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Home My Public Portal About5818 GOLDEN WEST AVE_Plumbing__ Y 1 WURKER'S COMPENSATION DECLARATION 20-0026 DPW 9/89 I hereby affirm that I have'a certificate of consent to self insure, 76A667A APPLICATION FOR PLUMBING PERMIT or a eertificate of Worker's Compensation Insurance, or a certified copy thereof(Sec.3800 Lab.C.) ____ COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT. OF PUBLIC WORKS DIV. Policy No. Company Certified copy is hereby furnished. El Certified APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM Qo FEE LOCALITY Date Applicant Z WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. Q COMPENSATION INSURANCE ASSESSOR ((�� (This section need not be completed if the work involved by the SHOWER MAP BOOK Q PAGE D 3 PARCEL Q 3 permit is for one hundred dollars($100)or less.) OWNER I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person in any manner so as to SINK MAIL ADDRESS become subject to the Workers'Compensation Laws. DISWASHER CITY / Y` TEL.NO. Z Date Applicant CLOTHES WASHER CONTRACTOR NOTICE TO APPLICANT: If, after making this Certificate of Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR ADDRESS provisions of the Labor Code, you must forthwith comply with such provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM LICENSED CONTRACTORS DECLARATION CITY TEL.NO. I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER (commencing with Section 7000) of Division 3 of the Business and STATE LIC. V Professions Code,and my license is in full force and effect. GAS SYSTEM OUTLETS LICENSE NO. CLASS OUTLETS OVER DISTRICT NO. PROCESSED BY 5 PER SYSTEM License Number Lic.Class FINAL DATE �� 2 VALIDATION All Contractor Date Vy ❑ I am exempt under Sec. q BY BAP.C.for this reason •c/`� `,'0 V'T Plan check fee J , Date: Signature PLUMBING PERMIT ISSUING FEE$ A6 mo ❑ TOTAL FEE d Q SINGLE FAMILY Plan check applicant _ HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from the Contractor's License Law `=` ! z a for the following reason (Section 7031.5, Business and Professions Address Code): W.�_1 `_IC::,j:''•_` City Tel. No. ®, I,as owner of the property,will do the work and the structure = =1 U f is not intended or offered for sale (Section 7044, Business E ,s 8 and Professions Code). , — �— "' CONSTRUCTION LENDING AGENCY = 4'=' `;")`I UC I hereby affirm that there is a construction lending agency for the s �=•r.' e performance of the work for which this permit is issued (Sec. 3097, Civ.C.) Lender's Name %i_3s{ )—S_I}Al L Lender's Address _I 1 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-mentioned property for inspection purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have ave a a certificate of consent to self in- 20-0026 DPW 4/90 suw,or a certificate of Workers'Compensation Insurance,or a 76A667A certified copy thereof (Sec. 3800, Lab. C. C�lull COUNTY OF LOS ANGELES DEPT. OF,PU03LIC WORKS Policy No. Company Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM. @ FEE LOCALITY WATER CLOSET(TOILET) Dote Applicant ` NEAREST BATH TUB CROSS ST. CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER OWNER CLQ ��f (This section need not be completed if the work involved by MAIL — the permit is for one hundred dollars ($100)or less.) , LAVATORY ADDRESS I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers'Compensation Laws.: DISHWASHER ��'��4 CCCIII CONTRACTOR Date. Applicant CLOTHES WASHER ADDRESS NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS ly with such provisions or this permit shall be deemed revok- STATE LIC. ed.. J WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that 1 am licensed under provisions of Chapter GAS SYSTEM OUTLETS i ` 9(commencing with Section 7000)of Division 3-of the Business OUTLETS OVER LyG"�U and Professions Code, and my license is in full force and ef- 5 PER SYSTEM. FINAL /tJ VALIDATION fect HOSE BIB DATE lJ ?