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Home My Public Portal About10918 DAINES DR_Plumbing__ WORKER'S COMPENSATION DECLARATION 20.0026 DPW 9189 APPLICATION FOR PLUMING PERMIT 6A66]A I hereby affirm that I have a certificate of consent to self insure, F9 ora certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 i,�a"b. - - - 7n ' [ re4r r -f COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No.� ompany ' Certified copy is hereby furnished. W//,7�4 UILDING L zaCertified copy is filed with the county building inspection FOR APPLICANT TO FILL IN(PRINT OR TYPE) BADDRESS �t �r S d anr/t�mnen1. NUMBER FIXTURE OR ITEM Q FEE - /C /� LOCALITY C Date G Applican �V V f,✓ WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' / BATH TUB CROSS ST. - - '' -- - COMPENSATION INSURANCE ASSESSOR -. . _ .. _ (This section need not be completed if the work involved by the / SHOWER MAP BOOK PAGE - PARCEL -- p + + I certify that in the performance of the work for which this permit Z, LAVATORY ermit is for one hundred dollars($100)or less.) OWNER is issued, I shall not employ any person in any manner So as to MAIL SINK ADDRESS S/i..w become subject to the Workers'Compensation Laws. DISWASHER CITY TEL,NO. Date Applicant- CLOTHES WASHER CONTRACTOR ,//^.� /� NOTICE TO APPLICANT: If, after making this Certificate of / f-/� Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR ADDRESS /� / provisions of the Labor Code, you must forthwith comply with such yy� V✓. �r-f-A - � b provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM / LICENSED CONTRACTORS DECLARATION CITU G �7 i TEL.NO. >_ I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER ddd a (commencing with Section 7000) of Division 3 of the Business and STATE /l lG,/�iS r LIC. A_'� U Professions Code, and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. 7 l7 Y 6 i CLASS 6 OUTLETS OVER DISTRICT NO. PROCESSED BY 5 PER SYSTEM O D Q License Number � " Lia Class C 61 FINAL VALIDATION W �� Contractor 3 DATE a L/ /gym gate C _ co I am exempt udFINAL Zder Sec. gy B.&P.C.for this reason Plan check fee D /� Date: Signature { (.—��✓� PLUMBING PERMIT ISSUING FEE$ �' Q - ❑ TOTAL FEE Plan check applicant SINGLE FAMILY AC-C.T.r HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law `.'i�` for the following reason (Section 7031.5, Business and Professions Address - -' I-G Code): i -_-(t1!' ❑ City Tel. No. I,as owner of the property, will do the work and the structure T CITAL 77 , 25 is not intended or offered for sale (Section 7044, Business and Professions Code). 2 D Ci1.1=(y( CONSTRUCTION LENDING AGENCY CHANCE 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 _ t1'• i 1 _- Lender's Address I certify that I have read this application and state that the above I D 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 prop or inspec on purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE / I I I Q � o 93 Signature W Permittee I Da e WORKER'S COMPENSATION DECLARATION 0-0026 76A667DPW 9/89 ' APPLICATION FOR PLUMBING PERMIT or hereby affirm that I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec. 3800 Lab. C.) / COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS _ - DEPT. OF PUBLIC WORKS DIV. Policy No. Company Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING - Certified copy is filed with the county building inspection ADDRESS department. TNUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. - - COMPENSATION INSURANCE- - — .. ASSESSOR _. (This section need not be completed if the work involved by the SHOWER MAP BOOK !Jd /J PAG,,:�7/ PARCELQ� permit is for one hundred dollars($100)or less.) NER I certify that in the performance of the work for which this permit LAVATORY c Ory is issued, I shall not employ any person in any manner so as toMAIL became subject to the Workers'Compensation Laws. SINK ADDRESS I 4twlr G DISWASHER CITY TEL / Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, atter making this Certificate of Exemption, you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY —� TEL.N0. } 1 hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER IL (commencing with Section 7000) of Division 3 of the Business and STATE LIC. O GAS SYSTEM OUTLETS LICENSE NO. CLASS (� Professions Cade,and my license is in full force and effect. DISTRICT ROCESSED BY OUTLETS OVER v O 5 PER SYSTEM O License Number Lic.Class ) F FINAL /�_ ,y_n— FDATE INA VALIDATION LLl Contractor Data ! �'" 'S { y ❑ FINAL _�ltl I am exempt under Sec. gy B.&P.C.for this reason ITENo Date: Plan check fee D }.Ttil 01-_ PLUMBING PERMIT ISSUING FEE ' Signature $ Uj_{_K 41. TOTAL FEE CHANCE .!