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HomeMy Public PortalAbout9838 DAINES DR_Plumbing__ • WORKER'S COMPENSATION DECLARATION 200026 DPW 9/89 APPLICATION FOR PLUMBING PERMIT 76A667A ' I 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. j 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 9838 DA I NES DR. TEMPLE CITY department NUMBER FIXTURE OR ITEM ® FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH. TUB CROSS ST BALDW I N AVE/ GOLDEN WEST COMPENSATION INSURANCE ASSESSOR f (This section need not be completed if the work involved by the SHOWER MAP BOOK 8588 PAGE 01 7 PARCEL 016 " permit is for one hundred dollars($100)or less.) LAVATORY OWNER DAVID S, HARRIS _ r I certify that in the performance of the work for which this permit- is issued, I shall,not employ*any person in any manner so as toSINK MAIL become subject to the Workers' Compensatio aw ADDRESS 9838 DA I NES DR. DISWASHER - - CITY TEMPLE CITY CALIF, TEL NO(818)285-0121 Date 9-27-93 Applicant - CLOTHES WASHER NOTICE TO APPLICANT If, after making this 1Wtificate of CONTRACTOR ` Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL NO I hereby affirm that I am licensed under provisions of Chapter.9 WATER HEATER d (commencing with Section 7000) of Division 3 of the Business and STATE LIC Q Professions Code,and my license is in full force and effect 1 GAS SYSTEM OUTLETS 14.5 LICENSE NO CLASS V OUTLETS OVER DISTRICT NO PROVQggD BY O 5 PER SYSTEM ([�J � License Number Lic Class 0 FINAL DATE V�kFD o ION d Contractor Date �:- r-� ❑ FINA 30 •?r 'Al Z I am exempt under Sec BY - { E l.�. B&P C for this reason t t t Date Plan check fee ; TATAL , 57 - 30 Signature PLUMBING PERMIT ISSUING FEE$ l( a EU ❑ TOTAL FEE CHANE SINGLE FAMILY Plan check applicant ) a HOME OWNER-BUILDER DECLARATION Name - E� :i'� ,' I hereby affirm that I am exempt from the Contractor's License Law ` for the following reason"(Section 7031 5, Business and Professions Address i�'`I�,4• "+'= Code) iI AM Q s 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 I hereby affirm that there is a construction lending agency for the j performance of the work for which this permit is issued (Sec 3097, Civ C) r 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 represen atives of this County to enter upon the above-mentioned proper r in e n rposes SEE REVERSE FOR EXPLANATORY LANGUAGE 9-27-93 S pature of/ftefirnittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0807300015 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID FEES PAID I BUILDING ADDRESS. I ITR 13805 LT 79 I 9838 DAINES DR I I 1FEE DESCRIPTION QUANTITY: UOM AMOUNT I TEMP CA 917802636 (ASSESSOR INFORMATION NUMBER. 1 I NEAREST CROSS STREET I 18588-017-016 101 PERMIT ISSUANCE FEE 27 75 I THOMAS PAGE 597 GRID• A3 LOCALITY TEMPLE CITY, Cl 1 107 BATHTUBS/SHOWERS 1 00 FIX 16.20 I 1 ITENANT 113 DISHWASHER(S) 1.00 FIX 16 20 (ISSUED ON PROCESSED BY PLAN BY EXPIRES ON I 125 LAVATORIES/SINKS 2.00 FIX 32.40 107/30/08 SR 01/26/09 I 145 WATER CLOSET/URINAL 1 00 FIX 16 20 1 I (OWNER: TEL NO 147 WATER HEATER(S) 1 00 WTH 16.20 IFINAL DATE FIN BY CODE I 1HARRIS, ANN MARIE - 151 LOW PRS GAS 5 OUTLET 1.00 SYS 1620 1 r O I 19838 DAINES DRIVE I TOTAL FEES 141.15 1 ITEMPLE CITY CA 91780 1 IDESCRI TION OF WORK 1 I I IPLUMBING FOR KITCHEN AND BATHROOM REMODEL I (APPLICANT. TEL NO I I I IO'LEARY (626) 287-0927- I 1 I 15823 AGNES AVENUE I ISPECIAL CONDITIONS- ITEMPLE CITY CA 91780 1 1 I I I I I ICONTRACTOR TEL NO I (APPROVALS DATE INSPECTOR SIGNATURE I ITOM O'LEARY CONSTRUCTION (626) 287-0927- 1 1 I 15823 AGNES AVENUE LIC NO I (UNDER SLAB WORK I I I ITEMPLE CITY, CA 91780 489354 B-1 I 1 I I I I 1 IWATER SERVICE I I 1 I I 1PLASTIC Y/N METAL Y/N I I I ARCHITECT OR ENGINEER: TEL. NO i ROUGH PLUMBING I I I 1 LIC NO I 1 I I 1GAS PIPING I I 1GAS VENT I I I I 1 1HOT WATER HEATER I I I I 1 1PLUMBING FIXTURES I I I I I ILAWN SPRINKLERS I I I I 1 IGAS TEST 1 I I I 1 (UTILITY COMPANY NOTIFIEDI I I I I ICwv I I I 1GRAY WATER SYSTEM 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 1REPORT ID DPR263 ROUTE TO BS0508 I I 1 1 I I I I I II _ COUNTY OF LOS-ANGELES, TEMPLE 'CITY - # 0508 PLUMBING PERMIT ' L^EPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0505270012 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT LEGAL ID FEES PAID BUILDING ADDRESS TR: 13805 LT 79 9838 DAINES DR FEE DESCRIPTION QUANTITY• UOM AMOUNT TEMP CA 917802636 ASSESSOR INFORMATION NUMBER NEAREST CROSS STREET- BALDWIN 8588-017-016 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE. 597 GRID: A3 LOCALITY: TEMPLE CITY, C 51 LOW PRS GAS 5 OUTLET 1 00 SYS 16.20 TENANT TOTAL FEES 43 95 ISSUED ON PROCESSED BY PLAN BY: EXPIRES ON. 05/27/05 JK 11/23/05 OWNER TEL NO ZIL D E FINAL BY. - CODE. MORCK HARRY M,DORIS TRUSTEES (626) 2868516- +9838 DAINES DR �TEMPLE CITY CA 91780 SCRI TION OF WORK GAS LINE FOR CENTRAL HEATING AND AIR CONDITIONING SYSTEM APPLICANT TEL NO BRYANT HEATING & AIR CONDITIONING (626) 286-1141- 1350 E LAS TUNAS DR SPECIAL CONDITIONS SAN GABRIEL CA 91776 _ CONTRACTOR. TEL NO: APPROVALS DATE INSPECTOR SIGNATURE BRYANT HEATING AND A, C, INC. (626) 286-1141- 1350 E. LAST TUNAS DR LIC NO UNDER SLAB WORK SAN GABRIEL, CA 91776 221751C20H WATER SERVICE PLASTIC YIN METAL YIN ARCHITECT OR ENGINEER. TEL NO _ ROUGH PLUMBING LIC. NO GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN ,SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID DPR263 ROUTE TO: BS0508