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Home My Public Portal About5926 ENCINITA AVE_Plumbing__ I WORKER'S COMPENSATION DECLARATION 20-0026 DPW 9189 1 hereby affirm That I have a certificate of consent to self insure, 76A667A APPLICATION FOR PLUMBING PERMIT or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sac. 3800 Lab.C.) COUNTY OF LOS AN DEPT. OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No.. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING F-1Certifiedcopy is filed with the county building inspection ADDRESS department. NUMBER FUTURE OR ITEM ® FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS ST. ` /� COMPENSATION INSURANCE BATH TUB ASSESSOR (This section need not be completed if the work Involved by the SHOWER MAP BOOK `J I PAGE Z526 PARCEL Q1 permit is for one hundred dollars(5100)or less.) OWNER - I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS 4:�`7 % ,. ✓� become subject to the Workers' Compensation Laws. DISWASHER CITU (v: TEL NO. a. _ Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of 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 CIN TEL.NO. d I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER / (commencing with Section 7000) of Division 3 of the Business and STATE LIC. GAS SYSTEM OUTLETS ��— LICENSE NO. CLASS Professions Code, and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY M 6 PER SYSTEM ��' O License Number Lic.ClassFIN V DATE Z Z l _GI ALIDATION LU Contractor Date rt on ❑ I am exempt under Sec. FINAL ?BV y B.BP.C.for this reason Date: Plan check fee PLUMBING PERMIT ISSUING FEE$ Signature 'r"•- TOTAL FEE Q 'j O�`NL c? ® .0 F-1 Plan check applicant J'A.:ji j y_ SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name CHAN1__ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address Clly L4�0City Tel. No. I, as owner of the property,will do the work and the structure h� .W is not intended or offered for sale (Section 7044, Business - J�r j i)11 ;j 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'a 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 property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permlttee Dae WORKERS'COMPENSATION DECLARATION ��®Yrl Ir®RJ Ir PLUMBING PERMIT I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87 u� G, I • insure, or a certificate of Workers'Compensation Insurance, 76A667A IILJII or a certified copy thereof (Sec. 3800, Lab. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No.—' Company - Certified copy is hereby furnished. BUILDING -�/ ZN / ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE( gDDRESSC p �-�r Tr C.i N LTR /w-F Certified copy is filed with the county building inspec- tion department. NUMBER FIXTURE OR ITEM C ,{ FEE LOC4LITV ps (�F� Date - Applicant WATER CLOSET 1. p• NEAREST 1'',LA�^,M�LE uT� tom• dU CERTIFICATE Of EXEMPTION FROM WORKERS' BATH TUB ( CROSS ST. TOWK, �NGz NI TA COMPENSATION INSURANCE SHOWER OWNER �Ilt'hJA "'�IZR-(�I (This section need not be completed If the work Involved by t ,� /P- d ,�L p the permit is for one hundred dollars ($100)or less.) LAVATORY I efl DDRESS - 7 �' "C'N�t/l A v I certify that in the performance of the work for which this p '✓ TEL. NO. g permit is issued, I shall not employ any person in any manner SINK B� CITY so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date Applicant CLOTHESWASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of SWIMMING POOL RECEPTOR Exemption, you should become subject to the Workers' SWIMMING TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be I iSTATF LIC. deemed revoked. WATER HEATER FDATE CLASS LICENSED CONTRACTORS DECLARATION TRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER ✓ O M and Professions Code,and my license is in full force and effect. 5 PER SYSTEM 2': /� ALIDATION "T ��• ,�.!.?1! O. License Number Lic. Class U. I IT_I Contractor Dote 5 a O TOTAL 8 I am exempt under Sec. p GHE :K :5.Lcr w B.BP.C. for this reason U) Plan check fee CHANGE ClCi —Date:— PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE 6/ 7i9:- Plan check applicant WfL'VA `T 0124 1 AM 3:01 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 Prof Bions Code): City Tel. No. (F12) — 63--D UJI, as owner of the property, will do the work and the structure is not intended or offered for sole (Section D 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 t Lender's Address I certify that I have read this application and state that the D 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-ment honed property for inspection purposes. ` _ SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat WORKER'S thatIhave a certificate DECLARATION 76A668DPW 9/69 ,APPLICATION FOR PLUMBING PERMIT 20-0026 0-002 A I hereby affirm that I have a certificate of consent to self insure, or a v.nlfica!e of Worker's Compensation Insurance, or a certified _ copy thereof(Sec.3800 Lab.C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company