-113 SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name ` I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address IC-ooAdelt' City Tel. No. _ 2023 1 ANIt)'• 1 L� 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). D 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 - D 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 _. proper or in ctio rposes SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WORKERS' COMPENSATION ATION DECLARATION APPLICATION FOR PLUMBING .PERMIT hereby affdm that.l have a certificate of consent to self in- 2000:16 DPW 4/97 ,. P9 care, ora certificate of Workers"Compensation Insurance,oro ICE 817(REV. 8/86) 'terrified copy Thereof (Sec. 3800 Lab C ) , I.'I�LYi/V No: - Company. - COVNT�'—OF-1, S-- ELES -DEPT. OF PUBLIC WORKS " Policy. - . Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE)' BUILDING �V �SJ ❑ Certified copy is filed with the county building inspection ADDRESS ADDRESS f v,-.�j ' department. - NUMBER 'FIXTURE OR ITEM LOCALITY Date ' Applicant ' WATER CLOSET.(TOILET) NEAREST CERTIFICATE OF EXEMPTION'FROM WORKERS' 'BATH TUB CROSS,ST.•J .(� 1%4 SHOWEROWNERCOMPENSATION INSURANCE'(This`sectionneed not ba compvleted if tBe'work inolved by _ MAILthe.permit is for one hundred dollars (5100).or lass.) - LAVATORY - - ADDRESS I certify that in the performance of the work'for which this per- I - mit is issued, I shall not employ any person in any manner so 'SINK - • CITY TEL. onto become sub'i the Workers' Compensation,vws. . _ DISHWASHER �• ' COMRACTOR Date Applicant "'" CLOTHES WASHER - (� , .NOTICE TO-APPLICANT_ If, after making this Cert rfimie of Ex- If, ADDRESS �! emption,you-should become subject to the Workers'Camper- SWIMMING POOC RECEPTOR - - - aryG</ c� No� `,3l cation provisions of the Labor Code, you must forthwith comp- �tiLAWN SPRINKLER SYSTEM ly with such provisions or this permit shall be deemed revok- - STATE </ LIC ed.' ''I - - WATER HEATER ! LICENSE NO.. 1Z( t CLASS l�`% _ 'LICENSED CONTRACTORS DECLARATION `' • DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed underprov sdns of Cfiapter GAS SYSTEM, , OUTLETS 9(commencing with Section 7000)of Division 3 of the Business - OUTLETS OVER:- and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION 0.> fect. �Z c DATE O License'Number / Lit Class SCA/o / FINAL Contractor > - ` -Date C�ZI < _ BY O ❑. o H I am exempt under Sec. 'i W ' B BPC for this reason - - W _ _ Plan check fee � - � � D � _ �• ., z. r: Dote - PLUMBING PERMIT.ISSUING FEE S ' Signature' - T - - - � - _ _ TOTAL FEE SINGLE FAMILY - - HOME OWNER-BUILDER DECLARATION' .Plan check applicant _ Ihereby affirm that I am exempt from the Contractor's License Name - - . - - a - - - Law for the following reason.(Section 7031.5,-Business and _ _ "y�' Professions Code): Address ❑• sw f, a,owner of the property, will do the' ark•ond the, City. Ti No. - '�T`_i�i_ structure isnot intended ar offered for sale(Section9044 , - 4L c Business and Professions Code). .L '` �- - D i i_.AL . s' CONSTRUCTION LENDING AGENCY' 'I hereby affirm that there is a construction lending agency for the•performance of-the work for w_l this,permlt is issued Lender's Name T.j I-I]Qi it, -f Lencl Address - - - -' I certify`thot I have read this application and state that.the - oboveinformation is correct. I agree to comply with all County ordinances and State lows regulating Plumbing, and hereby a�,e .bis County to enter upon the,ar inspection p rpo eS. SEE REVERSE FOR EXPLANATORY LANGUAGE i Sig at re'of Permittee - Date - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0904220008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91980 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITS: 10898 LT: 28 BE B ON: .003 I 10918 DAINES DR 1 IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917802920 ASSESSOR INFORMATION NUMBER I I NEAREST CROSS STREET:.SANTA ANITA 18573-017-019 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, Cl 145 WATER CLOSET/URINAL 1.00 FIX 16.20 1TENANT: 147 WATER HEATER(S) 1.00 WEE 16.20 11SSUED ON: PROCESSED BY: PLAN BY. EXPIRES ON: TOTAL FEES 60.15 104/22/09 SR 10/19/09 11OWNER: TEL. N0: I1 11 FINAL DATE FINAL 8Y: CODE: 1 BLANKENBAKER GEORGE (626) 448-8914- 110918 DAINES DR I ITEMP 917802920 1 IDESCRIPTION OF WORK 1 REPLACE WATER CLOSET AND WATER HEATER JAPPLI CANT: TEL. NO: ISTP ENTERPRISES INC. (626) 287-7544- 1 15454 TEMPLE CITY BE 1 1SPECIAL CONDITIONS: 1 ITEMPLE CITY CA 91780 I I I I CONTRACTOR: TEL. NO: (APPROVALS GATE INSPECTOR EIGNATURE ISTP ENTERPRISES, INC. (626) 287-7544- 1 1 15454 TEMPLE CITY BLVD. LIC. NO (UNDER SLAB WORK ITEMPLE CITY, CA 91780 598157BC36 IWATER SERVICE PLASTIC YIN METAL YIN I I ARCHITECT OR ENGINEER: TEL. NO: 1 1 IROUGH PLUMBING LIC. NO: GAS PIPING I I I GA5 VENT I I IHOT WATER HEATER I PLUMBING FIXTURES LAWN SPRINKLERS I I I I I I (GAS TEST I I I 1 I (UTILITY COMPANY NOTIFIED( I 1 I I IGWV I I I (GRAY WATER SYSTEM I I I I I I I I 11 I 11 I I I I I I I I I I I I I I 11 11 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I 11 ' (REPORT ID: DPR263 ROUTE T0: H50508 I I I I I I