HomeMy Public PortalAbout9035 EMPEROR AVE_Plumbing__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1112210033
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: I FEES PAID I BUILDING ADDRESS: 1
1 ON FILE 1 9035 EMPEROR AV 1
IFEE DESCRIPTION: QUANTITY: UOM: _ AMOUNT: ( SGAB CA 917752016
(ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 1
15382-011-010 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY, Cl
1 121 HOSE BIBB(S) 1.00 FIX 16.30 I 1
(TENANT: I TOTAL FEES 44.10 JISSUED ON: PROCESSED BY: PLAN BY: 1
I I 112/21/11 SR 1
10WNER: TEL. NO: 1 IFINAL DATE FINAL BY: CODE:
1CHANG CHIAO CHANG;GUH SHU HUEY (626) 451-0931- 1 1 I
19035 EMPEROR AV 1 I
ISGAB 917752016 1 IDESCRIPTION OF WORK 1
1 I IHOSE BIB AT GARAGE 1
I I
1APPLICANT: TEL. NO: 1 I I
ICERVANTES, LEONARD (818) 854-1159- I 1 I
122035 BURBANK BLVD. 1 (SPECIAL CONDITIONS: 1
IWOODLAND HILLS 91367 I I I
1CONTRACTOR: TEL. NO: 1 1APPROVALS D TE INSPECTOR SIGNATURE 1
1ARBEL CONSTRUCTION INC. (800) 787-8909- 1 1 I
122025 VENTURA BLVD. #205 LIC. NO 1 1UNDER SLAB WORK I I
IWOODLAND HILLS, CA 91364 894807 1 I 1 1 1
I I IWATER SERVICE I I
1 I IPLASTIC YIN METAL YIN 1 I I
1ARCHITECT OR ENGINEER: - TEL. NO: 1 I I I I
I - I IROUGH PLUMBING 1 I I
LIC. NO: I I I I 1
I I IGAS PIPING 1 1 1
I I I I I I
1 IGAS VENT I I 1
I I I I I
I I IHOT WATER HEATER I I I
I I I I I I
I I IPLUMBING FIXTURES I I I
I I I I I I
1 I ILAWN SPRINKLERS I I
I I IGAS TEST I I
I 1 11 I
I 1 (UTILITY COMPANY NOTIFIEDI I
I I I_ I
I CWV I I I
I I I I
I i 1GRAY WATER SYSTEM 1 1 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 I I I I I
I I I I I I
I I I I I I
I I I I I I
I IREPORT ID: DPR263 ROUTE TO: BS0508 1 1 1 1
I I i I
!7 WORKERS'COMPENSATION DECLARATI(;,J _ PPLI TI N FOR PLUMBING PERMIT
t
`lhereby affirm that I have a certificate of consent to self 76A..667A
insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81)
ora reified copy thereof (Sec. 3800, b. C.) i COUNTY OF LOS ANGELES 7— BUILDING AND SAFETY
Polity No. ��Company
Certified copy is hereby furnishe
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 3 J7
Certified copy is filed with the county building inspec- ADDRESS 0
tion epartment. NUMBER FIXTURE OR ITEM @ FEE LOCALITY
WATER CLOSET
Date Applicant NEAREST
YCRT KATE OF EXEMPTION F M WORKERS' BATH TUB CROSS ST.
COMPENSATION IN RANCE SHOWER OWNERA.f
(This section need not be completed if the work involved by MAIL `1
the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS
I certify that in the performance of the work for which this
permit is issued, I shall not employ any person in any manner SINK CITY TEL. NO.
so as to become subject to the Workers'Compensation Laws. DISHWASHERf
CONTRACTOR
Date Applicant CLOTHES WASHER
NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY TEL. NO.
with comply with such provisions or this permit shall be STATE r. LIC.
deemed revoked. WATER HEATER LICENSE NO. � CLASS �+ D
LICENSED CONTRACTORS DECLARATIONDISTRICT NO,
P CESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM UTLET
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER �` U "'.
and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL
Q DATE 4"D VALIDATION
- ,
License Num er ` 7 77 7 .t? / Lic. Class �'� �'`" C9
,�yy FINAL
ContracTo Ivdte BY
❑ I am a mpt under Sec. a
B.&P. . for this reason
Plan check fee
Signature
Date:
PLUMBING PERMIT ISSUING FEE$ D
/ >
TOTAL FEE / SU
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Address
Law for the following reason (Section 7031.5, Business and '
Professions Code): City Tel. No. sf o a o o 0 5
❑ I, as owner of the property, will do the work and the 2 0 0 1„�5 0
structure is not intended or offered for sale (Section
7044, Business and Professions Code). o 0 1 6505
CONSTRUCTION LENDING AGENCY '01
I hereby affirm that there is a construction lending agency forZ
the performance of the work for which this permit is issued 0 5.2 —
(Sec. 3097, Civ. C.).
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 representatives of A County to enter upon the
above-mentioned property pection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature Permittee Date