HomeMy Public PortalAbout9559 WOODRUFF AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION /P _r_ �PPLICATI N FOR PLUMBING PERMIT
i hereby affirm that I have a certificate of consent to self I 76A667A
insure, or a certificate of Workers'Compensation Insurance, I CE 817(REV. 10/81) Temple City
or a certified copy thereof(Sec. 3800, Lab. C.) I
Policy Nom+ 601392 Zenith Ins• Co.; COUNTY OF LOS ANGELES BUILDING AND SAFETY
ompany
❑ Certified copy is hereby furnished.
® ' FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
ADD ESS 9559 E- Woodruff
Certified copy is filed with the county building inspec-
tion department.Geo Br plbg• NUMBER FIXTURE OR ITEM Crit FEE
Date 106=86 APPIi4ant i WATER CLOSET LOCALITY Temple City
NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' I BATH TUB CROSS ST. Las Tunas & Temple Cit
COMPENSATION INSURANCE I OWNER
(This section noed not bo complotod if tho work involvod by I SHOWER f+nselim0
the permit is for one hundrod dollars($100)or less.) LAVATORY MAIL
ADDRESS 9559 Eo woodruff
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY Temple City TEL.N0485-5013
so as to become subject to the Workers'Compensation Laws. DISHWASHER
CONTRACTOR George Brazil Mg.
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of 1 420 So. Broadway
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY Gardena 90248 TEL. N0515-0404
LAWN SPRINKLER SYSTEM
with comply with such provisions or this permit shall be STATE4416x78 LIC. C 36
deemed revoked. WATER HEATER LICENSE NO. I CLASS
LICENSED CONTRACTORS DECLARATION DISTRICT NO. ROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS -1 '
(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER C_.oir v� r
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM 6 FINAL y� VALIDATION O
DATE
License Number24094=—Lic. Class C 36 1Jater Piping
Plumbing
❑ Date 10-6-86 Contractor FA
°
�.D
I am exempt under Sec: �
B.$P.C. for this reason y
Plan check fee
Date: PLUMBING PERMIT ISSUING FEE$ 10 50
Signature ;
TOTAL FEE 16L50
Pian check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address
Law for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No.
❑ I, 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). Blip
CONSTRUCTION LENDING AGENCY -5 6 2 5 A
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued #t o 0 0 0 0 5
(Sec. 3097, Civ. C.). I o o 1 6 5 0
I ,
Lender's Name o 0 0 1 6 5 0 50
Lender's Address I ( (113-86
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 I
above-mentioned property for inspection purposes.
p SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
D.B.S.1723M SETS 12.44 .- APPLICATION FOR-PERMIT
DEPARTMENT OF BUILDING..AND SAFETY;;
COUNTY OF LOS ANGELES ° PLV I T
WM.J. FOX.CHIEF ENGINEER
NATURE OF INSTALLATION.; DISTRICT NO. GROUP ZO E PERMIT NO.
ROUGH - FIXTURES COMPLETE �•+ �._
READY FOR
HEATER CESSPOOL I SEPTIC TANK /�Eic HY FIRST INSPECTION.. DA�TB/'ISSUED
GAS MISCELLANEOUS ,LGf/�• !- 'sem
J�J
APPLICANT FILL IN HEAVILY OUTLINED,.PORTION ONLY
JO
a NAME //i i {7��/ i�/sZcl AS 1.��' rt. ADDRFSS .L! .
m _
SSM. •ADDRESS �2. �. �Z... t �Yd/i"J],f��/> .LOCALITY i�,,F fS;e.t��I'•: [� �/!�t!� -
J .-� Fa fir -t NEAREST
L CITY rF.z w..l A/ �r(�! �/s TEL.NO. CROSS ST.
COUNTY
CERT.No. 1. EXPIRES NAME.
LOCATION OF SEPTIC TANS,OR CESSPOOL: z MAIL
NORTH ,' O ADDRESS'
CITY. TEL.No.
1 AM THE LEGAL POSSESSOR OR THE ABOVE LOB
ANGELES.COUNTY AL
OF QUALIFICATION.
PLUMBER
1 AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED
ABOVE.
