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Home My Public Portal About9215 BROADWAY_Plumbing__ WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 sure,or a certificdfe of Workers'Compensation insurance,oro 76A667A certified copy thereof (Sec. 3800, Lab. C.) [IILJIII COUNTY OF LOS ANGELDEPT. OF PUBLIC WORKS 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 G?/V �G7�LLClQL(/ VyV(��G department. NUMBER FIXTURE OR ITEM - @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. 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 ^-T ADDRESS I certify that in the performance of the work for which this per- mit is issued, I shall not employ any person.in any manner so SINK * CITY TEL as to become subject to the Work o pensotion Laws: - DISHWASHER n Date/n/ / �,A CONTRALTO N e OkJ �H^JR��V Applica sX CLOTHES WASHER gDDRE55 '�Q L( ,�`� NOTICE.TO APPLICANT- If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,youshould become subject to the Worker's'Compen CITY L%i!�'� TwT vJ7.3fN(o satlon provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be.deemed revok- - STATE / p LIC / ev ed. WATER HEATER LICENSE NO. (Oa 5/O CLASS Gr LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM - OUTLETS �A 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. - . HOSE BIB _ DATEMlicense Number � O FINALcc Contractor�/GG�C -Dole BY Q O I am exempt under Sec. B.BP.C. for this reason _ Plan Check fee, - W ® d N Date:- PLUMBING PERMIT ISSUING FEE E ? Signature - ' - � _ - TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan checkapplicant ct a hereby affirm that I g r exempt from the Contr31.5, Business License Name- '1�'i. Low for the following reason (Section 7031.5, Business and Professions Code): - Address ,'s:�lh �'1•'�'�t I, as owner of the property, will do the work and the City _ Tei. No. 1 I i= ' structure is not intended or offered for sole(Section 7044, -Fj IjA� 13 o v J Business and Professions Code).' _ CONSTRUCTION LENDING AGENCY_ I� 1_Ht':' t1.SJ I hereby affirm that there'is a construction lending agency for - CHNNGE the performance of the work for which this permit is issued ` (Sec. 3097, Civ. C.). - -- .. L11]13 3-11(_J 1 ,_./2,/'7t Lender's Namef .e ';SOL 1 AM KI Lender's Address I certify that I have read this application and state thot'the above information is correct. I agree to comply with all County ► ordinances and State laws regulating Plumbing, and hereby authorizeauthorize repjenlatives of this this County to enter upon the above-m tione pr erty for inspection purposes.. 4P 0-1� _ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date - a COUNTY OF LOS ANGELES TEMPLE CITY k 0508 PLUMBING-PERMIT) DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS EPL_0508-9803040014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL PAID iBUILDING ADDRESS: TR: 12410 LT: 3 9215-BROADWAY-1 FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: CTEMP CA-917802402 ASSESSOR INFORMATION R: NEAREST CROSS STREET: 8588-002-003 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY 47 WATER HEATER(S) 1.00 WTH 16.35 TENANT: TOTAL FEES 44.10 ISSUED OR: ROCS D Y: PLA Y: EXPIRES ON: 03/04/98 UT 03/04/99 OWNER: TEL. NO: FINAL DATE FINAL BY: _ /CODE: 9215CANFORA JOE S;GRACE M (818) 286-2472- i p- x 9215 BROADWAY e7 �J TEMP 917802402 D CRiPUL-01618--1 — CHANGE OUT-OF-WATER-HEATER) APPLICANT: TEL. NO: MARSH PLUMBING (818) 407-1247- SPECIAL CONDITIONS: PNGELES CO CONTRACTOR: TEL. N0: S MARSH PLUMBING (818) 407-1247- �.� ��•f APPROI�ALS DAT INSPECTOR SIGNATURE 7229 VARNA AVE. LIC. NO UN ER'SL B LORI NORTH HOLLYWOOD, CA 91605 147728/L * WA—TEP SERVICE ARCHITECT OR E ER: T NO: _I PLASTIC Y/N METAL Y/N LIC. N0: P RO�GA�PLUMB N�G aF 11111 Gni. I N�G r --- _— GAT VIiRN T- P BE L C TV0'�--Rt�� HOT (ITT H A R PL NG FF XTUR S 5 R ER�TFkI.S . - GAS ilii r' 0 UT ILI'(Y C A�tO NTN15fIT1 ED 46��c Se'rvlce T 1o"` c�-- -� GRAY WATER SYSTEM * ADDITIONAL DATA ON FILE REPORT ID: DPR263 ROUTE TO: BS0508 1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0208060004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 12410 LT: 3 9215 BROADWAY FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802402 ASSESSOR INFORMATION NUER: NEAREST CROSS STREET: ENCINITA 8588-002-003 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 3.00 FIX 48.60 TENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED BY: P S 0 : 13 DISHWASHER(S) 1.00 FIX 16.20 08/06/02 JK 02/02/03 25 LAVATORIES/SINKS 5.00 FIX 81.00 OWNER: TEL. N0: 45 WATER CLOSET/URINAL 3.00 FIX 48.60 TI-N-AL DATE FINAL BY: CODE: SY•PHUNG (MARIE) (626) 308-2849-WK 47 WATER HEATER(S) 1.00 WTH 16.20 90`51 ARGO PLACE 49 WATER TREATING EQUIP 1.00 SYS 16.20 ROSEMEAD 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 DESCRIPTION OF WORK TOTAL FEES 286.95 PLUMBING FOR ADDITION/REMODEL APPLICANT: EL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: ��; �fi�> APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO /�r� - _ DE OR WATER S RVICE �// ��''-✓��- •-- \ \\ PLASTIC Y/N METAL Y/N ARCHITECT OR RUINER—' EL. 0: �� i f �.✓ -i _i � 1 ROUGHL LIC. Nd:', _ �— i �� GA--S-TrPTNu VEN-r— HOT WATER HEATER PLUMBING IX ES AWN SPRINKLERS r I/ $• � � GAS TEST UTILITY COMPANY NO I WV erv;c a�,� GRAY WATERSYSTEM REPORT ID: DPR263 ROUTE TO: SS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLL14BING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0208060009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5905 LT: 75 BL: .001 9178 LAS TUNAS DR FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917801905 ASSESSOR NEAREST CROSS STREET: ENCINITA 5387-017-043 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY 05 BACKFLOW DEVICE(S) 1.00 DEV 16.20 TENANT: TOTAL FEES 43.95 S BY: RES N: 08/06/02 JK 02/02/03 OWNER: TEL. N0: FINAL DATE FINAL BY: � OD LOK;HARRY - 3 DESCRIPTION SPRINKLER SYSTEM FOR LANDSCAPE L. YINGBO ZOU - 707 E WINNIE WAY SPECIAL CONDIT ONS: - ARCADIA 91006 r. CONTRACTOR: i'� APPROVALS DATE INSPECTOR SIGNATURE TEL. N82 //,�� '_/ GOODVIEW LANDSCAPE DESIGN AND CONST (626) 821-9008- 707 E WINNIE WAY LIC. NO UNDER SL WO ARCADIA CA 91006 634348BC27 �; RK WATER SERVICE �, PLASTIC Y/N METAL Y/N CHI NG O; ','/ - ROUGH PLUMBING LIC. NO, GA§ PfWG GAS VENT HOT WATERHEATER PLUMBINGFIXTURES RES - LA PR N L S GAS TEST UTILITY MPA NY NOTM-M CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508