HomeMy Public PortalAbout4817 HALLOWELL AVE_Plumbing__ • WORKERS' I have a certificate
DECLARATION APPLICATION FOR PLUMBING PERMIT L�11
•I tierpbyl'affirm that I have a certificate of consent to self in- 76A667A 20-0026 PW 4/87 _7 t
Sure,or a certificate of•Workers'Compens tion Insurance,or a CE 817(REV. 8/86) U
certified co thereof (Sec. 3800, Lab.
Policy WO 5- Company l COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
❑ Certified copy is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING
(nj Certified copy is filed with the county building inspection ADDRESS
44L� NUMBER FIXTURE OR ITEM LOCALITY
de/gariment. @ FEE
WATER CLOSET(TOILET) �,
Date 7 Applicant NEAREST
CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB /S „ CROSS ST.
COMPENSATION INSURANCE SHOWER OWNER
(This section need not be completed if the work involved by MAIL
the permit is for one hundred dollars ($100)or less.) 3 LAVATORY a SU ADDRESOIQ J p,J, � p��
I certify that in the performance of the work for which this per- SINK al�/
mitis issued, I shall not employ any person in any manner so Sd CITY // �E p�/ TEL. 3: /7 7�
as to become subject to the Workers Compensation Laws. DISHWASHER Sv ✓�� _
CONTRAT/c-�AJ/� /����i✓ � ✓ys
Date Applicant / CLOTHES WASHER s ADDRE�B�� �C.� � �L�S
NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING.POOL RECEPTOR
emption,you should become subject to the Workers'Compen- CITYe� D�T� TELZ a!5-
sation provisions of the Labor Code, you must forthwith comp- LAWN SPRINKLER SYSTEM s
ly with such provisions or this permit shall be deemed revok- STATE LIC. (� 7
ed. WATER HEATER Tjj LICENSE NO. ���� LASS
LICENSED CONTRACTORS DECLARATION IRICT NO. _ ESS
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS $_!>' o(/
9((commencing with Section 7000)of Division 3 of the Business OUTLETS OVER g
fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL) V LIDATION
DATE/ `/ p
License Number O d Lic. Class4 // �j/!
49 FINALr
Contractor, 6f7AX'04115 q Date 7 BY Q
❑ I am exempt under Sec.
B.BP.C. for this reason pop.Plan check fee -
Date: PLUMBING PERMIT ISSUING FEE $ V 1
_Signature J '""" ' ' •
'TOTAL FEE D
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant
I hereby affirm that I am exempt,from the Contractor's License Name a
Law for the following reason (Section 7031.5, Business and �A nF
Professions Code): Address
—L)�z
`i1�t- ye3t
j t C p 3
❑ 'I, as owner of the property, will do the work and the City Tel. No.
structure is not intended or offered for sale(Section 7044, 1 ITEMS
Business.and Professions Code). pool ., �iT �
.n._^._ - -_.
CONSTRUCTION LENDING AGENCY f , C' C.. _
I hereby affirm that there is a construction lending agency for
the performance of the work for which this permit is issued CHANE 3
(Sec. 3097, Civ. C.).
00019-00011 �'!1'i i
Lender's Name � _ moi_/�"t
Lender's Address .r� 't 3 Ar,
�L.
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
a ove-mentioned property for inspectiourposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0807090013
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: FEES PAID BUILDING ADDRESS:
ITR: 15098 LT: 6 4817 HALLOWELL AV 1
I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803457
ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET:
18585-016-014 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: C5 LOCALITY: TEMPLE CITY, Cl
I 107 BATHTUBS/SHOWERS 1.00 FIX 16.20
1TENANT: 125 LAVATORIES/SINKS 2.00 FIX 32.40 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
1 145 WATER CLOSET/URINAL 1.00 FIX 16.20 107/09/08 SR 01/05/09 1
-1 TOTAL FEES 92.55 1
OWNER: TEL. NO: I IF AL DATE FINA BY: CODE:
KHAN, DEBRA (626) 442-0556- 1 1
14817 HALLOWELL AV I I
TEMP 917803457 ID CRIPTION OF WORK
1 11 BATHTUB, 2 LAVATORIES AND WATER CLOSET I
APPLICANT: TEL. NO:
UNIVERSAL REMODELING (888) 343-9111-
19135-A RESEDA BLVD. ISPECIAL CONDITIONS:
INORTHRIDGE CA 91324
1CONTRACTOR: TEL. NO: JAPPROVALS DATE INSPECTOR SIGNATURE 1
1UNIVERSAL REMODELING, INC. (818) 285-6939- 1 I
19135-A RESEDA BLVD., SUITE 195 LIC. NO JUNDER SLAB WORK
INORTHRIDGE, CA 91324 617830B I
WATER SERVICE I
(PLASTIC YIN METAL YIN
ARCHITECT OR ENGINEER: TEL. NO: 1-
- 1ROUGH PLUMBING
LIC. NO: 1
IGAS PIPING I
I 1
IGAS VENT I 1 1
I 1 1HOT WATER HEATER I I 1
I 1 (PLUMBING FIXTURES 1 I I
I I I I I I
I ILAWN SPRINKLERS
IGAS TEST I
(UTILITY COMPANY NOTIFIED( 1 1
I I ICwv I
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
I I I I I I
I IREPORT ID: DPR263 ROUTE TO: BS0508
1 I I I I