HomeMy Public PortalAbout6243 ENCINITA AVE_Plumbing__ 4.`-�, WnriKERS' COMPENSATION DECLARATION- APPLICATION-. FOR PLUMBING PERMIT
I �ereb 36A667 DPW 4/87 -
s Jteffirm teat Ih�•ve q certificate of�conse nt to self in- ]6A667A
sure,or a certificoiq of Workers'Compensation Insurance,ar a ,CE 817(REV. 8/86).
certified copy thereo (Sec 3800 Lob. C.) -
Policy No. Company _ COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS ,
Certified copy,is hereby furmshed:u'. ', - - -
Certifiedco is filed'with the count building p FOR APPLICANT TO FILL IN (PRINi'ORT,VPE) BUILDING
py y gins inspection I ADDRESS
deparfinenC _ - „ .x � NUMBER. _FIXTURE OR ITEM FEE LSA }}
j) .LOCALITY
Dale ' +- Applicant t f, _ 'v1ATER CLOSET ITOILFT7 (/ L7 NEAREST, / �/
CERTIFICATE OF EXEMPTION FROM WORKERS' - BATH TUB - CROSS ST. GO/sr COMPENSATION INSURANCE-INSURANCE ,1 SHOWER OWNER J 6 �Jy
(This section it"d.not be'completed'if the work involved by 11 q - MAIL
the permit is for,ona hundred dollars ($100)orAoss.) .� LAVATORY V ADDRESS -
I:certify that in the performance of heor whicthis per; - _
mit is issued,. sha not employ any p)aen�rll.n'
nny manner so SINK,' CITY TEL NO
as.tdbecom sub cT to the Workers Laws., DISHWASHER�nA ,({�, CONTRACTOR.
Date —/' r/ � APPlicant CLOTHES WASHER ADDRESS - '
NOTICE-T APP ICA T If, after ma ing this Certificate of Ex- SWIMMING'POOL RECEPTOR '
emptidn,you should become Subject to the Workers'Comport- CITY - TEL NO.
.sation-provisions of the Labor Code, you must forthwith comp- .LAWN SPRINKLER SYSTEM
ly with such.provisions or this permit shall,be deemed.revok- - - STATE - LfC.
ed. - } WATER HEATER 0 LIC SE NO. CLASS
LICENSED CONTRACTORS DECLARATION• - - O DISTRI NO� !' PROCE ED'BY
I hereby affirm that I am licensed under pravistons of Chapter GAS SYSTEM OUTLETS �J`Gl Of/
9(commencing with Section,7000)of Division 3 of the Business OUTLETS OVER'.
fed Professions Code, and my license is in full force and ef- S PER SYSTEM FINAL , 1 VALID ION a
- DATE ` C
License Num bet - Lic. Class U
FINAL cc
Cohiractai - Date BY O
I am exempt under Seca W
B,aP.C. far this reds on Plan check,fee - _ i
Date: PLUMBING PERMIT ISSUING FEE
Signature - `" TOTAL FEE
-SINGLE FAMILY . -
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby offirm,thot I dm:exempt from the Cowroctor's License Name -
Law for the following reason (Section.7031.5, Business and
Professions Code): Address -
% I, as'owner,of the property, will do,the work.and.the City - Tel. No,. 2788A A
-vructure is not amended a,offered for sale(Section 7044 - f
Business and Professions Code). - - -
D 5
u,� °
CONSTRUCTION LENDING.AGENCY - '
1 hereby affirmlhat there is a construction lending agency fol - ( - 40.50
the performance of the work for which this permit is issued - - - - _
(Sec. 3097, Civ. C.). - '° °'° 4,Q 5��
Lender's Name - o9. 09 8 7
Lender's Address -
certify Ihot-I have read this application and state that the
above'i tion is correct agree to comply with at County D -
ordin I s d State laws regulating Plumbing, and hereby
out ri r reser7.Jptivas of this County to a er upon the
ob ve- e i ed part arty
for Inspection pure =qs
_V /% (ly SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee 06te -
_ COUNTY OF LOS '-iGELES TEMPLE CITY p 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1109280034
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 5904 LT: 280 6243 ENCINITA AV
I IFEE DESCRIPTION. ?'QUANTITY: UOM:,=. AMOUNT: ( TEMP CA 919801640
(ASSESSOR INFORMATION NUMBER: �• NEAREST CROSS STREET:
15384-011-018 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
163 WATER PIPING BR/FIX 7.00 FIX 47.00 T 1
TENANT: 164 WATER PIPNG <m 1 1/2 1.00 LIN 16.30 TISSUED ON: PROCESSED BY: PLAN BY:
TOTAL FEES 91.10 109/28/11 SR
TOWNER: TEL. NO: TFINAL DA FIN CODE: T
TURN LAM (626) 318-8298-
16243 ENCINITA AV I,
ITEMP 917801640 1 MMRIPTION O WORK
17 FIXTURES COPPER REPIPE 1 IN WATER SERVICE
(APPLICANT: TET,. N0: T
IKEVIN TRUETH -
(SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE
IREPIPE 1 (818) 535-1778- 1 1
123679 CALABASAS RD LIC. NO (UNDER SLAB WORK
CALAHASAS, CA 91302 927892 C36 I
1
IWATER SERVICE
I I IPLAS TIC Y/N METAL /N
(ARCHITECT OR ENGINEER: TEL. NO:
- IROUGH PLUMBING
LIC. NO: 1 I
JGAS PIPING
JGNS'VENT
• , HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
GAS TEST
(UTILITY COMPANY NOTIFIEDI
Gw
GRAY WATER SYSTEM
I I I I I
II I I I 1 I
IREPORT ID: DPR263 ROUTE TO: BS0508 T