HomeMy Public PortalAbout9520 GARIBALDI AVE_Plumbing__ r
`• "��'Q" DECLARATION APPLICATION FOR PLUMBING PERMIT
I herby affirm that I have a certificate of consent to self 20-0028 DPW 6/87
Insure, or a certificate of Workers'Compensation Insurance, 7BA667A lul
or a certlfled co*thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy NQ.11,317 n t 'dofipan
Certtfied copy is hereby furnished.
❑ FOR APPLK.ANr TO FILL IN(PRINT OR TYPE) BUILDING
Certified copy Is filed with the county building Irmspec- J
tion department. ( NUMBER FIXTURE OR ITEM FEE LOCALITY
O
_ — Appllcan WATER CLOSET NEAREST `
U� CERTIFICATE OF EXEMPTN FROM WORKERS' BATH TUB CROSSIp � �•
COMPENSATION INSURANCE &40WER OWNiERIm(t
(This section need not be cornploted if the vrork Involy by MAIL
the perrntt Is for one hundred dollars($100)or less.)' LAVATORY ApD{
I certify that In the performance 6f the work for which this
permit Is Issued, I shall not-employ any person In any manner SINK r QQ – TENO.
to as to become subject to the Workers Compgrisatlon Laws. DZHWASHER
pa{e Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making tis Certificate of
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR /�Ll
Compdnsatiorl provisions of the tabor Code, you must forth- LAWN SPRIN7QER SYSTEM G �►C yN
with con5pl-y with such prgvWons or this permit shall be OJ LIC
LICB� B s�
deemed revgked. WATER HEATER '9 CLASS , ,
LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY
I hereby p"-that I am IlcenMd under provisions of Chapter 9 GAS STEM OUTLETS2. Q
(commendng with Sedton 7000) of Dlvlsion 3 of the Business OLRU73 OVER
and Prafeeslons Code,qnd my Ilcerns Is to full force and effed. 5 PER SYSTEM FINAL
.Q vquDAnfSN
/ Q DATE
License Number & J Uc. Class
FINPtL
CoPtractor,}LTn:) 2yOLA – Date 1 BY
pb�l I am exempt under Sec,
B.6P.C. for this reason PIRm check fee a010
Date:
Slgnatu `� KUM9ING PERMIT ISSUING FEE; BO
TOTAL FEE �Q
c
" Plan check appllcafit `L
SINGLE FAMILY ACCT T
HOW OWNER-BUILDER DECLARATION Name
I hereby affirm that I am exempt from the Contractor's License Addrou y(]7 55.50
Law for the following reason (Section 703.1.5, Business and +
Professions Coc}e): City' Tel. W. 1 ITM
❑ I, ds owner of the property, will do the work and the TOTAL. 65 - 50
struclure Is not Intended or offered for sale (Section �.y
7044, Business and Professions Code). polo �}�I Ii &5.50
CONSTRUCTION LENDING AGENCY
I hereby af4irm that there Is a construction lending agency for
the performance of the work for which this permit Is Issued
(Sec. 3097, Clv. C.)_
CJBpCr-"l 7/ 8/91
Lender's Name 7876 1 AM10:48
Lender's Address
I certify that I have read this application and state that the
above Informwa lon Is correct. I agree to comply with all County
ordinances and State law's regulating Plumbing, and hereby
authorize reprelentatives of this County to enter upon the
above-mentlonpd'property fo Ins¢sction purposes.
` EEE REVERfE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY Q 0508 PLUABINO PERIQT
DEPARD@PT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1012150017
BUI10ING AND SAFLrPY / LAND DEVELOPMERT TEMPLE CITY CA 91780
PRONE: (626) 285-0488 ETT:
LEGAL ID: FEES PAID BUIIS)ING ADDRESS:
TR: 6561 LT: 263 ON: .002 9520 GARZBALDI AV
FEE DESCRIPTION: QQTNPS7.'Y: DOM:- AMOUNT: TEMP CA 917801649
ASSESSOR INFORMATION NUMBER: N]M R&ST CROSS STREET: TP.YPT,F. CITY
5385-007-002 01 PERMIT ISSUANCE FEE 27.80 'THOMAS PAGE: 596 GRSD: J2 Lk>CALTTY: TE4PLE CITY, C
07 BA.TH'LSTBS/SHOS!RRS 3.00 FII 48.80
TENANT: 25 LAVATORIES/SINKS 4.00 FII 65.10 ISSUID ON: PROCESSED BY: PLAN BY:
45 WATER CLOSET/UR-INAL 3.00 FSS 48.80 12/15/10 SR
TOTAL FEES 190.50
0WNER: TEL. NO: FINAL DATE FINAL BY: CODE:
HPHC PROPERTIES LS,C (626) 382-1688- r ��I
19223 COLIM4A RD.4972 �(/1]�!/ t
ROWLAND HT9 91748 DESCRIPTION OF 11ORK
KITCHEN REMODEL AND THREE B7aTHROCM9 RIDCDEL PLUMBING
APPLICANT: TEL. NO:
WEI, LI (626) 696-0003-
517 N. CHANDLER AVE SPECIAL CONDITIONS:
MONTEREY PARK 91754
CONTRACTOR: TEL. NO: APPROVALS DATE IN9PECPOR SIGNATURE
LI NEI CONS`ISi=OH (626) 696-0003-
517 N. CHANDLER AVENUE #D LSC. NO UNDER SLAB WORT
MONTEREY PARK, CA 91754 837977 B
WA= SERVICE
PLASTIC YIN METAL YIN
ARCHITECT OR ENGIN=: TML. NO:
- ROUIM[ PLUMBING
LIC. NO:
GAS PIPING
GAS VENT
HOT Wk= HEATER
PLaqIIiO FIXTURES
LANE SPRIN[a ER.S
GAS TEST
UTII,ITY COMPANY NO==
CMV
GRAY WATER SYSTEM
REPORT ID: DPP-263 ROUTE TO: 890508