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Home My Public Portal About4909 CAMELLIA AVE_Plumbing__ WOPyKERS'COMPENSATION DECLARATION 76A6e7A I gereby affirm that I have i certificate of constnt to self cc eri (r-ea) ' APPLICATION FOR PLUMBING PERMIT 'fl'If insure, or a certificate of Workers'Compensation Insurance,or - - I I a certified copy thereof(Sec. 3800,Lab.C.) • . Ll COUNTY OF LOS ANGELES. BUILDING AND SAFETY ' Policy No. Company Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING ' ID - ADDRESS:- Q '(/ ' Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM O FEE , department. LOCALITY �L !� P WATER CLOSET Date Applicant NEAREST BATH TUB CROSS ST.�rJ eN^ ' z. e, 4 . CERTIFICATE OF EXEMPTION FROM WORKERS' - • COMPENSATION.INSURANCE, SHOWER OWNER L. LAVATORY /� MAIL (This section need not be completed if the work involved J ADDRESS _ O by the permitisfor one-hundred dollars (S100) or'less.) SINK - • CITY B TEL. NO. 919, " ,%3 U I certify that in the performance of the work for which this DISHWASHER _ r,+C �r M permit is issued, I shall not employ any person in any manner - CONTRACTOR �(/�G/� 0 so as to become subject to the Workers' Compensation Laws. CLOTHES WASHER ADDRESS - U Date Applicant t SWIMMING POOL.RECEPTOR d NOTICE TO APPLICANT: If, after making this Certificate of CITY TEL.NO. - to Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. z Compensation provisions of.the Labor Code, you must forth- LICENSE NO. CLASS with' comply with-such provisions or this permit shall be WATER HEATER deemed revoked. - GAS SYSTEM OUTLETS DISTRICT NO. PROCESSED BV LICENSED CONTRACTORS DECLARATION OUTLETS OVER /O 1 hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM 01 9 (commencing with Section 7000) of Division 3 of the Busi- - FINAL / ness and Professions Code; and my license is in full force and DATE I�• —�� -VALIDATION effect. FINAL License Number Lic.Class - BY ' Contractor Date p D1 am exempt from the licensing requirements as I am a Plan check fee l 1 licensed architect mor a registered .professional engineer PLUMBINGPERMIT ISSUING FEE$ 00 acting in my professional capacity. (Section 7051, Bus- iness and ProfessionsCode). TOTAL FEE 6 ' 00 Lic,or Reg.No. ,Date Plan check applicant HOME OWNER-BUILDER DECLARATION LAAdd,.as me - I hereby affirm that I am exempt from the Contractor's AveLicense Law.for the following reason (Section 7031:5, Busi- y Tel. Nor 6 ' ness and Professions Code): ,$,4TQ 1 A 0 I, as owner of the property, am exclusively contracting Gr ' with licensed contractors to construct the project, # oo;o e o 5 (Section 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY - 'j'o•o (a C O I hereby affirm that there is a construction lending agency e o e 1 6Q p x for the performance of the work for which this permit is U issued(Sea 3097,Civ.C.). A 0i Q, -8 1 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 SEE REVERSE FOR EXPLANATORY LANGUAGE - ordinances and State laws regulating. Plumbing, and hereby authorize representatives of this County 10 enter upon the _ above- entioned property for inspection purposes. Sqdfaturc,of Permi to Wte . COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0108310016 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGALS D BUILDING DRESS: TR: 14467 LT: 41 4909 CAMELLIA AV FEE DESCRIPTION: QUANTITY: LION: AMOUNT: TEMP CA 917804243 SSE�SO�G ORMAT ION NUMBER: NEAREST CROSS STREET: TEMPLE CITY BLVD. 8589-015-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED N: PROCESSED AN BY: EXPIRES . 45 WATER CLOSET/URINAL 1.00 FIX 16.20 08/31/01 JK 02/27/02 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 OWNER:ERIC WING (62 TEL. Na5534- TOTAL FEES 92.55 FINAL DATE FINAL BY: CCHIU, ODE: 4909 CAMELLIA AV �!T`OC TEMP 917804243 DESCRIPTION OFA PLUMBING FOR ADDITION PP TEL.-NO: SAME AS OWNER - . _ _ SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: '�-//; � APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO Uffff FRUL-W-WORcb WATER SERVICE F / v - PLASTIC Y/N METAL Y/N ARCHITECT ENGINEER: L. NO: / ROUGH PLum§TWU- LIC. NO" - �O , B f �" GAS PIPING GAS VENT i - HOT WATER HEATER p PLUMBING \ MR SPRINKLERS GAS TEST/ uTrD77 COMPANY NOTIFIED Cwv �ervice ..he.. . �R- - GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY - # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0412150005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDUG ADDRESS: TR: 14467 LT: 41 4909 CAMELLIA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804243 ASSESSOR INFORMAT 0 NUMBER: NEAREST CROSS STREET: TEMNPLE CITY 8589-015-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY, C 11 CLOTHESWASHER(S) 1.00 FIX 16.20 _ TENANT: 21 HOSE BIBB(S) 1.00 FIX 16.20 ISSUED ON: PROCESSED Y: PLAN BY: EXPIRES ON: 25 LAVATORIES/SINKS 1.00 FIX 16.20 12/15/04 JK 06/13/05 56 GAS REGULATOR 1.00 REG 16.20 OWNER: TEL. NO: TOTAL FEES 92.55 FINAL DATE FINAL BY: CODE: CHIU, ERIC/JULIE W - 4909 CAMELLIA AV j C' TEMP 917804243 DESCRIPTION OF WOR PLUMBING FOR ADDITION APPLICANT' TE 0: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO UNDER SLAB WORK WATER SERVICE PLASTIC YIN METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS - GAS-T5ST V UTILITY-COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508