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HomeMy Public PortalAbout5315 BARELA AVE_Plumbing__ Vt'PKER'SCOMPENSATIOhDECLARATION 20-0026 DPW 9189 APPLICATION FOR PLUMBING PERMIT ' Iihereby:aftirm that I have a certificate of consent to self insure, 76A667A or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspection ADDRESS ( 7 *3e r A— department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY k, ? j Date Applicant ' WATER CLOSET /jl1 NEAREST r ri CERTIFICATE OF EXEMPTION FROM WORKERS' 'BATH TUB CROSS ST. 1V COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the 1 SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars($100)or less.) OWNER ii A® 111.x I certify that in the performance of the work for which this permit LAVATORY � T - , L/f+�CL�/ Q . '-d�a is issued, I shall not employ any pk person in any manner so as to /�/.• [L. �"� MAIL become subject to the Workers'Compensation Laws. SINK ADDRESS DISWASHER CITY � L TEL.NO. Date Applicant CLOTHES WASHER L YI CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR l provisions of the Labor Code, you must forthwith comply with such ADDRESS dyL Z/ provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and STATE LIC. Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS U OUTLETS OVER DISTRICT NO. �p PROCESSED BY cc 5 PER SYSTEM ©� w t License Number Lic.Class C FINAL Z_ VALIDATION d DATE Contractor Date CO ❑ 1 am exempt under Sec. BY AL BAP.C.for this reason Date: Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ � ❑ TOTAL FEE / Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name 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. 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). ' 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, CC) ,-, C'. ^, —f t*S Civ.C.) �,j � -,3> rn a Lender's Name , P f �-t Lender's Address t•-'• r'� I certify that I have read this application and state that the above E' �) information is correct. I agree to comply with all County ordinances nn and State laws regulating Plumbing, and hereby authorize , representatives of this County to enter upon the above-mentioned '^•. r) f C+J property for,inspection purposes. +7 'Ji r'rt _ � SEE REVERSE FOR EXPLANATORY LAI�UkGE I�'+ f(}oro ?173 C=3 w r_ _r, Signature of Periaittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0901060003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: ITR: 14210 LT: 9 I I 5315 BARELA AV IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:( TEMP CA 917803243 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1 18589-002-009 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl 1 164 WATER PIPNG <= 1 1/2 1.00 LIN 16.20 1 1 (TENANT: I TOTAL FEES 43.95 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 101/06/09 SR 07/05/09 I (OWNER: TEL. NO: I IFINAL DATE FINAI BY: CODE: IWITTE MARK (626) 309-1700- P I 1 ' 15315 BARELA AV I T A ITEMP 917803243 1 1DSCgIPTIIDN OF WORK I REPLACE WATER MAIN I 1APPLICANT: TEL. NO: 1 1 1 TACE PLUMBING & SEWER CONTRACTOR (805) 208-8769- 1 1 _ 11560 NEWBURY RD. I ISPECIAL CONDITIONS: 1 INEWBURY PARK 91320 1 I I ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 1ACE PLUMBING AND SEWER CONTRACTOR I (805) 208-8769- 1 1 I 11560 NEWBURY RD SUITE 1 LIC. NO 1 1UNDER SLAB WORK I 1 I 1PMB 290 844340 C36 1 I 1 I 1 INEWBURY PARK CA 91320 1 IWATER SERVICE 1 1 1 I I PLASTIC YIN MET N 1ARCHITECT OR ENGINEER: TEL. NO: 1 111 I _ I ROUGH PLUMBING I I I LIC. NO: i I I I IGAS PIPING IGAS VENT 1 1 I IHOT WATER HEATER 1 IPLUD3ING FIXTURES I ILAWI2 SPRINKLERS 1 1 1 IGAS TEST 1 I I 1UTILITY COMPANY NOTIFIEDI II ICWV I I 1GRAY WATER SYSTEM I I I I 1 I I I I I I I I I I 1 1 I I I I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1103030008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: