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Home My Public Portal About9154 EMPEROR AVE_Plumbing__ ". WORKERS' COMPENSATION DECLARATION 2DPW 4/87 APPLICATION FOR PLUMBING PERMIT ere dffirm that I have a certificate o4 consent to self in- 76A6676A667A fie,or. certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) ertify thereof (Sec. 3800, Lab. C.) f COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS .Policy N&-, Company' ❑ Certified copy is hereby furnished. BUILDING - FOR APPLICANT TO FILL IN (PRINT OR TYPE) y ❑ Certified copy is filed with the county building inspection ADDRESS /��' C►'!1 ��2 department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY WATER CLOSET(TOILET) e►� /''� C1 Date Applicant / Q NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' ! BATH TUB CROSS ST. Rosp_{ti,e, � COMPENSATION INSURANCE- SHOWER OWNER r-3iL QFC (This section need not be completed if the work involved by MAIL the permit is for one hundred dollars ($100)or less.) 1 LAVATORY 11010 ADDRESS �- I certify that in the performance of the work for which this per- ' SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers' mpensation Laws. DISHWASHER CONTRACTOR,f p,, Date- _�47 Applicant CLOTHES WASHER 010 I Jr NOTICE TO APPLICANT: If, after ma n t C rtificote of Ex- ADDRESS N 1_0>3 S SWIMMING POOL RECEPTOR emption, you should become suble t 1' W rkers'Compen- CITY TEL. NO.' P�- sation provisions of the Labor Code, u st forthwith comp- LAWN SPRINKLER SYSTEM TJ/y ly with such provisions or this permit shall be deemed revok- STATE �/±� LIC. ed. f WATER HEATER LICENSE NO. yZ�L"7y CLASS C'!3 LICENSED CONTRACTORS DECLARATION .p�STRICT NO. PROCE ED BY I hereby affirm that I am licensed under provisions of Chapter / GAS SYSTEM 2_ OUTLETS `{/� 9(commencing with Section 7000)of Division 3 of the'Business OUTLETS OVER fe d Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION DATE License NumberyLS'zSy Lic. Class 0-' -3G U FINAL 99 Contractor_JlW/sJ0V})_ n/P-6 Date/0-31-420 BY IN I Ik O OVP ❑ I am exempt under Sec. W B.&P.C. for this reason oil, U) - Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TO5 ; TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that 1 am exempt from the Contractor's License Name 5 Law'for the following reason (Section 7031.5, Business and 8 Professions Code): Address ACCT.It El 1, C- as owner of the property, will do,the work and the City Tel. No. 3307 :s2=50 structure is not intended or offered for sale(Section 7044, i �� Business and Professions Code). CONSTRUCTION LENDING AGENCY , TOTAL 52 o 50 I hereby affirm that there is a construction lending agency for CHECK a2.5i the performance of the work for which this permit is issued (Sec. 3097,'Civ. C.). CHANGE .00 X0 r Lender's Name cioct i-n-oo1 1�1/ ! 't Lender's Address I certify that I have read this application and state that the 6049 1 AN above information is correct. I agree to comply with all County ► ordinances and State laws regulating Plumbing, and hereby authori re resentatives of this County to enter upon the above enti Ined property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re o P mitt a Date �1 D.B.S.17 25M SETS 2-47 APPLICATION FOR PERMIT DEPARTMENT BUILDING AND SAFETY ��'�� COUNTYY OF LOS ANGELES Wm. J. FOX. CHIEF ENGINEER NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURES COMPLETE ' HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION GAS- MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB f a NAME ADDRESS / W / m ADDRESS / LOCALITY a ri� 7 NEAREST 'J CITY TEL.Nb / • / CROSS ST. IL COUNTY CERT.No. EXPIRES W NAME '..� LOCATION OF SEPTIC TANK, OR CESSPOOL Z MAIL r�4' ADDRESS. NORTH O CITY"'f f TEL.NO. I AM THE LEGAL POSSESSOR OF THE A13OVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. N a 3 � OWNER CORRECTIONS SOUTH J DESCRIPTION OF WORK Z BATH TUB FURNACE c SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK SAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'S NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING I I METES GAS SODA FOUNTAIN GAS PIPING OUTL GAS VENT I i �a CESSPOOL -- TOTAL NUMBER OF FIXTURES SEPTIC TANK i CESSPOOI QEPTIC TANK SEWER I i $ D UTILITY CO.NOTIFIED TOTAL FEE FINAL D.S.S.