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HomeMy Public PortalAbout10902 WILDFLOWER RD_Plumbing__ •s, WORKERS'COMPENSATION DECLARATION APPLICAT10N FOR PLUMBING PERMIT I 'Hereby affirm that I have a certificate-of consent to self 76A667A 4"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.. BUILDING FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS �• OZZPAI/A AIWA Certified copy is filed with the county building inspec- tion department. rNUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST r • CERTIFICATE OF EXEMPTION FROM WORKERS' ' BAT}i TUB CROSS ST. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed IF the work involved by AWL the permit Is For one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued,I shall not employ any person in any anner SINK CITY L.NO. so as to become subject to the Worker 'Comp sati ws. DISHWASHER CONTRACTOR 771 on Date ,� ppltcant CLOTHES WASHER ADDRES NOTICE TO AP (CANT: If, after making this CertificateSWIMMING POOL RECEPTOR Exemption, you should become subject to•the Worker CITY TEL.NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this,permit shall be STATE •LIC. ,r deemed revoked. WATER HEATER LICENSE NO.ts ® CLASS(j LICENSED CONTRACTORS DECLARATION © DISTRICT NO�r, PRO BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 5-,- b (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDA ON } DAT (� LL License Number Lic. Class Q FI C,7 Contractor Date ❑ Q I am exempt under Sec. F- B.BP,C. for this reason Plan check fee ® CL Date: CC PLUMBING PERMIT ISSUING FEE$ -24.71.4'AI Signature F- TOTAL FEE # o o o 0 0 5' ' SINGLE FAMILY Plan check applicant J a o-1 650' HOME OWNER-BUILDER DECLARATION Name a,1 &5 0'L5 I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and U 52 7-8 6 Professions Code): City Tel. No. ❑ 1, as owner of the property, will do the work and the structure is not intended or offered for sale (Section 7044, 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 I certify that I have read this application and state that the above information is correct. I agree to comply with all County ordinances'and State laws regulating Plumbing, and hereby authorize representatives of this County to enter'upon the obo -me ion property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature at Permittee Date 76A667 (CE-617)- 3/73 C APPLICATION F=MWG PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING MAKE CHECKS PAYABLE TO: ADDRESS HARVEY T. BRANDY, COUNTY ENGINEER LOCALITY FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST NUMBER FIXTURE OR ITEM @ FEE CROSS ST. OWNER , V WATER CLOSET MAIL BATH TUB 1.75 ADDRESS ®Jo L., SHOWER 1.75 CITY TEL. NO r;Pf 0(. LAVATORY oa CONTRACTOR SINK 1.75 ADDRESS /�1.� (�� � '�^•' " DISHWASHER 1.75 CITY /p TEL. NQJS CLOTHES WASHER ;, 1.75 STATELIC LICENSE NO. /J ! O CLASS G3� SWIMMING POOL RECEPTOR 1.75 DISTRICT NO. GROUP ZONE CESSE1 BY i LAWN SPRINKLER SYSTEM 1.75 �® -� WATER HEATER 1.75 WASTE A AL OVAL GAS SYSTEM OUTLETS 1.75. INSPECTION RECORD v OUTLETS OVER 5 PER SYSTEM •30 CD F— c.7 , W a N Plan check fee See Reverse PLUMBING PERMIT ISSUING FEE $ 3 00 TOTAL FEE 7 1.04> APPROVALS DATE INSPECTOR'S SIGNATURE Plan check applicant UNDER SLAB WORK Name ROUGH PLUMBING Address GAS PIPING City Tel. N0. GAS VENT I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION HOT WATER HEATER •� AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEG4 OWNER OF, AND INTEND TO RESIDE IN THE ABOVE DES BED R S OENTIAL PROPERTY. FINAL SIGNATU RE ' OF PERMITT PERMIT VALIDATION qCK_ M.O. CASH PLAN CHECK IDATION CK. M.O. CASH 6.9 51"'APR 17 - 2 1 �-{� 7.0 0 d-'n 78 Aft87•_C.E#81.7 10-67 • C f�r •:e APPLICATION FOR 'PLUMBINePEIMI COUNTY OF LOS-ANGELES DERARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION fNMEAREST DING Q QO JOHN A. LAMBIE. COUNTY ENGINEER COLEMAN W. JENKINS. SUPT. OF BUILDING A 1� FOR APPLICANT TO