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Home My Public Portal About5008 GLICKMAN AVE_Plumbing__ DRKERS'COMPENSATION DECLARATION A .ICATIOIV FOR PLUMBING PERMIT I here Firm that I have a certificate of consent to self 20-0026 DPW 6/87 insure, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. 3641-92 Company State Fund ❑ Certified copy is hereby furnished. BUILDING FA ADDRESS APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 5008 Glickman Ave. tion department. ABPP INC. / Certified copy is filed with the county building inspec- NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple City Date Apptica PR SS1Ve P"Mlbing WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' Z BATHTUB CROSS ST. Lower Azusa Rd. COMPENSATION INSURANCE OWNER (This section need not be completed If the work involved by ROWER Texton Construction the permit Is For one hundred dollars($100)or less.) LAVATORY MAIL 1103 S. San Gabriel Blvd. #H ADD I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK CITY San Gabriel TEL. NO. 286-5691 so as to become subject to the Workers'Compensation Laws. I DISHWASHER CONTRACTOR Progressive Plumbing - Date Applicant / CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of 4257 Auction Ave. #F Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM CITY Baldwin Park TEL. No. 962-2428 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. 478794 CLASS C-36 LICENSED CONTRACTORS DECLARATION DISTRICT No. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 ! GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER _ and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION 0>1 478794 C-36 �- DATE /Z— License Number Lic. Class Q. Progressive Plbg. FINAL 1,2 ,;— Contractor Date bT s .moi-:' .:.�_J.v•.� ❑ I am exempt under Sec. vs B.&P.C. for this reason _ t_ Plan.checkfee 'i!'il» . _ •z Date: _._ •:�,_. PLUMBING PERMIT ISSUING FEE$ + E'• Signature TOTAL FEE SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name r•ii.?^i-1 _-i-1.+M1 ;,. I hereby affirm that I am exempt from the Contractor's License n,,,... Law for the following reason (Section 7031.5, Business and Address Professions Code): City Tel. No. ❑ 1, as owner of the property, will do the work and the structure 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 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 hereby authorize representatives of this County to enter upon the above-m 'property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE 3.4d mittee Date i W I'S COMPENSATION DECLARATIof consent to 76A666DPW9/89 PPI ATION FOR PLUMBING PERMIT 76A667A AP PI hereby affirr I have a certificate of consent to self insure, or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No. 12 2 3 0 2 9Company STATE FUND COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. �,,5 El Certified copy is hereby furnished. BUILDING !� rtl FOR APPLICANT TO FILL IN(PRINT OR TYPE) ADDRESS 5008 GL I CKMAN Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM @ FEE 1 2/1 4/9 21 TEXTON CONST LOCALITY TEMPLE CITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. W R A Z USA COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK 8585 PAGE 15 PARCEL 5 5 permit is for one hundred dollars($100)or less.) LAVATORY OWNER STARTS DEV. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS 6ol q FTGuEROA 4650 become subject to the Workers'Compensation Laws. DISWASHER CITY LA TEL.NO.21 36241555 Date Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of CONTRACTOR TEXTON CONST. Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS 1103 S SAN GABRIEL H provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM / LICENSED CONTRACTORS DECLARATION / CITY TEL.NO'81828660 )0 I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER AN GABREIL STATE LIC. !Z (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM - OUTLETS LICENSE NO. 5 7 0 9 7 8 CLASS B 0 Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY Cc B 5 PER SYSTEM ��`,� �� 0 License Number 5 7 0 9 7 8 Lic.Class V FINAL VALIDATION LU Contractor 'I'EXTnN CONST Date 12/14/92 DATE Z, U) ❑ I am exempt under Sec, FI AL Z B.&P.C.for this reason Plan check fee , Date: � PLUMBING PERMIT ISSUING FEE$ Signature ❑ TOTAL FEE �n Plan check applicant SINGLE FAMILY a HOMEOWNER-BUILDER DECLARATION Name STARTS DEV. I hereby affirm that I am exempt from the Contractor's License Law _ for the following reason (Section 7031.5, Business and Professions Address 601 S FIGUEROA 4650 Code): _ EJ 1, LA Tel.No. 21362415 5 I"I� I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business YT-11{'i?L _ a 30 and Professions Code). _ CONSTRUCTION LENDING AGENCY I. I hereby affirm that there is a construction lending agency for the --- performance of the work for which this permit is issued Sec. 3097, P ( Civ.C.) Lender's Name Lender's Address I certify that I have r��4 applicat' nand state that the above information is c eGr{. e to c �with all County ordinances P umb%n and hereby authorize� 9� 9 repr ntatE Ives thisfCou to enter upon the a ove-m tinned p erty f sp a ion pu. s s'� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date