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Home My Public Portal About8766 BURGHARDT RD_Plumbing__ 1 WO RKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING IDIfall.f� PERMIT �,_�1f y1 hereby affirm that I hove a certificate of consent to self 76A667A i'Y lf"If"IL PY Y Iltl FOR If" Y.YIH91fD Iltl`L9 Ir lG ll'19HE II \\l I{vlrsure, ar a certificate of Workers' Compensation Insurance, CE 817(REV:10/81 o�certified copy (Sec. 398 , by t.1 COUNTY OF LOS ANGELE17C. BUILDING AND SAFETY Poli r�2�� Company 0� /�� L� , Certified copy is hereby furnished. QFOR APPLICANT 70 FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS tion department. NUMBER 'FIXTURE OR ITEM C FEE OCALITY O 7)k/ Date Applisa WATER CLOSET NEAREST �7 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. S �. G COMPENSATION INSURANCE OWNER (This section need not be completed If the work involved by SHOWER IL O' c%E-/� �.� v L LAVATORY ADDRESS I S the permit is for one hundred dollars ($100)or less.) �s / Z D y 6 3 Q � 1 I certify that in the performance of the work for which this �. 7 [! permit is issued, I shall not employ any person in any manner SINK CITY I�,lL9 O7/7) TEL. NO.F 62,j2 so as to become subject to the Workers,,C p n5ati n Laws. DISHWASHER 6 — CONTRACTOR , Date Applicant CLOTHESWASHER `j ` .i✓ ADDRESS NO ICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY G �> Compensation provisions of the Labor Code, you must forth- Tl LAWN SPRINKLER SYSTEM TEL. NO. with comply with such provisions or this permit shall be STATE LCLASSe, deemed revoked. ` WATER HEATER -.�+ LICENSE NO. LICENSED CONTRACTORS DECLARATION DIST NO(/ PROCESSE I hereby affirm that I am licensed under provisions of Chapter 9 I GAS SYSTEM OUTLEtS ,,VVs t1C7 (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER f and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINALd ALIDATION O �/yy / DATE License Number �. Lic. Class y-/�^ a• Contract / �/ Date 7'J�-- BY AL U ❑ W I am exempt under Sec. B.BP.C. for this reason Plan check fee Z Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Q SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address 629' Law for the following reason (Section 7031.5, Business and '6A. Professions Code): _ City Tel. No.❑ ° S o o e e I, as owner of the property, will do the work and the n structure is not intended ar offered for sale (Section Z e 1 0'6 .0 7044, Business and Professions Code). D I CONSTRUCTION LENDING AGENCY _ ° °,1 06,5 0 F� I hereby affirm that there is a construction lending agency for �' 1.07-8 ) 07_8 3 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 hove read this application and state that the D above information is correct. I agree to comply with all County ordinances and State lows regulating Plumbing, and hereby , authorize representatives of this County to enter upon the abovr otiero rty for inspection purposes.sSEE REVERSE FOR EXPLANATORY LANGUAGE Signaturtee /Date ' DEC TION WORKERS't I have acertN cafe of corse APPLICATION FOR PLUMBING PERMIT I hergby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 insure.or a certificate of Workers' Compensation Insurance, 76A667A ar a'c`ertified copy thereof (Sec. 3800, Lak. C.) �. � COUNTY OF LO&ANGELES DEPT. OF PUBLIC WORKS , .Policy Nb'. W' 0 � Company - Certified copy is hereby furnished. BUILDING �(/ L /� ❑. FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS /W / ' l� Certified copy is filed with the county building inspe<- tion department. NUMBER FIXTURE OR ITEM [id FEE LOCALITY _ Dalei�. )C,O� , C/f WATER CLOSET � Applicont NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB. CROSS 57. G— COMPENSATION INSURANCE OWNER (This (This section need not be completed If the work involved by SHOWER MAIL 'z� ,l the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS u/1 0 I certify that in the performance of the work for which this -��y" permit is issued, I shall not employ any person in anyLmanner SINK Q CITY L�C t l TEL. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR 4707;&_J /V7/Q_ CII - Dote/T: If, after "not i � G"�'L\/ CLOTHES WASHER ADDRESS NOTICE Exemption, APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Compesat you provisions should become..subject , you Wt forth -CRYAfla DI TEL NO. IJ- Compensotion provisions Of the labor Code, you muss faith- LAWN SPRINKLER SYSTEM ' with comply with such provisions or this permit shall be _ STATE // yv LIC. deemed revoked. 'WATER HEATER LICENSE NO. �I J_ CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 - GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER - and Professions Cade,and my license is.in full force and effect. 5 PER SYSTEM FINAL R VALIDATION 5 LD 1 DATE —q Z. O' License Number Lic. Class _ _ _ U, t FINAL � Contractor - • ' Dwe.�._Y BY 0 I am exempt under Sec B.BP.C. for this reason 12 Plan check fee Dote: Z' PLUMBING PERMIT ISSUING FEE$ ,5'0 Signature � � TOTAL FEE fv Plan check applicant SINGLE FAMILY - HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I'om ezemptfrom the Contractor's License Address Law for the following reason (Section 7031:5, Business and ?Cl 7 Professions Code): City -Te 1. No. ` EliE I, as owner of the properly, will do the work and the structure is not intended or offered for sale (Section D . ' P-1 7044, Business and Professions Code). - t, Rr+_tTt;-,-,,,. `: __ .pit CONSTRUCTION LENDING AGENCY ;rtr_f_� I hereby nffirm that there is a construction lending agency for -: ._t?r'?I4t`C ,•_t�I! the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). Lender's Name Ai JJ L ' 149 i 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 lows regulating Plumbing, and hereby , authorize representatives of this County to.enter upon the - above-mentioned property for inspection purposes. , t SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date -• - - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT ` DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0910140006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: IBK: 164 PG: 31 PC: 2 8766 BURGHARDT RD IEEE DESCRIPTION: QUANTITY: DOM: ANAUNTSCAB CA 917752650 ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 5386-012-070 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl 113 DISHWASHER(S) 1.00 FIX 16.20 TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 11SSDED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I TOTAL FEES 60.15 10/14/09 SR 10/14/10 OWNER: TEL. NO: FINAL DATEFINAL BY: CODE: IYIP, KONG (626) 309-1479- 1 1 '•1 1��Y1 18766 BURGHARDT RD I SGAB 917752650 IDESURIPTION OF WORK PLUMBING FOR KITCHEN REMODEL 1APPLICANT: TEL. NO: IREN H ZHU (626) BOB-2704- 18631 HERMOSA DR. 1 SPECIAL CONDITIONS: [SAN GABRIEL CA 91775 CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IJ R TECH CONSTRUCTION (626) 808-2764- 18631 HERMOSA DR LIC. NO UNDER SLAB WORK [SAN GABRIEL CA 91775 750490 H [ WATER SERVICE PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER: TEL. NO: I I I - ROUGH PLUMBING A LI w�II LIC. NO: INCL/N�/I [GAS PIPING IGAS VENT I I I IHOT WATER HEATER PLUMBING FIXTURES I I (LAWN SPRINKLERS [ I I (GAS TEST (UTILITY COMPANY NOTIFIED[ CWV GRAY WATER SYSTEM I I I I [ I I REPORT ID: DPR263 ROUTE T0: eS0508