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Home My Public Portal About4820 HALLOWELL AVE_Plumbing__ WORKERS' COMPENSATION DECLARATION APPHCAMDN FOR PLUMBING PERMIT I hereby affirm that I have a,certificate of consent to-self 76A667A • i insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES � � BUILDING AND SAFETY Policy No. Company u)-/!P, ' - Certified copy is hereby furnished. ❑ FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspec- ADDRESS �� !� d [CGU tion department NUMBER FIXTURE OR ITEM @ FEE LOCALITY ,✓ �' Date19�s pplicant } WATER CLOSET .� NEAREST ~ _�-• 1 + 'l-r CERTIFICATE OF EXEMPTION FROM WORKERS' / BATH TUB ' 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($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this permit is issued, I shall not employ any person in any manner SINK X CITY TEL. NO. so as to become subject to the Workers' ginpensati n vws. s DISHWASHER (/ CONTRACTOR y �� ( Date ` Applicant CLOTHES WASHER Y, NOTICE NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR CITY J Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM ' ` TEL. NO. 7 �. with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY / } 9 I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS i spy - � y`` (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER 6J and Professions Code, and my license is in full force and effect. 5 PER SYSTEM FINAL g DATE '— � VALIDATION License Number Lic. Class 5 FIN Contractor Date BY ElI am exempt under Sec. �• e� B.BP.C. for this reason Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ 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 A Law for the following reason (Section 7031.5, Business and ddress "2.2 9 1 A Professions•Code): City Tel. No. ;t 0 0 0 0 0 ❑ . I, as owner of the property, will do the work and the • ' structure is not intended or offered for sale (Section 2 0 0 1!. Q v 0 7044, Business and Professions Code). CONSTRUCTION LENDING AGENCY ° ° U 0.5.O H I hereby affirm that there is a construction lending agency for -z the performance of the work for which this permit is issued C 2 7— v (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 re esentatives of this County to enter upon the above-m>e ti ned property for in�p ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Sigg6ture of Permittee bate WORKERS'COMPENSATION DECLARATION20-0026 PW 4/90 APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I hale a certificate of consent to self in- 76A667A suie,or a certificate of Workers'Compensation Insurance,or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. OLdJ� ,fit FOR APPLICANT TOBUILDING !FILL IN(PRINT OR TYPE) p� A' �� Certified copy is filed with the county building inspection ADDRESS department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET) . NEARESTQ, CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB 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 ($100)or less.) LAVATORY ADDRESS �° <;/7W I certify that in the performance of the work for which this per- �/ --- /' mit is issued, I shall not employ any person in any manner so SINK CITY 11 G TEL. NO. 11,j'91j as to become subject to the Workers'Compensation Laws. DISHWASHER CONTRACTOR Date 7 Applicant CLOTHES WASHER v pp� ADDRESS �— NOTICE TO APPLICANT: If, after making this Certificate of Ex- SWIMMING POOL RECEPTOR emption,you should become subject to the Workers'Compen- CITY TEL. NO. sation provisions of the Labor Code,you must forthwith comp- LAWN SPRINKLER SYSTEMS - ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER "P ` , and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATION fect. HOSE BIB DATE License Number Lic. Class ct FINAL Contractor Date cc I am exempt under Sec. Kc, . `d ` :ave B.&P.C. for this reason � Plan check fee pop- ` tttl� i'"n jv Date: PLUMBING PERMIT ISSUING FEE$ C •s'_'T AL 31-0-3 nIN Signature TOTAL FEE _� SINGLE FAMILYf lt HOME OWNER-BUILDER DECLARATION Plan check applicant I' 3� I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and Professions Code): Address - a _"J. •t AT�sias owner of the property, will do the work and the City Tel. No. 5Il.7J tructure 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 101111'.above information is correct. I agree to comply with all County ordinances and State laws regulating Plumbing, and hereby authorize presentatives ofos County to enter upon the above- tinned pro a . inspection purposes. 