FILL IN PR OR TYPE) SS ST. NUMBER FIXTURE OR ITEM EACH: FEE dq OWNER WATER CLOSET 3.50 MAIL BATH TUB 1.50 ADDRESS SHOWER - 1.50 CITY -TEL.NO. :gaol LA*'ATORi' 1.50 CONTRACT(R L -- SINK 1.50 ADDRESS C�2 DISHWASHER 1.50 TY TEL: NO 4��� ' CLOTHES WASHER 1.50 STATE ,SZI f` J�� LIC _ LICENSE ND-�+� OFCLASS 3WIMMINCi POOL RECEPTOR 1.50 DIST JGT NO. GROUP ZONE PR ESSED BY F LAWN SPRINKLER SYSTEM 2.00 e' t% C WATER HEATER 1.50 IND IAL V WASTE APPROVAL 00, CD GAS SYSTE OUTLETS 1.50 ' INSPECTION RE C.7 OUTLET V R W 5 PER VS M 30' �� h iWOZ GAL <o=n % 4A 009r a Plan check fee 25.7c of above. See reverse. PLUMBING PERMIT ISSUING FEE $ 2,,00 TOTAL FEE 6100. 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 RE ULATING GAS TEST PLUMBING. I HEREBY CERTIFY THAT 1 AM PROPERLY REGIS"_ D.4 D A D/OR UTILITY CO.NOTIFIED LIC04, ENSED AS REQUIRED BY LOS ANGELES COUNT N STA OF CALIFORNIA OR THAT 1 AM'THE L L NER INTE TO L N,THE ABOVE DESCRIS TI PERTY. ,, FINAL77 URE JACK R. ALLEN. SUPERVISING HANICAL ENG'R. RMITTEE mmmmod PERMIT VALIDATION CK. M.O. CASH PLAN CHECK VALIDATION CK. M.O. CASH M7629% MC12 5 D 8.00- 0 f ' 76AG67 8- CE 4.176-BB APPLICATION FOR PLUMBING PERMIT 1 BUILDING AND SAFETY DIVISION Department of County Engineer County of Loa Angeles BUILDING JOHN A.L.AMBIE,COUNTY ENGINEER ADDRESS CASSATT 0.GRIFFIM SUPT OF BUILDING LOCALITY FOR LIC O FILL IN NEAREST CROSS ST. OWNER DISTRICT NO. GROUP ZONE I READY FOR INSPECTION MAIL ADDRESS ' INDUSTRIAL CITYTEL. NO. WASTE APPROVAL PLUMBER . a - ey Dhti�Ing V-0• INSPECTION RECORD . W. Fleetwood :'1. ADDRESS__ 442 1.118.( ora Ed 5-1M CITY TEL.NO. _p LICENSE NO. NUMBER TYPE OF FIXTURE OR ITEM FEE WATER CLOSET (TOILET) @ $1.00 $ " BATH TUB @ $1.00 SHOWER @ $1.00 LAVATORY (WASH BASIN) @ $1.00 KITCI;IEN SINK @ $1..00 DISHWASHER @ $1.00: LAUNDRY TUB OR TRAY @ $1.00 ' CLOTHES WASHER @ .$1.00 WATER HEATER @ $1.00 GAS SYSTEM @ $1.00 APPROVALS DATE INSPECTTOORy'S SIGNATURE PERMIT $ 1 .00 ROUGH PLUMBING / i� tt�L�t roil GAS PIPING -/ v, i:.+�F:%%��-✓s TOTAL FEE GAS VENT 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THl APPLICATION [[��// !! AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY HOT WATER HEATER �'� a�f!.�". .!;. WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. PLUMBING FIXTURES I'. l`,9l� !:% 40 I:aq�!: 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR GAS TEST LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I A HE LE AL OWNER OF THE ABOVE UTILITY CO.NOTIFIED DESCRIBED RESIDENTIAL PERTY. ti A SOF PERMITI ROBERT A.WOOD, JOHN A.LAMBIE. OUNTY ENGINEER ATION SUPERVISING MECHANICAL ENG'R CK. N.O. CASH LAC03 5 1'8G; MT 18 3 1 0.00 r C'" . y COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9802020020 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: GAL ID: FEES PAID BUILDING ADDR S: TR: 23949 LT: 16 10902 WILDFLOWER RD FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803511 ASSESSOR N ORM 0 B R: NEAREST CROSS STREET: 8573-034-016 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.35 TENANT: 45 WATER CLOSET/URINAL 1.00 FIX 16.35 ISSUED ON: PROCESSED BY: PAN BY: EXPIRES ON: 47 WATER HEATER(S) 1.00 WTH 16.35 02/02/98 UT02/ 2/99 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.35 OWNER: TEL. NO: TOTAL FEES 93.15 FINAL DATE INAL BY CODE: WILSON JAMES H;SUSAN A (818) 579-0614- 10902 WILDFLOWER RD 4 l TEMP 917803511 MC-R-M-f-l-ON OF PLUMBING FOR BATHROOM EXTENTION PLICANT: TEL. NO: WINSLOW CONSTRUCTION (626) 358-6263- 525 W. WALNUT AVE. SPECIAL CONDITIONS: MONROVIA, CA CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR GNATURE WINSLOW CONSTRUCTION (626) 358-5263- 525 W. WALNUT AVENUE LIC. NO UNDER SLAB 0 c MONROVIA, CA 91016 668368 > �) 1241 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: LIC. NO: ROUGH PLUMBING GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY OTI C RAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508