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Home My Public Portal About4853 ARDEN DR_Plumbing__ WORKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A667A sure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING /cj5 Certified copy is filed with the county building inspection ADDRESS -JQ department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY .WATER CLOSET(TOILET) Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS 5T. COMPENSATION INSURANCE SHOWER OWNER (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any pe n in any manner so CITY TEL. NO. as to become subject to the WorkerS�Co ensation Laws. DISHWASHER CONTRACTORTeDn Date /0 Applicant / 4 CLOTHES WASHER ADDRESS d 0),)c -�a5 NOTICE T APP (CANT: If, after milking this Certific 1e of Ex-/ • i SWIMMING POOL RECEPTOR emption,you should become subject-to the Work;Ke CITY TEL. NO. _ cation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- �� STATE LIC. r <.� ed. WATER HEATER LICENSE NO. CLASS Lt� LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. �f HOSE BIB DATE S License Number /321 ' Lic. Class �'�� _ BY O i1uPDateJ / AL �( is U Contractor � � � I am exempt under Sec. 1_ U 1 1 Lt[[evjj 1%' LU B.&P.C. for this reason Pian check fee U' HL 72= 75 PLUMBING PERMIT ISSUING FEE$ }'��_ Signature TOTAL FEE -illy¢[(k _ �.E[YINGCE SINGLE DER 1 >/ Plan check applicant HOME``OWNER-BUILDER ECLARATION PP I hereby affirm thaT'9 am exempt from the Contractor's License Name for the following reason (Section 7031.5, Business and `'1000—lll�l ly '�IIP- Low ++ Professions Code): Address I, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, Business and Professions Code). S , 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 above- entioned property for inspection purposes- S//n SEE REVERSE FOR EXPLANATORY LANGUAGE Sign t r'e of Permittee Date ION DECLARATI WORKER'S ve'a certificate of consent to 76A666DPW9/89 APPLICATION FOR PLUMBING PERMIT Ll 76A667q I hereby affirm that I have'a certificate of consent to self insure, or a'cerfificate of Worker's Compensation Insurance, or a certified copy thereof(Sec`3800 Lab. C.), Policy No. 994965 Company REPUBLIC INDEMNITY COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. ❑/ Certified copy is hereby furnished. �( FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING - N. ARDEN DRIVE Certified copy is filed with the co my building inspection department. NUMBER FIXTURE OR ITEM @ L FEE LOCALITY TEMPLE CITY, CA Date 6/2t4/94 Applicant �� WATER CLOSET 6 5 `Q NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 170CROSS ST. COMPENSATION INSURANCE ASSESSOR p (This section need not be completed if the work involved by the SHOWER MAP BOOK p.J�.7 PAGEQ/,I— PARCEL e,Z)J permit is for one hundred dollars($100)or less.) OWNER INTEGRAL BUILDERS I certify that in the performance of the work for which this permit 6 "1LAVATORY AIL is issued, I shall not employ any person in any manner so as to SINK ADDRESS $29 S. become subject to the Workers'Compensation Laws. / DISWASHER CITY WALN�, CA TEL.NI�O9869-1075 Date Applicant / CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of FRANK MARRONE & SONS INC. Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such I IIADDRESS 9860 LOWER AZUSA ROAD provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY EL NIJNTE GA TEL.f-8/444-2548 d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencingwith Section 7000 of Division 3 of the Business and STATE LIC. O ) / GAS SYSTEM OUTLETS 16 LICENSE NO. 397884 CLASS136 116 0Professions Code, and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY a:° 5 PER SYSTEM Gam, Q License Number 397884 Lic.Class C/16 C/1 h �� 1' Q O W FINAL DATE -�`j, VALIDATION a F. MARRONE & SONS � 12/31/94 Contractor ' ate fA ElI am exempt under Sec. BY FINAL < B.&P.C.for this reason Plan check fee t7i 17 Date: PLUMBING PERMIT ISSUING FEE$ a� Signature Tn ❑ TOTAL FEE -89 . 0 5 Plan check applicant ;_;HELI sf''= t= SINGLE FAMILY } HOME OWNER-BUILDER DECLARATION Name ,. 1``Y` I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address Code): City Tel. No. ! ,'--'.ISSI. ❑ I, as owner of the property,will do the work and the structure - - -- is not intended or offered for sale (Section 7044, Business1 R _€ 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 above-mentioned prc t f �, Wfipurposes. /_/ SEE REVERSE FOR EXPLANATORY LANGUAGE S gnature of Permittee Date