HomeMy Public PortalAbout9439, 9441 BROADWAY_Plumbing__ ION
r" affirmEhatIhaeacerIONDECLARATent APP`ICATION FOR PLUMBING PERMIT
I hereby offnm 4hdt I have a certificate of consen Cto self in- -PO-0046 DPW 4187
sure,or a certificate of Workers'Com ehsation Insuronce,ora 76AM7A
P CE 817(REV 8/86)- -
certified copy thereof(Sec 3800, Lab. C. - ' ' - • '
• 'PolkyNo.•7:0-0489607gompa�yCNA .Ins'.. 'Co.' COUNTY OF LOS ANGELES - DEPT. OF PUBLIC WORKS. -
Certified copy is hereby furnished FOR APPLICANT TO FILL IN(PRINT OR TYPE)' BUILDING
® Certified copy is filed with the cou aty buildinginspection - - ADDRESS 9439 & 9441 �BCOadwa -
department. t, - NUMBER FIXTURE:OR ITEM @ FEE LOCALIT -
1 1-25-89. )) NEAREST Temple Clt� .
Date •• + Applicant OwPm BYns.• Pf hg, WATER CLOSET (TOILET) fp'� � NEAREST
.CERTIFICATE OF EXEMPTION FROM WORKERS' • BATH Tie CROSS 5T.
- .COMPENSATION INSURANCE - SHOWER.-
SHOWER' If OWNER D&A Construction
(This section need not be completed•if the work involved by Man
the permit is for one hundred dollars.($100)or less.) iAVATORY '� ADDRESS 1.50 N'. Santa Anita Ave. (1470
1 certify,thai in the performance of the work for which ihis per- SINK r O,
mit is issued, I shall not employ any persooin any manner so _ CITY _ Arcadia TEL.`N 44.7-5641
as-tobecome'subject to the Workers'Compensation Laws. i -
- DISHWASHER. CONTRACTOR Bros, Plumbing, Inc.
Date ' - .- Applicant CLOTHES WASHER Owe
ADDRESS 4265 "N. Baldwin Ave.
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR
emption,you should become subject to the Workers'Compen- _ t CITY El Monte TEL' NO.443-0O7B "
lotion provisions of the.Labor Code, you must forthwith comp- - LAWN SPRINKLER SYSTEM
ly with such provisions or this permit shall be deemed revok- STATE LIC.
ed.^ ' -I• • ' WATER HEATER CENSE NO, 231 741' - CLASS C36-20
' 1 LICENSED CONTRACTORS.DECLARATION STRICT NO, CESSED BY
('hereby affirm that I am licensed underprovisions of Chapter GA '15.S SYSTEM 12,
9(commencing with Section 7000)of Division 3 of the Business ' OUTLETS OVER lJ(J
and Professions Code, and my license is'in full force and ef- 5 PER.SYSTEM FINAL VAL ION Y
feet. .. DATE/O -1747 O
License Number � 231 741 - 'Lic.-Class C36-20 U
FINAL - -
Contractor Owen Bros. ' P1.bBDote 1-25-89 _ - - BY '-' - p
(( t h
❑r I am exempt under Sec: 'j''` °� Q
B.BP.C. for this reason - - .3311-.,'° ,1tf,�1,1f I N
Plan check fee D _.
-0ate:" - _ PLUMBING PERMIT ISSUING FEE $ D 1 I r`_ �`
s-_
Signature r<• TOTAL FEE - Z(7 j4ITAL T2 17 a 50
- .SINGLE FAMILY -, l - li'iGl.�. „011,.0
HOMEOWNER-BUILDER DECLARATION Plan check applicant
CINE III I
hereby affirm borl.alowing r exempt from(Section
Contractors License Name � f
Law for the following reason (Section 703E 5,•Busiaess and
Professions Cade):. - Address
I, as owner.of the property,.will do.the work and the City -Tel. No. �L94_dplll /.110 G�
- slructure.is not intended or offered for sale(Section 7044, - h?' S Tat I lL1��.5-
Business and Professions Code). - - D - -
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 Nome'
Lender's Address - -
certify that I have read this application and s{ate that the
above information is correct. I agree•to comply with all County 1 D -
or inonces and State laws regulating Plumbing;ond•hereby
horize'representatives of this County to enter.upon the - -
ve ntioned propert for inspection purposes: - _ -
-25-89 SEE REVERSE FOR-EXPLANATORY LANGUAGE
Si ure of Permittee Date
I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0203110013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
_ .. FEES PAID BUILDING ADDR ESS; - =.
TR: 46260 �.LT: 1 - '- "UN: 3 -" - - ! - `9439BROADWAY. A - - - --
FEE DESCRIPTION:. QUANTITY: UOM: AMOUNT: TEMP CA 917802400
ASSESSOR INFORMATON NEAREST. CROSS STREET: CLOVERLY -
8588-004-041 01 PERMIT ISSUANCE FEE 27.75 .THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY -
13 DISHWASHER(S) 1.00 FIX 16.20
TOTAL FEES 43.95 ISS 0 E LA EXPIRES
03/11102 JK 09/07/02
OWNER: rEL. NO: FINAL-DA E FINAL BY: CODE: -
9439 BROADWAY UNIT A (626) 309-0213- f['Z--OZ--
TEMP 917802406 DESCRIPTION 0 R C
C/O DISHWASHER
APPLICANT: L. NO:
APPLIANCEINSTALLERS INC (562) 986-5511-
3823 INDUSTRY AVE SPECIAL CONDITIONS:
LAKEWOOD 99712
PNGELES Co
CONTRACTOR: TEL. NO: 05 �^/�. APPROVALS DATE INSPECTOR SIGNATURE
APPLIANCE INSTALLERS INC. (562) 986-5511- �. y
3823 INDUSTRY AVE LIC. NO UNDER SLAB 0
LAKEWOOD CA 90712 594252C36 _
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT 0 NG - L.
ROUGH M G
_ LIC. �NO: 1111711 -
GAS PIPING
GAS VENT
PBLEDL C W0KS HOT WATER HEATER
PLUMBING F R S
O 0
LAWN NKLE S
O .D
LIP, GAS TEST
UTILITY COMPANY0
CWV
Service Til
GRAY E
I -
. - REPORT; ID: DPR263 ROUTE TO: BSO08 - - -
._ -