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Home My Public Portal About10945 DAINES DR_Plumbing__ 7GA667 (CE-619) - 1/75 APPLICATION FOR PLUMBING PERMIT {� COUNTY OF LOS ANGELES LJ 'DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION DINC MAKE CHECKS PAYABLE TO: ADDRESS 10945 Daines Drive HARVEY T. BRANDT, COUNTY ENGINEER LOCALITY Temple City- FOR APPLICANT TO FILL IN (PRINT OR TYPE) NEAREST 1.. CROSS ST. R� I NUMBER FIXTURE OR ITEM @ FEE OWNER Dominick D. Chila WATER CLOSET A2F BATH TUB ADDRESS 1127 Louise Ave. SHOWER CITY Arcadia TEL. NO. J,Fj6—L2$ LAVAToflv CONTRACTOR Owen Bros. PlumbinSINK ADDRESS 4265 N. Baldwin Ave. DISHWASHER 2.00 3 D CITY El Monte TEL. NO. "3-0078 CLOTHES WASHER .00 D STATEr/ LIC LICENSE NO. 231' 41 CLASS C36-2o SWIMMING POOL RECEPTOR .00 LAWN SPRINKLER SYSTEM 00 DISTRICQT NO.GR er PRO ESSED BV WATER HEATER .003 D INDUSTRIAL / WASTE APPROVAL a GAS SYSTEM OUTLETS .00 a INSPECTION RECORD U OUTLETS OVER C 5 PER SYSTEM .30 ^vLv Ok / �,�yy'. Plan Check fee See Reverse PLUMBING PERMIT ISSUING FEE S TOTAL FEE -7 S APPROVALS DATE INSPECTORS SIGNATURE Plan Check applicant _ UNDER SLAB WORK _ Name ROUGH PLUMBING 'Address GAS PIPING City Tel. No, GAS VENT HOT WATER HEATER I HEREBY ACKNOWLEDGE THAT 1 HAVE READ .THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY PLUMBING FIXTURES v� C�•. /q L WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING. GAS TEST• ,/f �T- I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED PND/OR UTILITY CO. NOTIFIED LICENSED AS REQUIRES BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM 'THE LEGAL OWNER OF, AND IN TEND TO RESIDE IN THE ABOVE DES (BED SI DE NTIAL PA D ERTT! FINAL SIGNATURE /� y OF PERMITTEE r • PERMIT VALIDATION cK.M M.O: CASH PLAN CHECK VALIDATION - CK. M.O. CASH 9 (49 DEC TION WORKERS'that t I have a certificate cafe of corse APPLICATION FOR PLUMBING PERMIT J� I-herebynffirm that I have a certifice le of consent to self 20-0026 DPW 6/87 v �ILJII insure, or a certificate of Workers' Compensation Insurance, 76A667A _ or%certified copy thereof (Sec. 3800, Lab. C. - COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ` r Certified copy is hereby'furnished. BUILDING ❑ FOR APPLICANT TO FILL IN'(PRINi OR TYPE) ADDRESS / !/ Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM C�Cr7 FEE LOCALITYLL— Date Applicant WATER CLOSET 0 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE SHOWERO OWNER ✓ ✓ L,i (This section need not be completed if the work Involved by MAIL ,q the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO. so as to become subject to the Workers'Compensation Laws. DISHWASHER L• CONTRACTOR Date Applicant F CLOTHES WASHER ADDRESS 'NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY ` GAS SYSTEM OUTLETS 1 hereby affirm that I am licensed under provisions of Chapter 9 ' (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full farce and effect. 5 PER SYSTEM FINAL VALIDATION O: DATEQ', License Number Lic. Closs U, FINAL Contractor Dote BY 9-1 0 1 am exempt under Sec.' aW al 6.8P.C. for this reason Plan check fee DZ; Date: / O PLUMBING PERMIT ISSUING FEE$ lO Signature TOTAL FEE Q Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name _ I hereby affirm that I am exempt from the Contractor's License Vit'"''( •z Law for the following reason (Section 7031.5, Business and Address 17_ _ .03 Professions Code): City Tel. No. El1, as owner of the property, will do the work and the _ ErB' structure is not intended or offered for sale ( iSection' D TUT r+.L yv._3 1 53 m 00 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY CHECK jG,_!n! I hereby affirm that there is a construction lending agency for1_:j-{}f(i{;: the performance of the work for which this permit is issued (Sec. 3097, Civ. C.). _ Lender's Name 0001-1 1;,13 (li' 7.''1_ tli j ;' r,;.: `tr ].`t1 Lender's Address � '+.Y+_ � 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 - r�'�aqqq��ve-meritioned'property for inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date WWORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT MIT Ts W1 affirm that have a cert ifim0 te of consent to self 20026 DPW 6/87 insure, or a c4oifimte of Workers' Compensation Insurance, 76A667A or a certified copy.thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy Nq. Compony ' Certified copy is hereby furnished. BUILDING �ec^}HJ 7 FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS .Q /, l •1^_ Certified copy is filed with the county building inspec- Y tion department. NUMBER FIXTURE OR ITEM @ FEE r LOCALITY ,� Dale Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER (This section need not be completed if tho'work involved by SHOWER the permit is for one hundred dollars($100)or less.) LAVATORY MAIL O ADDRESSID I certify that in the performance of the work for which this permit is issued, I shall not employ any person MPpy manner SINK CITY � TEL. NO.