HomeMy Public PortalAbout5324 ARDEN DR_Plumbing__ rt WORKERS'COMPENSATIONDECLARATION Ap WPl6eli"—AMN FOR Il"LluJ!lVv8MIG, PERM
I hereby affirm that I have a certificate of consent to self 76A667A
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 ND0029-109Qompan' CNA
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE), ADDRESS,
a Certified copy is filed with the county b it pec- ADDRESS 5324 Arden Dr".
tion department. NUMBER FIXTURE OR ITEM @ FEE
12/19/86 _ WATER CLOSET LOCALITY Tem l e City
Date - Applicant NEAREST
CERTIFICATE OF EXEMN F O OR BATH TUB
CROSS ST
COMPENSAT10/1NSURA 'E OWNER
'•(This'section'need not be coed if'the w involved by SHOWER KeVtri Costa
MAIL
the permit is for one hundred dollars ($100)or less.) LAVATORY. ADDRESS'53'24 Arden Dr .
I certify that in the performance ofthe'work for which this
SINK CITY TEL. NO
" permit is issued, I shall not he Wo any person in any manner Temple., Cl tV 9443-7443.
• so as to become subject to the Workers'Compensation Laws. 'DISHWASHER '
CONTRACTOR Nat Taylor & Sons. Plumb.
Date 'Applicant' CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS8402 .Katella Ave. /
Exemption; you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- CITY Stanton TEL. NIB 2'8-0550
LAWN SPRINKLER SYSTEM
with comply with 'such provisions or this-permit shall be STATE LIC.
deemed,revoked. 1 WATER HEATER` �j ,-U0 00 LICENSE NO. 136616 CLASS C 3 6
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY.
I hereby off irm-that l am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
and Professions Code,an ) f,the Business OUTLETS OVER
(commencing with Section 7000 of Drvisi
d my license i full f rce and effect. 5•PER SYSTEM i j)✓
Y FINALS (Jf�, VALIDATION
DATE tel✓ p},i
License Number ass C36
FIN L U.
Contractor Dat /1'/8 6 _ B
0.'
❑ if a exempt er C. 0
U
B P.C. for this re W
Plan check fee a'
Date: U)PLUMBING PERMIT ISSUING FEE$ 10 . 50 - _ Z
Signature6 4'Z'1 A
TOTAL FEE 16 50
# o 6,o o o 5 -
SINGLE FAMILY
Plan cIKeck applicant'
7
HOME OWNER-BUILDER DECLARATION Name ,;) 4 0-1 615 0
I hereby affirm that l am exempt from the Contractor's Licenseo 0 0,� 6'S v„
Law for the following reason (Section 7031.5, Business and Address
Professions Code')' City Tel. No. 2 0 5 m6 8
❑ I; as owner of theert ro '
P P Y-will.do the work and the ' •
structure ,is not intended or offered for sale (Section
704 Business and Professions Code).
CONSTRUCTION LENDING AGENCY"
I her 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.l have read this application and state that the "
above information is correct. I agr comply with all County D .
ordinances and State laws`re ati Plumbing, and hereby
authorize representatives o this aunty to enter upon the
a iTt ied erty or spection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
12/19/86
Signotur of P r> itt Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 -PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0202040012
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) '285-0488 EXT:
• LEGAL-ID: ._ . ...
FEES PAID BUILDING.ADDRESS:
TR: 11699 LT: 1 BL: .001 5324 ARDEN DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT.: TEMP CA 917803319
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: OLIVE
8585-020-001 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: .597 GRID: B4 LOCALITY: TEMPLE CITY
51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 '
TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
02/04/02 'JK. 08/03/02
OWNER: .. TEL. N0: _ FINAL DATE FINAL.BY: CODE:
GOETTLING TRS'.- (626) 359-2483 2ND
ARCD 910064709 DESCRIPTION OF WORK
INSTALL NEW HVAC
APPLICANT: TEL.- N0:
SAME AS OWNER
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: . , //%.� �i APPROVALS DATE INSPECTOR SIGNATURE
SAME-AS OWNER �
LIC.. NO i�� ,.P�..� �r`�, ���� UNDER SLAB WOR .
WATER SERVICE
!✓ PLASTIC Y/N METAL Y/N
ARCHITECT OR.ENGINEER: TEL. N0:'.
ROUGH PLUMBING
LIC. N0, iI GAS PIPING
-_- - - - S VENT
GA T
" HOT WATER HEATER
PLUMBING FIXTURES
\�\\ LAWN SPRINKLERS
GAS TEST
/i
UTILITY COMPANY NOTIFIED .
CWV .
r� GRAY WATER SYSTEM
REPORT ID: DPR263 ' ROUTE TO:,BS0508