ITR: 14210 LT: 9 I 5315 BARELA AV I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803243 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: OLIVE 18589-002-009 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl 1 _107 BATHTUBS/SHOWERS 2.00 FIX 32.50 I- 1 (TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.30 (ISSUED ON: PROCESSED BY: PLAN BY: 1 I 145 WATER CLOSET/URINAL 1.00 FIX 16.30 103/03/11 SR 1 I I TOTAL FEES 92.90 1 I (OWNER: TEL. NO: I IFINAL DATE FINAL BY: CODE: 1 IWITTE MARK A;LINDA J (626) 309-1700- 1 1 15315 BARELA AV /�/ `` I _� 1 ITEMP 917803243 1 (DESCR ''IPTION OF WORK I IPLUMBING FOR BATHROOM REMODEL I (APPLICANT: TEL. NO: I I (SAME AS OWNER ISPECIAL CONDITIONS: I I I I I ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1' ISAME AS OWNER - I I I LIC. NO 1 1UNDER SLAB WORK I I IWATER SERVICE 1 1 IPLASTIC YIN METAL YIN I 1ARCHITECT OR ENGINEER: TEL. NO: II I - I IROUGH PLUMBING 1 LIC. NO: I I I I IGAS PIPING I I I I I IGAS VENT I I I IHOT WATER HEATER I I I I I I I 1PLUMBING FIXTURES I I I I I ILAWN SPRINKLERS I I I I IGAS TEST I I I I I (UTILITY COMPANY NOTIFIED( I I ICWV I I I I IGRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1402100018 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ITR: 14210 LT: 9 I 1 5315 BARELA AV 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917803243 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18589-002-009 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CAI 1 _113 DISHWASHER(S) 1.b0 FIX 16.20 I (TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 11SSUED ON: PROCESSED BY: PLAN BY: 1 I 163 WATER PIPING BR/FIX 12.00 FIX .81.60 102/10/14 SR 1 I I TOTAL FEES 141.80 1 I IOWNER: TEL. NO: I IFINAL DAT FIN Y: CODE: 1 IWANG, YIBING (626) 286-8883- I I I 15315 BARELA AV I I ITEMP 917803243 1 IDE CRI TION F WORK ki I 1 (REPLACE DISHWASKER, SINK AND REPIPE 12 PLUMBING FIXTURES (APPLICANT: TEL. NO: 1 ISAME AS OWNER - 1 I 1 (SPECIAL CONDITIONS: 1 I I CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER - I I I LIC. NO JUNDER SLAB WORK I I I 1WATER SERVICE IPLASTIC YIN METAL YIN I 1 1ARCHITECT OR ENGINEER: TEL. NO: 1 I I I - IROUGH PLUMBING LIC. NO: I IGAS PIPING I I 1 I I I I 1GAS VENT I I I I IHOT WATER HEATER I I I I I I I I 1PLUMBING FIXTURES 1 I 1 I I I I I ILAWN SPRINKLERS I I I I I I I 1GAS TEST I 1 I I I I 1UTILITY COMPANY NOTIFIEDI I I I 1 jCWV I I I I 1GRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1402110010 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0486 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: I ITR: 14210 LT: 9 I I 5315 BARELA AV I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803243 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18589-002-009 02 009 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY CAI 145 WATER CLOSET/URINAL 1.00 FIX 16.20 I (TENANT: I ITOTAL FEES 44.00 11SSUED ON: PROCESSED BY: PLAN BY: 102/11/14 SR I . OWNER: TEL. NO: i FINtAl DATE FINY: CODE: (WANG, YIBING (626) 286-8883- 15315 BARELA AV Y' ITEMP 917803243 DESR PTION OP WORK -i (REPLACE WATER CLOSET ON POWDER ROOM 1APPLICANT: TEL. NO: i I (SAME AS OWNER _ 1 I I I iSPECIAL CONDITIONS: I Iagt (SAME AS OWNER (CONTRACTOR: TEL. N0: i IAPPR DATE INS ECT R IGNAT _ LIC. NO i 1UNDER SLAB WORK I (WATER SERVICE I 1 _i (PLASTIC Y/N METAL Y/N I 1ARCHITECT OR ENGINEER: TEL. NO:' - I (ROUGH PLUMBING I I LIC. NO: GAS PIPING IGAS VENT 1 IHOT WATER HEATER I I i (PLUMBING FIXTURES I I I [LAWN SPRINKLERS I IGAS TEST I (UTILITY COMPANY NOTIFIED( [CWV I I I I I I I I (GRAY WATER SYSTEM I I I I [ I I I I I I I I I I I I I I I I I I I I I I 1 I I I I I (REPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I