3 - > OWNER
CORRECTIONS
• SOUTH -
DESCRIPTION OF WORK
PATH TUB SURNACE
as
ROWER DISHWASHER
LAVATORY REFRIGERATOR
KITCHEN SINK WATER SOFTENER
FLOOR SINK SANDTRAP
LOP SINK RLOOR DRAIN
WASH TRAY URINAL APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE IMBPECTOR•S NAME
WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I
METER GAB SODA FOUNTAIN
OUTL GAS PIPING
GAS VENT h, e
CESSPOOL t!i I '\� �'. ' IJ 1
TOTAL NUMBER OF FIXTURES SEPTIC TANK I
. )CESSPOOL SEPTIC TANK 04SEWER I I
S / UTILITY CO.NOTIFIED I I
I TOTAL FEE ` ( d
111 FINAL VC
n.B:S.I3 2UM SETS 18.44 - .' _ APPLICATION FOR PERIW
DEPARTMENT OF -BUIL DING.AND SAFETY: � mm mm' 4 I
f• COU VY..OF LOS'ANGELES -.
ww J. FOX. CHIEF ENGINEER -
NATURE OF 'INSTALLATION•. DISTRICT ,O. GROUP ZONE PERMIT-NO.
•
ROUGH FIXTURES _I COMPLETE � •. . _ =
READY FOR
DATE ISSUED -
HEATER CESSPOOL. . RECEIVED By..,SEPTIC TANK � FIRST INSPECTION �r
' GAS MISCELLANEOUS -
APPLI ANT- FILL. IN jIIEA y OUTLINED PORTION- ONLY'
BB �
cc. •NAME. �: - ADJODRESS
�. ADDRESS -I/ `t. _T 6 ,$ _! � LOCALITY,
• O rsa—p_ NEAREST
- •
d. CITY �E 9l� TEL.No. CROSS ST.
COUNTY +a?i I"
CERT.No..-
3t"� EXPIRES .. ryf IC NAME .. +
-LOCATION OYSEPTIC TANS, OR CESSPOOL MAIL•
3 ADDRESS , . .
NORTH' O
CITY TEL.No:' '
1' AM THE LEGAL POSSESSOR-OF THE ABOVE LOS .
ANGELES COUNTY'CERTIFICAT OVAL C'A1ION.
rrce
• PLUMBER
rAM THE LEGAL OWNER OF THE PROPERTY DESCRISRD-
ABOVE.
` - OWNER'
_ CORRECTIONS
SOUTH
DESCRIPTION'OF WORN
BATH TUB FURNACE
J HOWER- DISHWASHER = Ai
AVATORY REFRIGERATOR F
ITCHEN SINK •• --WATER SOFTENER
FLOOR.BINK'' AND TRAP
¢LOP SINK' FLOOR DRAIN '
WASH TRAY URINAL. APPROVALS
WATER CLOSET DRINKING FOUNTAIN DATE tNS`P,icTOR�'t/I�rNAMs_
_.WATRER HEATER, ^ENTAL.LAVATORY ROUGH PLUMBING-)
METE GAS ' SODA FOUNTAIN
"""�pU� GAS PIPING
GAS VENT _ I.
_ /f- CESSPOOL I I
TOTAL NUMBER'OF FIXTURES, _ V v•"
f ! SEPTIC TANK
CESSPOOL *iEPTIGTANIC -+"'r- SEWER I I
$ -UTILITY CO.NOTIFIED I I
I TOTAL. FEE . �+ v s
FINAL .,
dVp
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9701150016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING-AD-DRESS:
TR: 6561 LT: 257 9559 WOODRUFF -AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802043
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5385-013-011 ti 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
07 BATHTUBS/SHOWERS 2.00 FIX 32.70
TE T: 21 HOSE BIBB(S) 1.00 FIX 16.35 ISSUED ON: PROCESSED BY: P EXPIRES ON:
25 LAVATORIES/SINKS 3.00 FIX 49.05 01/15/97 TC 01/15/98
45 WATER CLOSET/URINAL 2.00 FIX 32.70
OWNER: TEL. NO: 47 WATER HEATERS) 1.00 WTH 16.35 FINAL DA E � FINAL B CODE:
WONG, JESSE (213) 222-8929- 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.35 ,, `q
9559 WOODRUFF AV TOTAL FEES 191.25 `
TEMP 917802043 DESCRIP IO R
OF O
PLUMBING FOR NEW ADDITION AND NTERIOR REMODEL
AMERICAN APPLICANTTECH CONSTRUCTION (213) 222-8929-
`S �® SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: r �` APPROVALS DATE INSPECTOR SIGNATURE
AMERICAN TECH CONSTRUCTION (213) 222-8929- f »
130 E. AVE 32 LIC. NO '�,� _ 0 C0�' DER SLAB WOR
LOS ANGELES, CA 90031 013107 - _ _-
WATER SERVICE
ARCHITECT OR
-ENGINEER: TEL. 0: ® 0 ��11� cj, PLASTIC Y/N METAL Y/N
- ROUGH P MBI G
LIC. N0:
GAS PIPI G
GAS VENT
v ��T WATER HEATER
�A PLUMBING FIXTURES
LAWN SPRINKLERS
�� S ES
UTILITY COMPANY 0 FI D
C V
GRAY WATER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR263 ROUTE TO: BS0508