_ License Number Lic. Class } 9L O Contractor Date BYAL ACCT ACCT.'VL 0 1 am exempt under Sec. OOS n 910 fl O B.BP.C. for this reason 1 ITEMS U Plan check fee ► TOTAL ?i o 70 LU Date: PLUMBING PERMIT ISSUING FEE$ 0 CHECK 91.70 Signature TOTAL FEE l� CHANGE .00 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant I hereby affirm that I am exempt from the Contractor's License Name '' Law for the following reason (Section 7031.5, Business and O O�Q 01 3/ 4/96 Professions Code): Address 5102 1 AM 9:57 I, as owner of the property, will do the work and the City Tel. No.LAJ p structure is not intended or offered for sale(Section 7044,- Business 044,Business and Professions Code), CONSTRUCTION LENDING AGENCY I herebyaffirm 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 abov mentioned pperty for inspection purposes. .� SEE REVERSE FOR EXPLANATORY LANGUAGE Sig ature of Perm' Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9709110006 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA - --" - "DUPL"ICATE--- --- PHONE: -PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDR SS: TR: 6561 LT: 450 5818 GOLDEN WEST AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917802203 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-027-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 2.00 FIX 32.70 TENANT: 21 HOSE BIBB(S) 1.00 FIX 16.35 ISSUED ON: PROCESSED BY: PLA BY: EXPIRES N 25 LAVATORIES/SINKS 2.00 FIX 32.70 09/11/97 VG 09/11 45 WATER CLOSET/URINAL 2.00 FIX 32.70 OWNER: TEL. NO: TOTAL FEES 142.20 FINAL DATE FINAL BY: CODE: YU CHING KWAN;ZHI JUAN LU GUAN (818) 286-1598- 5818 GOLDEN WEST AV Z TEMP 917802203 DESCRIPTION OF WORK PLUMBING FOR ADDITION APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. N0: _ ��\\Jr ', �J APPROVALS DATE INSP TOR SIG URE SAME AS OWNER LIC. NO -�\ "�� `_` _ ��\ � UNDER SL B WORK • �� \� �i/ Oil � ��.' f WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: �� ` ' �� "��\ �' , ROUGH PLUMBING VoLIC. N0: � ' ' � GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS 4_9�� % GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 �tUiIB N PER DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS 50,•8 9 ,1.1,,00 1 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: LT FEES PAID y HiLQI� TR: 6561 LT: 450 8180` DEN WE�S•T� FEE DESCRIPtiON: QUANTITY: UUM: AMOUNT: T MP CA 917802203 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-027-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS "AGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, C 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.2G TENANT: TOTAL FEES 43.95ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 11/16/99 UT 05/14/00 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: YU CHING KWAN;ZHI JUAN LU GUAN (818) 286-1598- 5818 GOLDEN WEST AV TEMP 917802203 (DESCRIPTION OF WORK 6NG//WTEM GAS LINE FOR NEW HEATING AND COO APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: a� 6� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO � UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: 1_ ROUGH PLUMBING LIC. N� GAS PIPING �- — ----- -- ------- --------- —I GAS VENT cc J I�\1;l J l �� HOT WATER HEATER 11 ! J J lJ 0�J u -- ----------- -- ------- PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST _ � I �','-14�� UTILITY COMP NY NOTIFIED L ��®� CWV / GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 LUMB'ING PERM1IT_. DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SPL~0508 990730,0006 BUILDING AND SAFETY / LAND DEVELOPMENT. TEMPLE CITY CA 91780 PHONE: (626) 285=0488 EXT: LEGAL ID: FEES PAID BUILDING"ADDRES W TR: 6561 . LT: 450 18 GOE N T_AV" FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP-=917802x203 " ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LAS TUNAS 8587-027-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX', 16.20- TENANT: 51 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: TOTAL.FEES 60.15 07/30/99" UT 01/26/00 OWNER: TEL. NO: FINAL DATEFINAL BY: C YU CHING KWAN;2HI JUAN LU GUAN - �7�,_ 5818 GOLDEN WEST AV TEMP 917802203 DESCRIPTrON OF WORK PLUMBING FOR GUEST HOUSE APPLICANT: TEL. NO: SAME AS OWNER SPECIAL CONDITIONS:. CONTRACTOR: TEL.. NO: ®� 6h� APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER LIC. NO UNDER SLAB WORK WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. N0: ROUGH PLUMBING r� �111111J1 , GAS PIPING Li j GAS VENT U HC �nUOHOT WATER HEATER LJ w PLUMBING FIXTURES O 0EJ '^ / LAWN SPRINKLERS t+, GAS TEST �! L UTILITY COMPANY NOTIFIED ® CWV GRAY WATER SYSTEM . REPORT ID: DPR263 ROUTE TO: BS0508