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HomeMy Public PortalAbout9650 CRAIGLEE ST_Plumbing__ WORKERS'COMPENSATION DiStLP:R,ATION .� '` APPLOCAVOONI FOR G LUL o ONO Pamir I hereby affirm that I have a certificate ofconsent to self 76A667A insure, or a certificate of Workers' Comp sation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec:3806OTL C.') COUNTY OF-LOS ANGELES BUIL>MG AND SAF Policy No. Company - ❑ Certified copy:is hereby furnished. . _( FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING }L1A/L Certified copy is filed with theonty building inspec- ADDRESS do department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY L L11 12-R WATER CLOSET Date Applicant NEAREST / CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. L COMPENSATION INSURANCE OWNER . SHOWER (This section need not be completed if the work involved by MAIL 7(� -the permit,is for one hundred dollars'($100)orless.) . ' LAVATORY ADDRESS I certify that in'the performance of the work for which this ��j permit.is issued, I shall not-employ any person',in any manner SINK CITY EL. NO �iG. yA'�3 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHES WASHER ' ADDRESS 1437 NOTICE TO APPLICANT: If; after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR. Compensation provisions of the Labor.Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO. With comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS C LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS'SYSTEM OUTLETS �`� (commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code,and my licens is in full force and effect. 5 PER SYSTEM FINAL VALIDATION cOi License N' er Lic. Class L� C °� Co t ".i •DATE " I FINAL 0 Contractor Date BY b LU ❑ I am emp n (� �., B.&P.C. for this reason Plan check fee //V ?i Z Date: PLUMBING PERMIT ISSUING FEE>$ Signature TOTAL FEE - Plan check applicant Zj° 1 r5 SINGLE FAMILY , -150 HOME OWNER-BUILDER DECLARATION Name 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 structure is not intended or offered for sale (Section 7044, Business and Professions Code). + CONSTRUCTION LENDING AGENCY 8(}'R,2 It 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 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 abov entionecl for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE VZtU(d4_ , C/// YIJ3 Signature of Permittee Date + I WORKERS'COMPENSATION D.ECLARAT,ON o o //��,� nn� M I hereby ctffirmrthat I have a cgrtif cafe 5f consent to self1. 20-0026 DPW 6/87 �����- -��®� ��� ���UV❑L�I�uV� ������ -insure, of a tertificate of Workers' Compensatibri Insurance,- 764667 o;a certified copy thereof (Sec: 380U; lab. Cjpj COUNTY OF LOS ANGELES DEPT. OF PUBLICWORKS ' Policy No.zZ Company C5/7?ZJr_41hAL ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is'filed with the county building inspec- ADDRESS / tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY o /� ,P C.s WATER CLOSET Date Applicant © NEAREST 10 CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 55' CROSS ST. COMPENSATION INSURANCE SHOWER J7 OR (This section need riot be completed If the work Involved by Lam" MAIL the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 5al7L� I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner. SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR p Date Applicant = I I CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: if, after making this Certificate of 211414 w• eQ7r1/ '197� Exemption, you ,should become subject to the Workers' SWIMMING POOL RECEPTOR4�4Q Compensation provisions of the Labor Code, you must forth- CITY ` TEL. NO. lJ 7-9Dwith comply with such provisions or this permit.shall be LAWN SPRINKLER SYSTEM c q deemed revoked. WATER HEATER ISTATE ENSE NO. /50 / CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROAEDBY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS 0 '(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and m license is in full force and effect. 5 PER SYSTEM. Y FINAL ALI IOW License NumberSg3� Lic. Class DATE U �./_',� FINAL Contractor e6dte %��� BY ❑ I am exempt under Sec. lU B.&P.C. for this reason Plan check fee DZ Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant SINGLE FAMILY 5 HOME OWNER-BUILDER DECLARATION Name s I hereby affirm that am exempt from the Contractor's License A{_CTA ss Low for the.following reason (Section 7031.5, Business and Addre_ _ »,-,('� ,. ��-55 C� 3307 _tV n•:i r Professions Code): City Tel. No.❑ 1 .1 TENS I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section TOTAL & - s= 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CHECK 9­50 I hereby affirm that there is a construction lending agency for CHANGE, ,(I.I .the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). ,, Lender's Name I�VrJO-I Jl�.1 4/19190 Lender's Address 1t�iv 1 AM 8e2.9 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. SEE REVERSE FOR EXPLANATORY LANGUAGE - Signature of Permitttgo Date i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508_9701280004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID• FEES PAID �BUILDING_ADDRESS: ON FILE L65.0_CRAIGLEE}ST FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801410 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: i 5383-015-027 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY 13 DISHWASHERS) 1.00 FIX 16.35 TENANT: TOTAL FEES 44.10 ISSUED ON: PROCESSED BY: PLAN BY: EXPIR ON: 01/28/97 TC 01/2 /98 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CALDERON PHILIP;OVENTILE CHARLOTTE 9650 CRAIGLEE ST All TEMP 917801410 DESCRIPTION OF WORKI /J CHANGEOUT OF DISHWASHER APPLICANT: TEL. NO: MC DONALD ELECTRICAL SERVICE (909) 885-3827- 'SSS SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: �' � •` APPROVALS DATE INSPECTOR SIGNATURE MC DONALD ELECTRICAL SERVICE (909) 885-3827- 337 S. ARROWHEAD LIC. NO �, ,y.i �'+; `, \ '.UNDER SLAB WORK SAN BERNARDINO, CA 92408 49139 B ------"" --- -- - - - - - -- - 1 WATER SERVICE � iy' �1� _��( co" �1 PLASTIC Y/N METAL Y/N r, :;ARCHITECT OR ENGINEER: TEL. N0: j L��//;; =I��/ 1[��1 ���4 i;�! 1 L'co -- - - - - - - - ROUGH PLUMBING LIC. NO_ r,�r-�� I �I' t �� j �- - GAS PIPING GAS VENT CHOT WATER HEATER PLUMBING FIXTURES \� O LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508