATER HEATER CITY TEL NO d I hereby affirm that I am licensed under provisions of Chapter 9 — / // 8 (commencing with Section 7000) of Division 3 of the Business entl GAS�,�HA OWLETS4� SENSE NO 100 6P `S g Lrc Proteealonn Code,entl my[manse Is In full force end effect ry rr rix pyEp DISTRICT NO PROCESSED Bcc Y / a- SYSTEM h �/ Q License Number"03666 Uc Clea f_ FINAL V a r rr..�� ,,rr ° DATE VALIDATION a Contractor �rr�/aSL�Date 5 fA ❑ I am exempt under Sec FINAL ZBY a 5fl4CT.r B 8P c ler this reason 101 Date Plan check fee , 7707 116.60 Signature PLUMBING PERMIT ISSUING FEE$ 1 ITEMS ❑ TOTAL FEE p TIRI AL 126- 60 Plan check applicantv CHECK 125.6CI SINGLE FAMILY �` HOME OWNER BUILDER DECLARATION Name t'HAN6E ,{ f I hereby affirm that I am exempt from the Contractor a License Lew for the following reason (Section 7031 S Business and Professions Address Code) ❑ I as owner of the1 12� 7�?- Tel N , r C_4 o rj yds IJCII0[{-cgs property will do the work and the structure City pL is not intended or offered for sale(Section 7044 Business , �96 1 010:12, and Professions Code) CONSTRUCTION LENDING AGENCY I hereby affirm that there is a construction lending agency for the peAormance of the work for which this permit Is issued(Sec 3087, Civ C) Lender•Name Lender a Address I certify that have read this application and state that the above , Iniormelion le mac I gree to comply With all County ordinances and State a I Ing Plumbing and hereby authorize represent es a unty o enter upon the above mentioned Pr f2- /� 1QZBEE REVERSE FOR EXPLANATORY LANGUAGE I PeyRi ilea Date