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Home My Public Portal About5801 ENCINITA AVE_Plumbing__ WOthat I haveCOMPENSATION DECLARATION 260D2a DPW 9/89 APPLICATION FOR PLUMBING PERMIT BA6a7A I hereby affirm that I have a certificate of consent to sell insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab. C.) I - COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No Company ❑ Certified copy is hereby furnished. F-1Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING i Certified copy is filed with the county building inspection ADDRESS Q I r department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY I C; Dale Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK PAGE PARCEL permit is for one hundred dollars(S700)-or less.) OWNER LAVATORY ,IU 1 D�V� N I certify that in the performance of the work for which this permit ,V is issued, I shall not employ any person in any manner so as to $INK MAIL / �Y become subject to the Workers'Compensation Laws. ADDRESS Z LA l/ DISWASHER CITYArco J I el TEL.NO.fJ D Date Z�-�. Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Ce icate of CONTRACTOR Exemption, you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER a (commencing with Section 7000) of Division 3 of the Business.and STATE LIC. O Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS U OUTLETS OVER DISTRICT NO. PROCESSED BY 5 PER SYSTEM Q License Number Lic.Class 2 G _O �U(/ ,LLG�Cc. F_ !if FINAL0 DATE 9 VALIDATION W Contractor Date '" �� Ai:i_T,it (q ❑ I am exempt under Sec. BY AL "j I3' 2 'S- _ i B.BP.C.for this reason 1 ITEM: Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ �� Lip ® TOTAL 72 - 75 Signature ❑ TOTAL FEE CHECK ! .7 J Plan check applicant CHANGE SINGLE FAMILY , HOME OWNER-BUILDER DECLARATION Name LA I hereby affirm that I am exempt from the Contractor's License Law O T� for the following.reason (Section 7031.5, Business and Professions Address Irl 30-00131 / '-Px —1 Code): Tel. No. 7 11,639 1 AM 9.41 c City Q'( ., I, as owner of the property,will do the work and the siruCWre 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 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 this County to enter upon the above-mentioned 0 or inspe i purp e . SEE REVERSE FOR EXPLANATORY LANGUAGE Signatur of Pe ittee Date "WORKERS' COMPENSATION DECLARATION APPLICATION'I 7PM ei90 FOR PLUMBING YCBB9i02MIThereby, affirm that I have a certificate of consent to self in- jb�A sure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lob. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. 994965 Company Rep. Indemnity ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 580/ 2W ENCINITA AV NUE Certified copy is filed with the county building inspection ADDRESS deportment. NUMBER FIXTURE OR ITEM FEE P U � LocAUTv TEMPLE CITY, CA Date A��9 /07q� Applicant WATER CLOSET(TOILET) NEAREST J - CERTIFICATE OF EXEMPTION FROM WORKERS' O.s V BATH TUB CROSS ST.OC �Q COMPENSATION INSURANCE SHOWER - TT OWNER Hung Chou & ASSOC• (This section need not be completed if the work involved by MAIL - the permit is for one hundred dollars ($100)or less.) LAVATORY Q ADDRESS 2894 Larkfield, Avenue I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so J` CITU Arcadia, CA -TEL. N474-7267 as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Frank Marrone & Sons, Inc. Date Applicant CLOTHES WASHER53 NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTORADDRESS 9860 Lower Azusa Rd. emption,you should become subject to the Workers'Compen- ' CITY sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS E I Monte (S4& 444-2548 ly with such provisions or this permit shall be deemed revok. STATE LIC. ed. . - / WATER HEATER ICENSE No. 397884 CLASS C/36 C/16 LICENSED CONTRACTORS DECLARATION / DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS y 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and m license is in full force and ef- 5 PER SYSTEM FINAL Y VALIDATION Lice. 397884 C/36 C/16 HOSE BIB DATE —� a License Number Li[. Class O FINAL O F. Marrone & So 12/31/92 By Contractor ate cc O I am exempt under Sec. U B.&P,C. for this reasonPlan check fee ® p w Dote: PLUMBING PERMIT ISSUING FEE$ -j— z Signature /_(!� TOTAL FEE S SINGLE FAMILY ' HOME OWNER-BUILDER DECLARATION Plan check applicant - c 1 hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business andf_�;I ,� Professions Code): Address _"„_ A!/ =St•a@J DI, as owner of the property, will do the work and the City Tel. No. structure is not intended or offered for sale(Section 7044, j ITEM'�0 Business and Professions Code). �- ® 1 i_iTAL 2Sz6 o 1 _= CONSTRUCTION LENDING AGENCY �� nM rc I hereby affirm that there is a construction lending agency for -i tCCY, "�� the performance of the work for which this permit is issued ,ylli (Sec. 3097, Civ. C.). Lender's Name ILon_I—on1 6t 2-1 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 lows regulating Plumbing, and hereby authorize representatives of this County to enter upon the abov mentio ed property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of lfrmittee Date