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Home My Public Portal About5932 BURTON AVE_Plumbing__ ',WORKERS' COMPENSATION DECLARATION APPLICATION PP ICA 4I®f.Sll FOR PLUMBING II LLA IOIIap,I� ItD21�/,1 IT • i rheMby affirm that have a certificate of consent to self 76A667A L'Ylr Ir IL Nsi'Y II II CI FOR Y�IL 01'9HE1� 11�1&9 If"L�II'L9H0 II insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lob. C. COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGn 2- V YY 7f 114 q Certified copy is filed with the county building inspec- ADDRESS `I kJ r /'L fl'// tion department. NUMBER FIXTURE OR ITEM FEE LOCALITY - Date Applicant WATER CLOSET � NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed If the work involved by SHOWER j'x C `2. o .'rl lQ qP the permit is for one hundred dollars ($100)or less.) LAVATORY MAIL �� Y•f- hi/3 9,6 .1—j 1 certify that in the performance of the work for which this ADDRESS E// �N YL permit is issued, I shall not employ any person in any manner / SINK � CITY Go�i ^ .� TEL. NO. j so as to become subject to the Workers'Compensation Laws. (7 cJ )/Date x��'' ^ DISHWASHER CONTRACTOR V `� ` Applicant y- "�/�-/ CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. With comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. OCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and m license is in full force and effect. 5 PER SYSTEM y FINALVALIDATION DATE 0 License Number Lic. Class V FIN 09 Contractor Date BY O h ❑ I am exempt under Sec. G B.BP.C. for this reason Date: Plan check fee D Z PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE - Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Nome I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, as owner of the property, will do the work and the `3 7 2.7 A structure is not intended or offered for sale (Section o D oto 7044, Business and Professions Code). # e1n5 CONSTRUCTION LENDING AGENCY 2° - 2250 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued 0 0 0 2 Z,5 0 5 (Sec. 3097, Civ. C.). ' 0 € 23 —BA Lender's Name Lender's Address I certify that I have read this application and state that the D 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 property for inspection purposes. I SEE REVERSE FOR EXPLANATORY LANGUAGE is Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 ppLTMBI G PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS hC_0508-960619b003 'BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BULL .LNG-ADDRESS TR: 5903 LT: 101 UN: .002 f59�BURTON-AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: -SGAB CA 917752630 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HERMOSA 5386-014-058 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: G3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.35 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.35 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.35 06/19/98 UT 06/19/99 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.35 OWNER: TEL. NO: TOTAL FEES 93.15 FINAL DATE �1 FINAL BY: 'DE: STEELE THOMAS A;JEANNE S (626) 287-2344- 5932 BURTON AV [ SGAB 917752630 DESCRIPTION OF W RK PLUMBING FOR NEW BATH A D GAS LINE APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: �/ APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - ,7 LIC. NO �\ UNDER SLAB WORK �� WATER SERVICE ARCHITECT OR ENGINEER: --TEL N0: I� PLASTIC Y/N METAL Y/N ROUGH PLUMBING LIC. NO: r GAS PIPING � .. GAS VENT HOT WATER HEATER PLUMBING FIXTURES ,'i `I LAWN SPRINKLERS ' f / GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: 850508 WORKERS'COMPENSATION DECLARATION re AssvA IYh-egby;,!firm that I have a certificate of consent to self wen lz-ea) APPLICATION FOR PLUMBING PERMIT insure, opa certificate of Workers'Compensation Insurance,or a certified cupy thereof(Sec. 3800,Lab.C.) lD�tel /� COUNTY OF LOS ANGELES BUILDING AN D;SAFETY' Policy NoY/b 4f Company 5 I ,9-7E -Fal4T ,Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ADDRESS 5932 'Burton Avenue . Certified copy is filed with the co tv uilding i pect NUMBER FIXTURE OR ITEM O FEE I P tm L LOCALITY Tem} ie City WATER CLOSET ''`""L' Uate Applicant NEAREST ' BATH TUB CROSS ST. �� .Z`lIIlaS'•' C'R�E OF EXEM TION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER Toro Steele MAIL (This section need not be completed if the work or less.) I LAVATORY ADDRESS 5932 .Burton Avenue by the permit is for one hundred dollars ($100) or less.) - y SINK CITY Tem1e Cl91775 TEL. NOL87.2344. 0 1 certify that in the performance of the work for which this DISHWASHER U permit is issued, I shall not employ any person in any manner _ CONTRACTO 2 so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS 1607. Garth Avenue 0 Date Applicant SWIMMING POOL RECEPTOR 0 NOTICE TO APPLICANT: If, after making this Certificate of CITVLos Angeles 90035 TEL. NO2_76-2503- W Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM a) STATE LIC. N Compensation provisions of the Labor Code, you must forth- WATER HEATER LICENSE N0400095. CLASS B Z with comply with such provisions or this permit shall be deemed revoked. DISTRICT NO. FIROCESSED BY GAS SYSTEM OUTLETS �r LICENSED CONTRACTORS DECLARATION OUTLETS OVER / e / zZ I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL 4 VALIDAT IC ness and Professions Code, and my license is in full force and DATE / (J effect. FINA License Numb p�` Lic. Class _ BY Contracto Date J F1 I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$ - acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name <8856A e o a e e s I hereby affirm that I am exempt from the Contractor's Address License Law for the following reason (Section 7031.5, Busi- City Tel. No. - - ' e - 1 ,650 ness and Professions Code): - o o e 5 0 1, as owner of the property, am exclusively contracting with licensed contractors to construct the .project 0 1,26-88 (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 agre to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws re go ing Plumbing, and hereby authorize represent yes oft County to enter upon the above a ion ed p petty f r spection rposes. t to a ittee Date