11 ` SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Perm t e bate WORKERS'COMPENSATION DECLARATION• APPLICATION FOR PLUMBING PERMIT ei I''` '20-0026-DPW 4/87• Qre y affi�m.?hat I have a certificate of consent to self in- 76A667A sfirP,•° certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) " certifi€+d copy thereof (Sec. 3800, Lob. C. COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Certified copy is hereby furnished. Certified copy is filed with the county building inspection FOR APPLICANT'TO FILL IN (PRINT OR TYPE) BUILDINGADDRESS department. NUMBER FIXTURE.OR ITEM [rla FEE LOCALITN O�;V pl Date Applicant NEATER CLOSET(TOILET) 6� NEAREST / G i/C! CERTIFICATE OF EXEMPTION FROM WORKERS' I BATH TUB v iq 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.) LAVATORY �Q ADDRESS ^dI57, — XI I certify that in the performance of the work for which this per- SINK mit is issued, I shall not employ any person in ny manner so / CITY .� TEL. NO. as to become subject to the Workers' Co p sa/ons. DISHWASHER. CONTRACTOR Date Applicant' ✓ CLOTHES WASHER NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS ec , em tionyou should become subject to the Workers'Com en- e'er` SWIMMING POOL RECEPTOR p y I p CITY TEL. NO. sation provisions of the Labor Code, you must forthwith comp- ly with such provisions or this permit shall be deemed revok- STATE LIC. ed. , WATER HEATER LICENSE NO. ASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter / GAS SYSTEM OUTLETS Q 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fan ed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL VALIDATIO DATE CL O License Number ��, Lic. Class _ V FINAL ' Contractor Date �yBY O I•am exempt under Sec. LU B.&P.C. for this reason Plan check fee. , g Date: PLUMBING PERMIT ISSUING FEE $ Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant - s I hereby affirm that I am exempt from the Contractor's License Name H>`'�'T'� Law for the following reason (Section 7031.5, Business and -c ^ 88 Professions Code): [Address ti` `"`;ii?si_ 8na50 I, as owner of the property, will do the work and the ity Tel. No. _ structure is not intended or offered for sale(Section 7044; �;u ;";(� 83 .al! Business and Professions Code). CHANGEi 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 j(g'I —yfl; j 3/ i39 (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 an State laws regulating Plumbing, and hereby authorize esentatives of this County to enter upon the above-mn� oned pr r pection.purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Date s COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0610220009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: I FEES PAID I BUILDING ADDRESS: 1 ITR: 13645 LT: 11 BL: .001 1 I 4820 HALLOWELL AV I I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ( TEMP CA 917803456 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LOWER AZUSA 18585-017-015 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 597 'GRID: C5 LOCALITY: TEMPLE CITY, Cl 147 WATER HEATER(S) 1.00 WTH 16.20 I (TENANT: I TOTAL FEES 43.95 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 I 110/22/08 SR 04/20/09 I (OWNER: TEL. NO: I 1FINAL DATE /p ,, CODE: 1 IKHAIR, PETER (626) 926-0866- r 14820 HALLOWELL AV E ITEMP 917803456 I (DESCRIPTION OF WORK I (REMOVE AND REPLACE WATER HEATER I (APPLICANT: TEL. NO: I i IMR. HANDYMAN (626) 836-8601- I I I 1150 E. MONTECITO AVE I (SPECIAL CONDITIONS: I (SIERRA MADRE 91024 I I I I I I I (CONTRACTOR: TEL. NO: 1 1APPROVALS DATE INSPECTOR SIGNATURE I IMR. HANDRYMAN (626) 836-8601- 1 1 I 1150 E. MONTECITO AVE. LIC. NO 1 1UNDER SLAB WORK I I I (SUITE B 807495 I I I I I (SIERRA MADRE, CA 91024 I 1WATER SERVICE I I I I (PLASTIC Y/N METAL Y/N I I I (ARCHITECT OR ENGINEER: TEL. NO: I I I I I I I (ROUGH PLUMBING I I I 1 LIC. NO: I I I I I IGAS PIPING I I i I IGAS VENT I I I I I I IHOT WATER HEATER I 1 7 IPLUMBING FIXTURES I (LAWN SPRINKLERS I I I I I I I IGAS TEST I I 1 I I I I I (UTILITY COMPANY NOTIFIEDI I I I ICWV I I I 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 I I IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I