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HomeMy Public PortalAbout6324 ENCINITA AVE_Plumbing__ WORKERS,COMPENSATION BECLARATION APPLICATION PP IC p TION F®® PLUMBING DL p llpp BIN PERMIT I hereby, affirm that I hovea certificate of consent to self in- 20-0026 DPW 4190 P91r IL 'b Y9 0 Ytl 7( Ir IL'LY9V9 OCI69 Ir lG ll'(9tlB II sure,E4 a Ler9ficote of Workers'Compensation Irisurohce,or a certified Lopt reo4 a 800, Lab. p' COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Polity No. ompany ❑ Certified copy is hereby furnished. BUILDING FOR APPLICANT,TO FILL IN(PRINT OR TYPE) ADDRESS � �7 r �p�/✓�/H Certified copy is filed with the<ou bu Iding inspection dep e t NUMBER FIXTURE OR ITEM @ FEE LOCALITY i/�J� 1q/�L/O7/tl/nom I WATER CLOSET(TOILET) g ��� Date _- Applimnt Jt7 NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' 3 BATH TUB' i/ 3O CROSS ST. �. . COMPENSATION INSURANCE SHOWER 7 OWNER �M5 (This section need not be completed if the work involved by .. - MAIL the permit is for one hundred dollars($100)or less.) LAVATORY 0 ADDRESS //W9 L �,C/.tJf�f7 I certify that in the performance of the work for which this per- / SINK - CITY / TEL. NO. mit is issued, I shall not employ any person in any manner so as to become subject to the Workers Compensation Laws. DISHWASHER j ' 117 ` O CONTRACTOR Date- Applicant - CLOTHES WASHER �� NOTICE TO APPLICANT: If, after making this Certificate'of Ex- ADDRESS emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY ]/Q s•4 TEL. NO. sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEMS 2ur r ' I07Iuuu../// ly with such provisions or this permit shall be deemed revok- - STATE / LIC. �! J ed. l WATER HEATER /© LICENSE NO / �/ CLASS LICENSED CONTRACTORS DECLARATION / GAS SYSTEM OUTLETS / /O DISTRICT NO. PR ESSED BY I hereby affirm that I am licensed under provisions of Chapter l Sr 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VA ATION tett. / 9s 7 _•,/ � HOSE BIB .3� DATE a License Number Lic. Class _ K(�� p `,� Am FINAL O Contractor /G4 "9�eto 4 BY 114 ¢O I am exempt under Sec. �f t- B.BP.C. for this reason Plan check fee y Date: _ PLUMBING PERMIT ISSUING FEE$ O - Z Signature ' TOTAL FEE SINGLE FAMILY 30 HOME OWNER-BUILDER DECLARATION Plan check applicant - 1 I hereby affirm that I am exempt from the Contractor's License Name Low for the following reason (Section 7031.5, Business and I ACCT.' Professions Code): Address 3303 349.36 I', as owner of the property, will ao the work and the Ciiy Tel. No. 1 ITEMS structure is not intended or offered for sale_(Section 7044, Business and Professions Code). TOTAL 3.4-'4' _ 30 CONSTRUCTION LENDING AGENCY GHEGY, 349.30 1 hereby affirm that there is a construction lending agency for - CHANGE .GG the performance of the work for which this permit is issued (Sec. 3097, Civ. C.).Lender's Name0000—0001 5/13/96 Lender's Address 6353 1 AM 8:05 1 certify that I have read this application and state that the above information is correct. I agree to comply with all County t ordinon a d State laws regulating Plumbing, and hereby outho ze re resentatives of this County to_enter upon the - ob -men op prope y for k spectio po es. �Jl Q - SEE REVERSE FOR EXPLANATORY LANGUAGE Sig'atur of Permittee Date v i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9611050007 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL FEES PAID BUILDING ADDRESS: ON FILE 6324 ENCINITA AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801316 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LONGDEN 5382-017-033 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY 05 BACKFLOW DEVICE(S) 1.00 DEV 16.35 TENANT: TOTAL FEES 44.10 ISSUED ON: PROCESSED : PLAN EXPIRES ON: 11/05/96 TC 11/05/97 OWNER: - - TEL. N0: FINAL DATE FINAL BY: /J CODE: ENCINITA TRUST (818) 287-6092- 11_5.44 �1/6t1 6324 ENCINITA AV TEMP 917801316ESCRPRINKLTIWORK SPRINKLER SYSTEM FOR NEW SINGLE FAMILY RESIDENCE APPLICANT: —NO- RAYOS LANDSCAPE (818) 303-7972- M111 W.ONROVIAL NORTE `o✓ SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: v .� - APPROVALS DATE INSPECTOR SIGNATURE RAY'S LANDSCAPE CO. (818) 303-7972- r o 111 W EL NORTE LIC. NO 1 R AB 0 K MONROVIA CA 91016 547313 C27 — �,.`.,I- _ - WATER SERVICE �� f 1 I�� LL�l� PLASTIC METAL Y/N ARCHITECT .OR NG[ 0: \J(�� C) LL�1 0 - -- - -- - -- ------ -- -- ROUGHPLUMBING MB MBING LIC. NO: I -T GAS PIPING GAS VENT `OT WATER HEATER P UMBI G FIXT R S N S NKL S / ®� `>•.�' �1���� G ST-ES-T— UTILITY COMPANY NOTI=D o C V GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508