-I-7 25M SETS 11-46 APPLICATION FOR PERMIT -DEPARTT_ OF BUILDING AND SAF COU ETY ��'�� ' 1" COUNTY OF LOS ANGELES Wm. J. FOX. CHIEF ENGINEER _ NATURE OF INSTALLATION DISTRICT NO. GROUP ZONE PERMIT NO. ROUGH FIXTURESCOMPLETE _ HEATER CESSPOOL I-I SEPTIC TANK RECEIVED BY READY FOR DATE ISSUED FIRST INSPECTION GAS- MISCELLANEOUS APPLICANT FILL IN HEAVILY OUTLINED PORTION ONLY JOB E NAME ADDRESS W m ADDRESS LOCALITY J NEARE8T S. CITY TEL.No. CR0888T. COUNTY CERT.No. EXPIRES NAME LOCATION OF SEPTIC TANK, OR CESSPOOL Y MAIL 3 ADDRESS NORTH O CITY TEL.NO. IAM THE LEGAL POSSESSOR OF THE ABOVE LOS ANGELES COUNTY CERTIFICATE OF QUALIFICATION. PLUMBER I AM THE LEGAL OWNER OF THE PROPERTY DESCRIBED ABOVE. R D 3 N OWNER I CORRECTIONS SOUTH J DESCRIPTION OF WORK z_ BATH TUB FURNACE [7 SHOWER DISHWASHER O LAVATORY REFRIGERATOR KITCHEN SINK WATER SOFTENER FLOOR SINK BAND TRAP SLOP SINK FLOOR DRAIN WASH TRAY URINAL APPROVALS WATER CLOSET DRINKING FOUNTAIN DATE INSPECTOR'8 NAME WATER HEATER DENTAL LAVATORY ROUGH PLUMBING METER. GA8 SODA FOUNTAIN GAS PIPING OUTL l GAS VENT I 1 CESSPOOL TOTAL NUMBER OF FIXTURES SEPTIC TANK CESSPOOI PEPTIC TANK SEWER I I $ UTILITY CO.NOTIFIED I TOTAL FEE FINAL WORKERS' COMPENSATIPN DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby affirm that I have a,certificate sof consent to self 20.0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS PbI cy No?O- 896Q'+ Company CNA Iris. CO. 13 Certified copy is hereby furnished. ® FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS 5454 El Monte Ave. tion department. NUMBER FIXTURE OR ITEM Q FEE LOCALITY Temple City Date 1-1-90 Appligont Owen Bros. Plumbin WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Da ine S COMPENSATION INSURANCE OWNER SHOWER Allen McCarty (This section need not be completed if the work Involved by MAIL the permit is for one hundred dollars ($100)or-less.) LAVATORY ADDRESS 5454 E1 Monte I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY Temple City TEL. NO.443—1 595 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOROWen BIOS. Plumbing, Inc. Date Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of 4265 N. Baldwin Ave . Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY E1 Monte TEL. N6.43-0078 Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE 231-741 LIC. C36-20 deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION W,5y ICTOCES�D BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and m license is in full force and effect. 5 PER SYSTEM Y FINAL V bDAT10N License Number 91 1-74 1DATE Lic. Class 1716-90 0.FINAL Contractor Owen Bros. P1mbDate 9-30-9 1 BY �: ❑ I am exempt under Sec. VP B.&P.C. for this reason CL Plan check fee ® Z Date: PLUMBING PERMIT ISSUING FEE$ Signature .Q TOTAL FEE _ Plan check applicant SINGLE FAMILY r ACCT. HOME OWNER-BUILDER DECLARATION Name 1 hereby affirm that I am exempt from the Contractor's License Address `~'+=1?1 ITEMS ��" �1 Law for the following reason (Section 7031.5, Business and � i �' Professions Code): City Tel. No. 1_ITa ❑ I, as owner of the property, will do the work and the structure is not intended or offered for sale (Section ® CHECK 16.50 7044, Business and Professions Code). CHANGE CONSTRUCTION LENDING AGENCY 9fl'I 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.). (3(_100-1_10!111 121 1189 ?190 1 =11 Lender's Name All 8 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 this County to enter upon the �a ve- oned op f1#or inspection purposes. i SEE REVERSE FOR EXPLANATORY LANGUAGE le kSignature of Per ee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0805080008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: I FEES PAID I BUILDING ADDRESS: I ITR: 14396 LT: 9 BL: .001 I 9154 EMPEROR AV I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 SGAB CA 917752019 I (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 15382-015-010 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: J1 LOCALITY: TEMPLE CITY, Cl 1 147 WATER HEATER(S) 1.00 WTH 16.20 I (TENANT: I TOTAL FEES 43.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: I 105/08./08 SR 11/04/08 I (OWNER: TEL. NO: I IFINA D-A�T11) FIN CODE: (ARAGON, VIRGINIA (626) 286-0536- �/iy �� 19154 EMPEROR AV I_ i' Cv VV �l ISGAB 917752019 IDESCRIPTION OF WORK 1 (WATER HEATER CHANGE OUT SAME LOCATION 1 (APPLICANT: TEL. NO: I I ISOUTHWEST PLUMBING (909) 986-3900- 1 1404 S. EUCLID AVE. ISPECIAL CONDITIONS: I (ONTARIO, CA 91762 1 I I I I I I ICONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE ISOUTHWEST PLUMBING (909) 986-3900- 1 1404 S. EUCLID AVENUE LIC. NO 1 (UNDER SLAB WORK I 1 (ONTARIO, CA 91762 815947 C36 1 I 1 1 1 (WATER SERVICE I 1 IPLASTIC YIN METAL YIN I 1 (ARCHITECT OR ENGINEER: TEL. NO: I I I I - ! IROUGH PLUMBING I 1 LIC. NO: I I I IGAS- PIPING 1 1 1 1 IGAS VENT I 1 1 1 IHOT WATER HEATER I I IPLUMBING FIXTURES I 1 1 I (LAWN SPRINKLERS I IGAS TEST I 1 I (UTILITY COMPANY NOTIFIED( 1 I 1CWv I I 1 (GRAY WATER SYSTEM I 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 IREPORT ID: DPR263 ROUTE TO: BS0508 1 1 1 I I I I I I