� J yl- so as to become subject to the Workers'Comp tion Laws. DISHWASHER - CONTRACTOR ,. Date, ,�L- 'K? Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Exemption, you should become subject to the Workers SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. NO. with comply with such provisions or this permit shall be LAWN SPRINKLER SYSTEM STATE LIc. deemed revoked. WATER HEATER LICENSE NO. CLASS I LICENSED CONTRACTORS DECLARATION DISTRICT NO PROCESSED B I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL /J�C) VALIDATIO r DATE ( / O License Number Lic. Class ` O' FINALContract Dale 9Y I am exempt under Sec. Vuf B.BP.C. for this reason Plan check fee _ n. te. PLUMBING PERMIT ISSUING FEE$ Signature\ TOTAL FEE [7 Plan check applicant -' SINGLE FAMILY "t s HOME OWNER-BUILDER DECLARATION Name =Too I hereby affirm that I am exempt from the Contractor's License Address =Too Law for the following reason (Section 7031.5, Business and - " Professions Code): City Tel'No. =7 28.50e�L. - 28o _ ❑ 1, as owner of the property, will do the work and the - 1 ITM structure is not intended or offered for sale (Section �s 7044, Business and Professions Code), D TOTAL • 2®o 50 CONSTRUCTION LENDING AGENCY `KICK _ 29.50 I hereby affirm that there is a construction lending agency for - rr��ssL the performance of the work for which this permit is issued - �� sW (Sec. 3097, Civ. C). Lender's Name M-Ml 5/26/89 Lender's Address - 3M 1 AN 8:44 1 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 represent l5f as of this County to enter upon the above-men Toned r erty for inspection purp ses• s / SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date - WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING ING Ir LS'I MIT J� I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 ar �1LJII insure, 37,a cCmificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES - DEPT. OF PUBLIC WORKS PoliicyNo, 10-0489606mpany CNA Ins. Co. ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) G BBUILDINUILDIN 10945 Dairies tion copy is filed with the county building inspec- tion department.= NUMBER FIXTURE OR.ITEM' -� LOCALITY. 5-19-89 Owen Bros. lmb WATER ,1 Tem le Cit ( Date •Applitont p t NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' _ BATH TUB CROSS ST, COMPENSATION INSURANCE r (This section need not beicompleted if the work involved by .Y I SHOWER __ OWNER Lee Valentine— the permit is for one hundred dollars ($100)or less.) MAIL LAVATORY ADDRESS 10945 Dairies' I certify.that in the performance of the work for which this - - permit is issued, I shall not employ any person in any manner SINKCITY Tem' le C 1 t TEL. NO, so as to become,subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOROwen BIOS. P1LLfib ingr IRC. Dote Applicant CLOTHESWASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of - 4265 N. Baldwin Ave. Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR NO TEL. . Compensation provisions of the labor Code, you must Forth- LAWN SPRINKLER SYSTEM CITY,: El MO _ e - -00 with comply with such provisions or this permit shall be STATE y� LIC. deemed revoked. WATER HEATS , ' . LICENSE NO`. XX 231-741 •CLAss C36-20 LICENSED CONTRACTORS DECLARATION DIPROCESSED BY hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTE OU TS ST o. •�� C7 •_ �O (commencing with Section 7000) of Division 3 of the Business OUTLE SOVER and Professions Code, and my license is in full force and effect. 5 PER STEM IN'L ' - VALIDATION a},) 231-741 C36-20 DATE p License Number Lic. Class p FINAL Contractor Owen Bros. Plnmbdrag 5- 19-89 BY 0. 0 I am exempt under Sec. C) Eye- t! W B.BP.C. for this reason0.f PlatChet fee ar Date: LUMBING PERMIT JSS G FEE$ '�v D Z Signature I_rTOTAL FEE Plan check applicant r', a- — ____._.._..._....... .. _ .._. SINGLE FAMILY s ,. ,.�....s. ._ __.._ . ._.. HOME OWNER-BUILDER DECLARATION Nome I hereby affirm that 1 am exempt from the Contractor's LI nsa - ---« — _-- •--.-.---._.__.,._._ . .=Tod ---- ,--- Law for the following reason (Section 7031.5, Business Address Professions Code): City Tel. No. E] I, as owner of the property, will do the work and the ---._ , .,•._..._`.---._ 1 YTS.....:.._.. structure is not intended or offered for sale (Section - TOTAL 34 o U® 7044, Business and Professions Code). �L CONSTRUCTION LENDING AGENCY thereby an there is a construction lending agency he performrmancee of the work for which this permit is issued (Sec 3097, Civ. C.). Lender's Name Lender's Address 1 AN 8826 � ...., I certify they I have read this oppllmtion 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 is County to enter upon the ..eve-m ed prop y r spection purposes. q SEE REVERSE FOR EXPLANATORY LANGUAGE d. I / \Signature of Permittee Date