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Home My Public Portal About10516 DAINES DR_Plumbing__ W0JRKERS'COMPENSATION DECLARATION 20-0026 DPW 4/90 APPLICATION FOR PLUMBING PERMIT I heaieby, affirm Yhaf I have a certificate of consent to self in- ' Sufi or a cu''rtificote of Workers'Compensation Insurance,or a 76A667A ` ^ cerrnfied copy thereof (Sec 3800, Lab C ) clUll Policy NoCompany - COUNT'40FbLOS,ANGELES_• DEPT. OF PUBLIC WORKS ❑ Certified copy is hereby furnished ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING / a Certified copy is filed with the county building inspection ADDRESS S�tj department NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) - NEAREST CERTIFICATE OF EXEMPTION BATH TUB CROSS ST FROM WORKERS' tl COMPENSATION INSURANCE SHOWER OWNER UohH Me%' essle MCLI'I (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less,) LAVATORY ADDRESS S^6h I'Al(Z I certify that in the performance of the work for which this per- SINKp mit is issued, I shall not employ any person in any manner so CITY TEL NO p /00 as to become subject to the Workers'Compensation Laws DISHWASHER CONTRACTOR 61J;1e� J Date Applicant CLOTHES WASHER ADDRESS ` NOTICE TO APPLICANT If, after making this Certificate of Ex- 5��e SWIMMING POOL RECEPTOR emption, you should become subject to the Workers'Compen- CITY TEL NO sotion provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC ed WATER HEATER LICENSE NO CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER �J and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VA�IE}4TION fect HOSE BIB, DATE c License Number Lic Class J , Contractor Date / BY AL I i IT El a U Q ❑ 1 am exempt under Sec TOTAL 4 O -� 0 c_ iLs_i i! =_ B&P C for this reason WPlan check feea-i�, N Date PLUMBING PERMIT ISSUING FEE$ — Z Signature TOTAL FEE - J A SINGLE FAMILY d IJ i—L i1_�_ HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that 1 am exempt from the Contractor's LicenseName _ {N e5" Law for the following reason (Section 7031 5, Business and Professions Code) Address �as owner of the property, will do the work and the City Tel No structure is not intended or offered for sale(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 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 ,+ -/3 . �lZ SEE REVERSE FOR EXPLANATORY LANGUAGE 01 nature of Permittee Date ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508' PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9608260004 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID FEES PAID BUILDING ADDRESS: TR: 7690 LT: 13 - 10516 DAINES DR FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802812 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: HALIFAX 8586-029-017 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY 25 LAVATORIES/SINKS 1.00 FIX 16.35 TENANT: TOTAL FEES 44.10 ISS ON--. PRO E D BY: PLAN BY: EXPIRES ON: 08/26/96 TC 08/26/97 OWNER: TEL. NO: FINAL DATE FINAL B CODE: GARIBAY, ROBERTO (000) 000-0000- f/ 10516 DAINES DR. lhf�' l /f TEMPLE CITY, CA 5ncRIP ZION OF WORK SINK FOR NEW KITCHEN CABINETS APPLICANT: LUIS GONZALEZ (213) 221-7035- 2339 ALTA ST. SPECIAL CONDITIONS: LOS ANGELES, CA CONTRACTOR: TEL. NO: (\� Ooh APPROVALS DATE INSPECTOR SIGNATURE LUIS GONZALEZ (213) 221-7035- 2339 ALTA ST. LIC. NO UNDER B WOR LOS ANGELES, CA 406807 WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0. - LIC. N0: OUGH PLUMBING ttttn GAS PIPING 1j� GAS VENT VV U �c !J 'S�� HOT WATER HEATER (o o t UMBI T RES D \ fLAWN SPRINKL,ERS S T UTILITY COMPA I I ED C GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508