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Home My Public Portal About4861 DOREEN AVE_Plumbing__ WORKERS' COMPENSATION DECLARATION APPLICATION FOR PLUMBING IPERMIT- hereby affirm that havecertificate of consent to self 817A City Of Temple City insure, or a certificate of Workers' CE81 kers' Compensation Insurance,. CE ](REV. 10/81) or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES BUILDING AND SAFETY Policy No. 201916 Company SCIF ❑ Certified copy is hereby furnished. _ "r^ r FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING7XCertified copy is filed with.the county building'inspec- ADDRESS 4831 RNO Doreen Ave tion department. NUMBER FIXTURE OR ITEM Cd FEE LOCALITY y. Date 4/1/89 Applicant General Install. WATER CLOSET NEAREST Tem le .Cit CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. ' COMPENSATION'INSU RANCE SHOWER OWNER (This section need not be completed If the work involved by MAIL ' mg the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 4831 NO Doreen Ave. I certify that in the performance of the work for which this permit is issued, 1 sholl not employ any person in any manner SINK CRY 6112336-2854 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR General Installation Co Date Applicant CLOT WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMIBOOL RECEPTOR 6558 West Blvd. . Exemption, you should_become subject to the Workers' - Compensation provisions of the Labor Code, you must forth- LAWN SPRIN SYSTEM CITY Los Angeles TEiNO90043 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. 1WATER HEATER 6 00 LICENSE NO. 151839 CLASS C3 6 LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby off irm that I am licensed under provisions of Chapter 9 GAS SYSTEM A OUTLETS r (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and effect. 5 PER SYSTEM / FINAI/J VALIDATION a License Number 151839 tic. Class C36 DATE _ O W.0_ Provin 4/89 �' FI 0, Contractor Date - ] � 1 J I am exempt under Sec. OF B.BP.C. for this reason -307 1 7 5.. Plan check fee 3 ��'�-=0 Date: PLUMBING PERMIT ISSUING FEE$ 10 50 1 IT_h1 Signature TOTAL FEE 16 SO i�l)Hi_ Plan check applicant NECK 1.14 t _ SINGLE FAMILY C'H��1 HOME OWNER-BUILDER DECLARATION 'Name r I hereby affirm that I am exempt from the Contractor's License Address . Law for the following reason (Section 7031.5, Business and I'IJ;_il I-I'L';11 1/vl)!1G Professions Code): City Tel. No. IJ _ , 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 performance of the work for which this permit is issued (Sec. 3097, Civ. C.). ' Lender's Nome Lender's Address I certify that I hove read this application and statethat 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-m noon rap rty or inspection purPoses � ! � SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of PernrUticfe �� Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0011080005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 13645 LT: 47 4831 DOREEN AV FEE DESCRIPTION: QUANTITY: LOM: AMOUNT: TEMP CA 917804140 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LOWER AZUSA 8585-024-032 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C5 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 TENANT: 11 CLOTHESWASHER(S) 1.00 FIX 16.20 ISSUE ON: PROCESSED BY: PAN BY: EXPIRES ON: 25 LAVATORIES/SINKS 2.00 FIX 32.40 11/08/00 UT 05/08/01 45 WATER CLOSET/URINAL 2.00 FIX 32.40 OWNER: TEL. N0: 47 WATER HEATER(S) 1.00 WTH 16.20 FINAL DATE FINAL BY: CODE: ZHANG;KARA (626) 675-4676- 51 LOW PRS GAS 5 OUTLET 2.00'SYS 32.40 4831 DOREEN AV TOTAL FEES 189.75 TEMP 917804140 DESCRIPTION OF WORK PLUMBING FOR 2 NEW BATHROOMS, WATER HEATER RELOCATION, GAS LINE FOR WATER HEATER AND FOR DRYER APPLICANT: 7EL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: SAME AS OWNER APPROVALS DATE INSPECTOR SIGNATURE - LIC. NO ij- �; �:, ��V UNDER SLAB WORK J ti ,�' ✓, j) �-\ � WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: ROUGH PLUMBING _I cel CIL. NO 9 / _ ,^ /7 -1 � (/ 5 !7/J �"J 7'N T 7•t,.I Q, � -(§f��4� GAS PIPING GAS VENT NOT WATER HEATER - - - / PLUMBING-Tl XT URES LAW"PRINKLERS GAS TEST 4-0 NOTIFIED �\ �46 >- �i /10�:�. . C GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508