HomeMy Public PortalAbout9933 DAINES DR_Plumbing__ WORKERS'COMPENSATION DECLARATION 76A667A
I hereby affirm that I have a' certificate of consent to self CE 617 (z-SO) APPLICATION FOR PLUMBING PERMIT
insure, or a certificate of Workers'Compensation Insurance,or — /j "fl
a certified copy thereof(Sec. 3800,Lab.C.)
COUNTY OF LOS ANGELES BUILDING AND SAFETY
Policy No. Company
Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING G7
❑ ADDRESS / 4� 2�
Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM O FEE
department. LOCALITY
WATER CLOSET
Date Applicant NEAREST
BATH TUB CROSS ST. �..
CERTIFICATE OF EXEMPTION FROM WORKERS'
COMPENSATION INSURANCE SHOWER OWNER
LAVATORY MAIL
(This section need not be completed if the work involved LADDRESS - }
by the permit is for one hundred dollars ($100) or less.) SINK
CITY TEL. NO. o-
0
I certify that in the performance of the work for which this DISHWASHER
permit is issued, I shall not employ any person in any manner CONTRACTOR ,y G U
yr
S o as t ;�b�ec/ooypn�iee'�subject to the Work s' Compensation Laawws. CLOTHES WASHER ADDRESS - _ 0
I � �jC Applicant sl� SWIMMING POOL RECEPTOR (~j
NO ICE O APPLICANT: If, after making this Certificate of CITY TEI elAO Si d
Exemption, you should become subject to the Workers' LAWN SPRINKLER SYSTEM STATE LIC. to
Compensation provisions of the Labor Code, you must forth- LICENSE NO.1_1;Z 2_ CLASS G Z Z
with comply with such provisions or this permit shall be WATER HEATER
deemed revoked. GAS SYSTEM OUTLETS DISTRICT NO. P ,CESSED- V
LICENSED CONTRACTORS DECLARATION OUTLETS OVER ( L�d
I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM
9 (commencing with Section 7000)of Division 3 of the Busi- FINAL VALIDATION
ness and Professions Code, and my license is in full force and DATE
effect. ''�
NAL
License Number,25 4/ ic.Class-6- 7— BY
CAIA" a 6 10 5
F1I am exempt from the licensing requirements as I am a Plan Check fee /
licensed architect or a registered professional engineer PLUMBING PERMIT ISSUING FEE$
acting in my professional capacity (Section 7051, Bus-
iness and Professions Code). TOTAL FEE 1
Lic.or Reg.No. Date Plan check applicant
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's Address
License Law for the following reason (Section.7031.5, Busi- City Tel.No.
ness and Professions Code):
I, as owner of the property, am exclusively contracting 3 9 7$A
El
with licensed contractors to construct the project o 0 0 0 o 5
(Section 7044,Business and Professions Code).
CONSTRUCTION LENDING AGENCY .2.0.0 1 2.5 0
i hereby affirm that there is a construction lending agency 0 0-0 1 2 5 0 55
for the performance of the work for which this permit is
issued(Sec. 3097,Civ.C.).
051
j Lender's Name 382
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 SEE REVERSE FOR EXPLANATORY LANGUAGE
ordinances and State laws regulating Plumbing, and hereby
authorize representatives of this County to enter upon the
above-me oned property for inspection purposes.
Signature of Permittee Date
Y. COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1011290005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: FEES PAID
BUILDING ADDRESS:
ITR: 13805 LT: 53
9933 DAINES DR
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917802639 I
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: I
18588-016-028 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
I 107 BATHTUBS/SHOWERS 1.00 FIX 16.30 1 I
TENANT: 113 DISHWASHER(S) 1.00 FIX 16.30 11SSUED ON: PROCESSED BY: PLAN BY: I
125 LAVATORIES/SINKS 2.00 FIX 32.50 111/29/10 SR I
145 WATER CLOSET/URINAL 1.00 FIX 16.30 1 I
1OWNER: TEL. NO: I TOTAL FEES 109.20 IFI AL DATE FINAL Y: CODE: 1
ICHI CHIH LIU (626) 447-8558- 1 1
19933 DAINES DR
TEMP 917802639
I IDMSnRfPTlIbN OF WORK 1
IPLUMBING FOR KITCHEN REMODEL AND NEW BATHROOM 1
I I I
(APPLICANT: TEL. NO:
IJIANBING YANG1 I I
(626) 674-0647- I 1
11949 FALSTONE AVE
iSPECIAL CONDITIONS:
HACIENDA HTS 91745 I
I 1 I
I I
1CONTRACTOR: TEL. NO: .1 (APPROVALS DATE INSPECTOR SIGNATURE
JIANPING YANG (626) 674-0647- 1
11949 FALSTONE AVE LIC. NO 1 (UNDER SLAB WORK
HACIENDA HEIGHTS, CA 91745 644420/8
IWATFR SERVICE I I
I I (PLASTIC Y/N METAL Y/N
1ARCHITECT OR ENGINEER: TEL. NO: I
- I ROUGH PLUMBING
LIC. NO: I
IGAS PIPING
I I I
IGAS VENT
I I I
IHOT WATER HEATER
I I I
(PLUMBING FIXTURES
I I I
ILAWN SPRINKLERS
I I I
1 IGAS TEST I'
I I I
(UTILITY COMPANY NOTIFIED( II
jCWV I I I
I I I
I IGRAY TER SYSTEM I 1 1
1 I I ISI I
I I I I I I
1 I I I I I
i I I I I I
(REPORT ID: DPR263 ROUTE TO: BS0508