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Home My Public Portal About9906 BOGUE ST_Plumbing__ WORKERS' COMPENSATION DECLARATION ' APPLICATION FOR PLUMBING PERMIT 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 No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county building inspec- ADDRESS o tion department. NUMBER FIXTURE OR ITEM @ FEE WATER CLOSET LOCALITY Date Applicant NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWER ® OWNERD alis (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS P 1 certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Comp ti L DISHWASHER CONTRACTOR Date 3-9Applicant CLOTHES WASHER ADDRESS V� NOTICE TO APPLICANT: If, aft r mo g this Certificate of c'�/�/ iw2 Exemption, you should beta a su ject to the Workers' SWIMMING POOL RECEPTOR CITY TEL. NO. p Compensation provisions of the Labor Code, you must forth- ✓Q� LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE ��/ LIC. deemed revoked. WATER HEATER LICENSE NO. ( CLASSICOF36� LICENSED CONTRACTORS DECLARATION DISTRICT NO �- PR E ED BY 1 hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS ✓ (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM _ 3� DA EL f — VALID ION kp License Number �:2a'52Lic. Clasr/f ` FIN 0 Contracto IIO_lvDate LM I am exempt under Sec. � B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ —To ;23967A Signature TOTAL FEE 6— # o o a a o 5 Plan check applicant SINGLE FAMILY � ° ° 2&5 O HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License o o o 2 8.5 O= Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. 2 0 3-8 6 ❑ 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, 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 r pert i or inspection purposes. - SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ture of permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9609030018 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID• FEES PAID BUILDING ADDRESS: TR: 15159 LT: 9 9906 BOGUS ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802631 ASSESSOR INFORMATION NUMBER: NEAREST CROSS. STREET: BALDWIN 8588-015-017 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.35 TENANT: TOTAL FEES 44.10 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 09/03/96 TC 09/03/97 OWNER: TEL. NO: FINAL DATE FIN L BY: CODE: BEYER DOUGLAS D;MARTHA A (818) 285-3692- 9906 BOGUE ST TEMP 917802631 DESCRIPT C OFWORK CHANGE EXISTING TUB TO INCL E CIRCULATING TUB APPLICANT: TEL. NO: SAM VAN CONSTRUCTION (310) 207-3835 SPECIAL CONDITIONS: 1I 41 CONTRACTOR TEL. N0: APPROVALS DATE INSPECTOR SIGNATURE SAM VAN CONSTRUCTION (310) 207-3835- 1538 S. CARMELINA AVE. LIC. NO UNDER SLAB WORK LOS ANGELES, CA 90025 720037 B WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: ROUGH PLUMBING LIC. N0: GAS PIPING - - - GAS VENT HOT WATER HEATER PLUMBING FIXTURES - �� LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED cWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508