F] Certified copy is hereby furnished. - ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM ® FEE LOCALITY Dale Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' CROSS [C7 �y�Lc COMPENSATION INSURANCE BATHTUB ASSESSOR PAGE BO PARCEL (This section need not be completed if the work Involved by the SHOWER MAP BOOK (�J O permit is for one hundred dollars($100)or leas.) NER I certify that in the performance of the work for which this permit LAVATORY is issued. I shall not employ any person in any manner so as to MAIL SINK ADDRESSS:J WGiNl 74 VG- become subject to the Workers'Compensation Laws. DISWASHER CITY TEL. ,7v Date Applicant CLOTHES WASHER CONTRACTOR 1 -36 NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers' Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code, you must forthwith comply with such 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 TATE LtC. 0 (commencing with Section 7000) of Division 3 of the Business and LICENSE NO. CLASS Professions Code, and my license is in full force and effect. GAS SYSTEM OUTLETS �— V OUTLETS OVER DISTRICT NO. O PROCESSED BY Q 5 PER SYSTEM 0 License Number Lic.Class V FINAL uL ?. V/1LIDAION W DATE f O Contractor Date Z fA F-1FINAL I am exempt under Sec. B.SP.C.for this reasonS"! Plan check fee 1I'i n_ - _ '� -` Date: cr Signature PLUMBING PERMIT ISSUING FEES - ❑ ,TOTAL FEE 6 t_NpFi;7� ,i)ii Plan check applicant - SINGLE FAMILY _ HOMEOWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address 7L j 1 AMID, B Code): ❑ I, as owner of the property, will do the work and the structure City Tel. No. 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 t ' 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 herchv authorize representatives of this County to enter upon the above-mentioned property for-insp e ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE r'// �Ylvl N/JA/l • Signature of Permittee Date COUNTY OF LAS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1111210011 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0480 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 6561 LT: 379 BL: .001 UN: .002 5926 ENCINITA AV I IFEE DESCRIPTION: QOANTITY: UOM: AMOUNT: ( TEMP CA 919801931 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 18587-001-018 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl 107 BATHTUBS/SHOWERS 2.00 FIX 32.50 . (TENANT: 113 DISHWASHER(S) 1.00 FIX 16.30 (ISSUED ON: PROCESSED BY: PLAN BY: 1 125 LAVATORIES/SINKS 3.00 FIX 48.80 111/21/11 SR 1 1 145 WATER CLOSET/URINAL 2.00 FIX 32.50 1 1 (OWNER: TEL. NO: 151 IOW PRS GAS 5 OUTLET 1.00 SYS 16.30 1FINAL DATE FINAL BY: CODE: ZHANG, XUAN (626) 757-6685- 1 TOTAL FEES 174.20 1 � �� 19168 LAS TUNAS DRIVE ITEMP 917801931 �CRIPTION OF WORK I (PLUMBING FOR KITCHEN AND BATHROOMS REMODEL I (APPLICANT: TEL. N0: I I (PUN, PETER (626) 572-9181- 1 1 12714 STINGLE AVE I ISPECIAL CONDITIONS: 1 ROSEMEAD CA 91770 I (CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE IJ P CONSTRUCTION (626) 572-9181- 1 1 12714 STINGLE AVENUE LIC. NO I IUNDEP, SLAB WORK I I I ROSEMRAD, CA 91770 642751 B I 1 I I WATER SERVICE I (PLASTIC YIN METAL YIN I ARCHITECT OR ENGINEER: TEL. NO: 1 1— I 1 ROUGE PLUMBING LIC. No: 2Y I I (GAS PIPING I I I I I I (GAS VENT I I I I I I I IHOT WATER HEATER 1 1 1 I 1 I IPLUMBING FIXTURES I I I I I I I I ILAND SPRINKLERS I I I GAS TEST I I I I I (UTILITY COMPANY NOTIFIED( I I IGS I I I GRAY WATER SYSTEM 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 ., 'REPORT ID: DPR263 ROUTE T0: 850508 COUNTY OF LOS ANGELES TEMPLE CITY q 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1112210006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID BUILDING ADDRESS: ITR: 6561 LT: 379 BL: .001 ON: '.7002 1 5926 ENCINITA AV I FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:I TEMP CA 917801931 1ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18587-001-018 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl 111 CLOTHESWASHER(S) 1.00 FIX 16.30 (TENANT: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.30 (ISSUED ON: PROCESSED BY: PLAN BY: TOTAL FEES 60.40 112/21/11 SR OWNER: TEL. N0: I FINAL DATE FINAL Y: CODE: ZHANG, XUAN (626) 757-6685- 19168 LAS TUNAS DRIVE 1 ITEMP 917801931 IDESCRIPTION OF WORK ICLOTHESWASHER AND GAS LINE FOR LAUNDRY ROOM (APPLICANT: TEL. NO: IPUN, PETER (626) 572-9181- 12714 STINGLE AVE SPECIAL CONDITIONS: ROSEMEAD CA 91770 I 1 I I (CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE IJ P CONSTRUCTION (626) 572-9181- 1 1 12714 STINGLE AVENUE LIC. NO (UNDER SLAB WORK ROSEMEAD, CA 91770 642751 B IWATER SERVICE IPLA59'IC YIN METAL YIN I I ARCHITECT OR ENGINEER: TEL. NO: 1 - IROUGH PLUMBING 1 LIC. NO: GAS PIPING IGAS FENT I IHOT WATER HEATER I PLUMBING FIXTURES LAWN SPRINKLERS 1 GAS TEST I I I I IOTILITY COMPANY NOTIFIEOI I I 1 I GRAY WATER SYSTEM I I I_ II I I 1 I I I I I I I II I I I I I I I I II I I I I I I 1 I 1 I 1 1 I I I REPORT ID: DPR263 ROUTE TO: BS0508 1