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Home My Public Portal About5012 GLICKMAN AVE_Plumbing__ %, 3'S COMPENSATION DECLARATION 20-0026 DPW 9/89 APPI ATION FOR PLUMBING PERMIT 76A667 I hereby affiri I have a certificate of consent to self insure, 7BA667A or a certificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) Policy No.1 2 2 3 0 2 9 Company STATE FUND COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS- 5012 GL I CKMAN department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date 1,2 1 1Q 1 9 2pplicant TFXTON CONT WATER CLOSET cROSSST. LOWER AZUSA _ CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 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($100)or less.) LAVATORY OWNER STARTS INTL. DEV. INC. I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner so as toMAIL SINK ADDRESS become subject to the Workers'Compensation Laws. 601 S FIGUEROA 4650 DISWASHER CITY I TEL.NO. 21 36241 5 Date Applicant CLOTHES WASHER CONTRACTOR TEXTON CONST. NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS1103 S SAN GABRIEL H provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CIN SAN GABRI ELTEL.No- 8182866090 I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS L CET SE NO. rj]O 9 ]$ CLASS $ Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY a: 5 PER SYSTEM 0 License Number 5 7 0 9 7 8 Lia Class $ FINAL jZ VALIDATION LU DATE Contractor TFX'PON CONST Date 1 2/1=4/92 v D ❑ FINAL Z I am exempt under Sec. BY B.&P.C.for this reason Date: Plan check fee Signature PLUMBING PERMIT ISSUING FEE$ ElTOTAL FEE v _ SINGLE FAMILY Plan check applicant HOME OWNER-BUILDER DECLARATION Name STARTS DEV i��`-I•� 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 46-50 Tl�! =�'�`.-,. Code): City LA Tel.No. 21 3 6 2 41 5 5 s C ❑ I,as owner of the property,will do the work and the structure is not intended or offered for sale (Section 7044, Business iEMS I NL 39—30 and Professions Code). , 3 CONSTRUCTION LENDING AGENCY i I hereby affirm that there is a construction lending agency for the CHANGE performance of the work for which this permit is issued (Sec. 3097, Civ.C.) IL 21 7 4 Lender's Name _ ; '; H. j Lender's Address I certify that I hav d this ap lication and state that the above , information is c ec I agre o omply with all County ordinances and State I s r gulati P mbing, and hereb authorize repre nta es this C un to enter uj abo -mentioned p erty or' spection oses. 1 i '(! �,� SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee, (Date i DRKERS'COMPENSATION DECLARATION Al .ICATION FOR PLUMBING PERMIT ��77 I hers..., _.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. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ® Certified copy is filed with the county building inspec- ADDRESS 5012 Glickman Ave. tion department. ABPP INC. NUMBER FIXTURE OR ITEM Q EE LOCALITY Temple Cit pp Date A wRgressive Plumbing 3 WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' Z & BATHTUB CROSS ST. Lower Azusa Rd. COMPENSATION INSURANCE SHOWER OWNER Texton Construction (This section need not be completed If tho work involved by MAIL the permit is for one hundred-dollars ($100)or less.) LAVATORY ADDRESS 1193 S. San Gabriel Blvd. #H I certify that in the performance of the work for which this SINK CITY TECNO. permit is issued, I shall not employ any person In any manner Sari Gabriel 286-5691 so as to become subject to the Workers'Compensation Laws. DISHWASHER Z�f CONTRACTOR Progressive Plumbing Date Applicant CLOTHES WASHER / ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of 4257 Auction Ave. #F Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITYTEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM Baldwin Park 962-2428 with comply with such provisions or this permit shall be STATE LIC. 478794 deemed revoked. WATER HEATER LICENSE NO. CLASS C-36 LICENSED CONTRACTORS DECLARATION / DISTRICT NO. PROCESSED BY I hereby affirm-that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code, U�►LIDATION and my license is in full force and effect. 5 PER SYSTEM FINAL �", o, License Number 478794 Lic. Class C-36 DATE ��`� Progressive Plbg. FINAL _ ,_- Contractor Date BY `! 0. ❑ I am exempt under Sec. •.:i.: �:..< »:_ � ,.� Lt3 B.B,P.C. for this reason t.1;, __G Plan check fee Cl) Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE Plan check applicant - - -• --• SINGLE FAMILY :••,,, HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Address Law for the following reason (Section 7031.5, Business and Professions Code): City Tel. No. ❑ I, 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-mentione roperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE ;�� o- L Signa re of Per ittee Date a' COUNTY OF LOS ANGELES TEMPLE CITY ## 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 1408270019 G. BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ITR: 50066 LT: 1 UN: 1 I 1 5012 GLICKMAN AV 1 I IFEE DESCRIPTION: QUANTITY: UOM; AMOUNT:1 TEMP CA 917804022 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: 18585-015-056 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY CAI 1 145 WATER CLOSET/URINAL 3.00 FIX 48.60 1 (TENANT: 192 NO PERMIT OWNER—BLDR 171.90 DOL 171.90 JISSUED ON: PROCESSED BY: PLAN BY: I I TOTAL FEES 248.30 108/27/14 SR I I I 10WNER: TEL. NO: 1 1F TE ( F/I'�N1fALLY/B/'Y: CODE: CHANG KUO—YU;LINDA LING FENG (626) 454-5005— 1 // 1 c' ' .FC 5012 GLICKMAN AV ` ITEMP 917804022 IDESCRIPTION OF WORK 1 I 1 (REPLACE THREE WATER CLOSETS (APPLICANT: TEL. NO: 1 1 ISAME AS OWNER I I ISPECIAL CONDITIONS: I I I I ICONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE ISAME AS OWNER — 1 I LIC. NO i., JUNDER SLAB WORK I I I I I IWATER SERVICE I I I IPLASTIC YIN METAL YIN I I I ARCHITECT OR ENGINEER: TEL. NO: I I I I I I — i IROUGH PLUMBING 1 LIC. NO: _ I 1 I GAS'PIPING I I I I I I I I' IGAS VENT I I I I I I I 1 IHOT WATER HEATER I I I I I I I I IPLUMBING FIXTURES II I I I I I I (LAWN SPRINKLERS I I I I 1 IGAS TEST I I I 1 I JUTILITY COMPANY NOTIFIEDI I I ICWV I I I I 1 (GRAY WATER SYSTEM I I I I I I I I I I I I I I I I I I I I I I I I I IREPORT ID: DPR263 ROUTE TO: BS0508 1 I I I 1 I I I I I