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HomeMy Public PortalAbout5624 HALLOWELL AVE_Plumbing__ r ION 20-0026 WORKER'S I have a certificate of consent to 76A667ADPW 969 APPLICATION FOR PLUMBING PERMIT I hd'reby affirm that I have a certificate of consent to self insure, or a ceitificate of Worker's Compensation.Insurance, or a certified cFpy thereof(Sec.40800 Lab. C.) COUNTY OF LOS ANGELES DEPT.OF PUBLIC WORKS DEPT.OF PUBLIC WORKS DIV. Policy No. Company Certified copy is hereby furnished. ElFOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ��Z = Certified copy is filed with the county building inspection ADDRESS c— department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE ASSESSOR (This section need not be completed if the work involved by the SHOWER MAP BOOK P PARCEL permit is for one hundred dollars($100)or less.) - OWNER I certify that in the performance of the work for which this permit LAVATORY is issued, I shall not employ any person i any man r so as to SINK MAIL become wct the Workers' Compensat' n Law ADDRESS DISWASHER CITY / / TEL.NO. ! yC 35_2 Date�( Applicant CLOTHES WASHER NOTICE T6 APPLICANT: If, after mak' g this Certificate of CONTRACTOR Exemption,you should become subject to the Workers'Compensation SWIMMING POOL RECEPTOR provisions of the Labor Code, you must forthwith comply with such ADDRESS (J f provisions or this permit shall be deemed revoked. LAWN SPRINKLER SYSTEM -7� r� LICENSED CONTRACTORS DECLARATION CITY �/J L TEL.NO. !/Q 7! I hereby affirm that I am licensed under provisions of Chapter 9 WATER HEATER STATE �rrr ) 0 (commencing with Section 7000) of Division 3 of the Business and GAS SYSTEM OUTLETS LICENSE NO. �/t;,i CLASS Professions Code,and my license is in full force and effect. 00 OUTLETS OVER DISTRICT NO. PR SSED BY I�{ S � zo 5 PER SYSTEM �C� �1 � License Number CCS? Lic.Class c� FINAL �/+y/� VALIDATION � DATE �•-�,0 G' Contractor Date C0 ❑ I am exempt under Sec. FFIINAL }Q�/er///�"� B.&P.C.for this reason Cf L P 3 as te: � Signature 1 PLUMBING PERMIT ISSUING FEE$ 0 ElTOTAL FEE Plan check applicant SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name _ I hereby affirm that I am exempt from the Contractor's License Law for the following reason (Section 7031.5, Business and Professions Address h, r Code): ` EJ City Tel.No. ijt• I,as owner of the property,will do the work and the structure _1,.-{s is not intended or offered for sale (Section 7044, Business TT jam: and Professions Code). , 3 11 `r`I� CONSTRUCTION LENDING AGENCY ! i€ � 20°° �350 I hereby affirm that there is a construction lending agency for the �� (_.•, _IeSt performance of the work for which this permit is issued (Sec. 3097, Civ.C.) a HHAING ,._€'•.i Lender's Name 0 10 T" 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 umbing, and hereby authorize representativ of this Co to enter upon the ve- entioned property for inspection p es. 1 SEE REVERSE FOR EXPLANATORY LANGUAGE •-�r 1 0 Signatu of F�errlflttee q to y 1*ORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 20-0026 DPW 4/90 sure,or certificate of Workers'Compensation] r9 nce,or 76A667�A, certified copy thereof (Sec. 3800, Lab. C. t =or COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDINGn /I „� Rol— department , Certified copy is filed with the county building inspection ADDRESS ` /�J' V department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY Date Applicant WATER CLOSET(TOILET)_ NEAREST / `d yr CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. I Ile U COMPENSATION INSURANCE SHOWER OWNER C2� (This section need not be completed if the work involved by the permit is for one hundred dollars(5100)or less.)' LAVATORY ADDRESS U t-,/. , / I certify that in the performance of the work for which this per- SINK Q Q }nit is issued, I shall not employ any person in any manner so CITY v TEL. NO. / as to become subject to the Workers Compensation.Lows.' DISHWASHER' • CONTRACTOR � v Date Applicant CLOTHES WASHER lEvs ,� nn NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR CITY �N�,d, �' T 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- STATE3g i 7 v CLASS - ed WATER HEATER LICENSE NO. J LICENSED CONTRACTORS DECLARATION DISTRICT NO. CES ED 8Y I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 67. 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER and Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL fect. '7 L, ? / HOSE BIB DATE �-?,� V TION License Number / ! U a. Lic. Class `F' b IZ.:n'� FINAL �/�l \ Contractor t" 6L P TA'''I-14) Date /_ ' �� ^ BY cc ©• (fit✓ `"r�J 0 I am exempt under Sec. U B.