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Home My Public Portal About5014 GLICKMAN AVE_Plumbing__ DRKERS'COMPENSATION DECLARATION Al .ICATION FOR PLUMBING PERMIT I here Firm that I have a certificate of consent to self 20-0026 DPW 6/87 insure,yr a certificate of Workers'Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS u Polic 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 5014 GliCkman Ave. tion department. ABPA INC. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Temple City Date Appl4pgressive Plumbing WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' Z BATH TUB O CROSS ST. Lower Azusa Rd. COMPENSATION INSURANCE OWNER (This section need not be completed if the work involved by AAIL SHOWER TeXtOn Construction the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS 1103 S. San Gabriel Blvd. #H I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINKCITY San Gabriel TEL. NO. 286-5691 so as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR progressive Plumbing Date-- Applicant CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS4257 Auction Ave. #F Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM Baldwin. Park TEL. NO. 962-2428 with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATERLICENSE NO. 478794 CLASS C-36 LICENSED CONTRACTORS DECLARATION / DISTRICT NO. PROCESSED BY (% I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS er� rf (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION 478794 C-36 Z a/ L O DATE Z ®. License Number Lic. Class U. Progressive Plumbing FINAL It Contractor Date BY Elam exempt under Sec. W, BAP.C. for this reason n3 Plan check fee tA, Date: PLUMBING PERMIT ISSUING FEE$ !� Signature TOTAL FEE Plan check applicant — SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name y ".•4;ir3:;. I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Address ,_', � 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 - •^i :.•.. the performance of the work for which this permit is issued -,}•1� !1 `F"'"� ''"' (Sec. 3097, Civ. C.). E 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-mentionedroperty for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signa re of Permittee Date V R'S COMPENSATION DECLARATION 6DPW9/89 APP :ATION FOR PLUMBING PERMIT 76A66 I hereby affir I have a certificate of consent to self insure, 76A667A 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 9Company 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) BDDRE S UILDING 5014 GL I CKMAN Certified copy is filed with the county building inspection department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date 12/14/92 Applicant TEXTON CONST WATER CLOSETNEAREST TEMPLE CITY CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. LOWER AZUSA COMPENSATION INSURANCE 1ASSESSOR (This section need not be completed if the work Involved by the SHOWER _LOOK PAGE �PARCEL permit is for one hundred dollars($100)or less.) R STARTS DEV I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as toMAIL SINK ADDRESS 601 S FIGUEROA 4650 become subject to the Workers' Compensation Laws. DISWASHER CITY LA TEL.NO. 2136241555 Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of TEXTON CONST Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code, you must forthwith comply with such 11 0-4 S SAN GABRIEL 14 provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY SAN GABRI EL TEL.No.81 8 2 8 6 6 09 0 CL I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE LIC. 0 (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. 570978 CLASS B U Professions Code,and my license is in full force and effect. OUTLETS OVER DISTRICT NO. PROCESSED BY cc 5 PER SYSTEM �)♦" Q License Number 5 7 0 9 7 8 Lic.Class B FINAL �Z 18 L VALIDATION W Contractor TEXTON CONST Date 12/14/92 DATE coIL ❑ FINAL I am exempt under Sec. FBY I B.&P.C.for this reason Date: Plan check fee Signature , PLUMBING PERMIT ISSUING FEE$ ❑ TOTAL FEE Plan check applicant c SINGLE FAMILY HOME OWNER-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 3307 Code): City LA Tel.No. 213624155El � L I,as owner of the property,will do the work and the structure —��—a, is not intended or offered for sale (Section 7044, Business I` I Ht_ :s s —r and Professions Code). ', C CONSTRUCTION LENDING AGENCY e91 I I hereby affirm that there is a construction lending agency for the �'f-f�aNGE+ '\ performance of the work for which this permit is issued (Sec. 3097, .4 Civ.C.) }, Lender's Name Lender's Address `I certify that I have read this application and state that the above , f information is correct. I agr to comply with all County ordinances land State laws regulat' Plumbing, and hereby authorize reprep ntatives of this C ty to enter upon he ab ve-mentione pr a ty or'n pection rposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 -LUMBINGPERM DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS9L_05Q$ 0005090013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BU.-LLDING ADDRESS TR: 50066 LT: 1 UN: 2 5014 _LCKdAN AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917804022 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LA ROSA 8585-015-057 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY 49 WATER TREATING EQUIP 1.00 SYS 16.20 TENANT: TOTAL FEES 43.95 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 05/09/00 UT 11/05/00 OWNER: TEL. NO: FINAL DATEEXPIRR7 Y: CODE: WONG;DAVID (626) 453-8828- 5014 GLICKMAN AV TEMP 917804022 DESCRIPTION OF WORK INSTALLATION OF WATER SOFTENER APPLICANT: TEL. NO: ACTION CONTRACTORS (310) 515-1311- 17111 S. BROADWAY SPECIAL CONDITIONS: GARDENA, CA CONTRACTOR: TEL. NO: J �''�-� ��V41 `•`\`• Vii;• .• APPROVALS DATE INSPECTOR SIGNATURE ACTION CONTACTORS, INC. (310) 515-1311 \,•s 17111 BROADWAY LIC. NO i- ,_/� >> �� ` UNDER SLAB WORK GARDENA, CA 90248 652535 ! �� '• WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: r ` ROUGH PLUMBING LIC. N. GAS PIPING - -- - �— -, ------- -- - - GAS VENT 4 ::u ` it 't` u,�a T- HOT WATER HEATER -- - -- - _/— - -- ---- _--- PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST UTILITY COMPANY NOTIFIED t� s,,y f�"�•''' CWV _ h GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 1