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Home My Public Portal About6367 ENCINITA AVE_Plumbing__ 5 r' .NVORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBINGPERMIT I.hereby,affirm that I have a certificate of consent to self in- .•�bAW6 DPW 4/87 5yr�or a certificate of Workers'Compensation Insurance,ora CE 817(REV. 8/86) certified copy thereof-(Sec.'3800,Lab. C.) Policy Na Company COUNTY OF LOS-ANGELES DEPT. OF PUBLIC WORKS F . Certified copy is hereby furnished. - FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING O Certified copy is filed with the county building inspection ADDRESS fiI 7 Fn rj n I tau department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) NEAREST rn ' CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUBSHOWER CROSS Si. / COMPENSATION INSURANCE - OWNER ! t (This section need not be completed if the work involved,by MAIL -61 the permit is for one hundred dollars ($100) or less.) LAVATORY ADDRESS I certify that in the performance of the work for which Ihis per- SINK ' mit is issued, I'shall not employ any person in any manner so 'CITY TEL NO. as to becomesubject to the Workers'Compensation Laws. ., DISHWASHER ` CONTRACTOR Date ' Applicant CLOTHES WASHER ADDRESS , raaA - NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR - emption,.youshould become subject to the Workers Compen- _ CITY sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEM V TEL. NO. -' ly with such provisions or this permit shall be deemedrevok- STATE _ UC. ped. - WATER HEATER LICENSE NO, CLASS LICENSED CONTRACTORS-DECLARATION DISTRICT. �./ ROC - hereby affirm that I am licensed under provisions of Chapter GAS SYSTE OUTLET$ ✓T (O/ 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 7 c VALIDATION - d fect. ,J) DATE /Z.��3�Lr License Number �] U Lic. Class C'_yV - �J U Contracfoi Nyrhl��n /Date Vat � FI AL(/ �' O -� I am exempt under Sec W a B.BE,C. for this reason Pian Check {@B D Z Dater PLUMBING PERMIT ISSUING FEE S Signature - - TOTAL FEE t SINGLE FAMILY — HOME OWNER-BUILDER DECLARATION Plan check applicant `r I hereby affirm that am exempt from the Contractor's License Name A�-CT•1 Law for the following reason (Section 7031.5, Business and Professions Code): Address 1:Q7 161.50 I, as owner of the property, will do^the Work and the City . - -Tel. No. 1 11EMS structure is not intended or offered far sale(Section 7044, r C Business and Professions Code). - D T13TAL 1-6 a !TO CONSTRUCTION LENDING AGENCY CHECK Ib.�CI I hereby affirm that there is a construction-lending agency for r Il the performance of the work for which this.permit is issued - CHANUE ,•�- (Sec 3097, Civ. O.). Lender's Name " 01000-MCII 11/29/8 Lender's Address 't 116+ 1 AM 8:10. I certify that I have read this.application and slate-that the - above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing,-and hereby - outhoriz present ves of this County to enter upon the . above- Honrey f r inspection purposes. ' SEE REVERSE FOR EXPLANATORY LANGUAGE ' S' na of Ve K me ate 1 COUNTY OF-LOS ANGGLES TEMPLE CITY k 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0506 1207100035 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID BUILDING ADDRESS: ITR: 12115 LT: 20 6367 ENCINITA AV IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: ( TEMP CA 917801318 (ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 15382-023-012 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl 1 107 BATHTUBS/SHOWERS 2.00 FIX 32.40 1 1 TENANT: III CLOTHESWASHER(S) 1-00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: 1 113 DISHWASHER(S) 1.00 FIX 16.20 107/10/12 SR 1 121 HOSE BIBB(S) 1.00 FIX 16.20 (OWNER: TEL. N0: 125 LAVATORIES/SINKS 2.00 FIX 32.40 IFINAL DATE FINAL EY: CODE: ILIN, DAVID (626) 675-1449- 145 WATER CLOSET/URINAL 1.00 FIX 16.20 1 16367 ENCINITA AVE 147 WATER HEATER(S) 1.00 WTH 16.20 112 31^1�/ ITEMPLE CITY CA 91780 1 TOTAL FEES 173.60 IDECCRIPTION OF WORK PLUMBING FOR KITCHEN, BATHROOMS, LAUNDRY ROOM AND WATER HEATER IAPPLICANT: TEL. NO: IKE BY DESIGN, LARRY KU (626) 679-5238- 1828 E. VALLEY BLVD ISPECIAL CONDITIONS: ISAN GABRIEL CA 91776 1 (CONTRACTOR: TEL. NO: (APPROVALS DATE INSPECTOR SIGNATURE ITSH CONSTRUCTION AND DEVELOPMENT (626) 688-5255- 1 15605 TEMPLE CITY BLVD. #B LIC. NO (UNDER SLAB WORK ITEMPLE CITY, CA 91780 952913-B I I IWATER SERVICE I I PLPSTIC Y/N METAL YIN I (ARCHITECT OR ENGINEER: TEL. NO: IROUGH PLUMBING I /M LIC. NO: I v' 1 GAS PIPING IGAS VENT I I I I I HO1' WATER HEATER PLUMBING FIXTURES (LAWN SPRINKLERS GAS TEST (UTILITY COMPANY NOTIFIEDI I (GRAY WATER SYSTEM I I I I I I I 1 _ IRE PORT ID: DPR263 ROUTE T0: 850508 I 1 I 1 • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1211290032 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: (LEGAL ID: FEES PAID_ BUILDING ADDRESS: ITR: 12115 LT: 20 6367 ENCINITA AV I IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:( TEMP CA 917801318 1 1ASSESSOR INFORMATION NUMBER: I NEAREST CROSS STREET: 15382-023-012 101 PERMIT ISSUANCE FEE 27.80 THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 1 TENANT: TOTAL FEES 44.00 ISSUED ON: PROCESSED BY: PLAN BY: 111/29/12 SR OWNER: TEL NO: (FINAL DATE FIj�A]�Y: CODE: ILIN, DAVID (626) 675-1449- _�•,y/'I(Y1V) 16367 ENCINITA AVE YY / ITEMPLE CITY CA 91780 DESCRIPTION OF WORK GAS LINE (APPLICANT: TEL. N0: 1ERIC (626) 68B-6255- 15605 TEMPLE CITY BL ISPECIAL CONDITIONS: (TEMPLE CITY CA 91780 I I 1CONTRACTOR: TEL. N0: JAPPROVALS DATE INSPECTOR SIGNATURE 1 ITSH CONSTRUCTION AND DEVELOPMENT (626) 688-6255- 1 1 1 15605 TEMPLE CITY BLVD #B LIC. NO JUNDER SLAB WORK 1 1 ITEMPLE CITY CA 91700 952913 1 1 1 WATER SERVICE IPLASTIC YIN METAL YIN (ARCHITECT OR ENGINEER: TEL. NO: - ROUGH PLUMBING LIC. NO: IGAS PIPING (GAS VENT IHOT WATER HEATER I IPLUMBING FIXTURES LAWN SPRINKLERS IGAS TEST UTILITY COMPANY NOTIFIED( GRAY WATER SYSTEM I I I I I I I I (REPORT ID: DPR263 ROUTE T0: BS0508 1