&P.C. for this reason kJ Plan check fee 0. 0 Date: PLUMBING PERMIT ISSUING FEE$ 2-7sQ 3 Signature TOTAL FEE SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Plan check applicant C I hereby affirm that I am exempt from the Contractor's License Name Law for the following reason (Section 7031.5, Business and AC•C•Ta$ Professions Code): Address' I, as owner of the property, will do the work and the 'City Tel. No. 303 91>?0 structure is not intended or offered for sale(Section 7044, 1 ITEMS Business and Professions Code). oil. TOTAL 9 i —70 CONSTRUCTION LENDING AGENCY CHECK 91=70 1 hereby affirm that there is a construction lending agency for the performance of the work for which this permit is issued CHANGE .00 (Sec. 3097, Civ. C.). Lender's Name 0000_00011 5/20/96 Lender's Address 6516 1 AM11=31; 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 ab mone property for inspection.p poses. S SEE REVERSE FOR EXPLANATORY LANGUAGE Signature of Permittee Dat WORKERS'COMPENSATION DECLARATION APPLICATION FOR PLUMBING PERMIT I hereby, affirm that I have a certificate of consent to self in- 76A666 DPW 4/90 76A667A sure,or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3600, Lob. C.) � cs7 f, COUNTY OF LOS ANG'LES;.,_ DEPT. OF PUBLIC WORKS Policy No.WIML-3'lb01ompany `{ "�"�' ' Certified copy is hereby furnishe FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING 9 Certified copy is filed with the county building inspection ADDRESS 5i6 department. NUMBER FIXTURE OR ITEM @ FEE "Y y WATER CLOSET(TOILET) Date ltu� LOCALITY Applicant NEAREST q .I CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. \+1 COMPENSATION INSURANCE SHOWER OWNER a (This section need.not be completed if the work involved by MAIL a_ `A _ ',� ` �� � PC---(- I �� � ' n-a-i hal the permit is for one hundred dollars($100)or less.) LAVATORY ADDRESS ., (.1- Q tl+�`' Q J\L C 1w`� , I certify that in the performance of the work for.which this per- SINK eplfne5 mit is issued, I shall not employ any person in any manner so CITY TEL. NO. as to become subject to the Workers Compensation Laws. DISHWASHER ` !1 F a CONTRACTOR I¢A fa/ Date Applicant CLOTHES WASHER �..._ Y- NOTICE TO APPLICANT: If, after making this Certificate of Ex- ADDRESS `� 1./i1. emption,you should become subject to the Workers'Compen- SWIMMING POOL RECEPTOR sation provisions of the Labor rode,you must forthwith comp- LAWN SPRINKLER SYSTEMS CITY TEL. Ne'�4Lp Ltd ly-with such provisions or this permit shall be deemed revok- STATE LIC. ed. WATER HEATER kQ , LICENSE NO. Oqc► f Z CLASS LICENSED CONTRACTORS DECLARATION DISTRICT NO. PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM OUTLETS 9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER fed Professions Code, and my license is in full force and ef- 5 PER SYSTEM FINAL — VALIDATION qq, 1! — t y, License Number 3�61�� Lic. Class .�%3 ' HOSE BIB DATE ACCT. [�s FINAL O Contractor Date lowtCU BY ®. 0 1 am exempt under Sec. i- B.&P.C. for this reason Plan Check feeS a Date: - PLUMBING PERMIT ISSUING FEE$ Signature SINGLE FAMILY TOTAL FEE !-� HOME OWNER-BUILDER DECLARATION Plan check-applicant_. V 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 El I, as owner of the property, will do the work and the City Tel. No. i 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-me lone roperty for inspection purposes. s. SEE REVERSE FOR EXPLANATORY LANGUAGE (101 yl I UP Signature of Permittee D Te COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0501100001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 12392 LT: 19 BL: .001 5624 HALLOWELL AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: ARCD CA 910078419 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: LIVE OAK 8586-013-025 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: B3 LOCALITY: TEMPLE CITY, C 07 BATHTUBS/SHOWERS 2.00 FIX 32.40 TENANT: 25 LAVATORIES/SINKS: - 1.00 FIX 16.20' ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 45 WATER CLOSET/URINAL 1.00 FIX 16.20 01/10/05 JK 07/09/05 TOTAL FEES 92.55 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: NASSAR, CHARBEL (626) 447-9481- 5624 HALLOWELL AV ARCD 910078419 DESCRIPTION OF WORK PLUMBING FOR NEW BATH. APPLICANT: TEL. NO: SAME AS OWNER - SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: 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: ROUGH PLUMBING LIC. NO: GAS PIPING GAS VENT HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS / GAS TEST UTILITY COMPANY NOTIFIED CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS05O8