HomeMy Public PortalAbout9837 HALLWOOD DR_Plumbing__ WORKERS' COMPENSATION DECLARATION APPUCAYMN FOR PLUMMIG,IG, PER61�i PT
I hereby affirm that I have a certificate of consent to self 20-0026 DPW 6/87
. ,
m5ire, or a certificate of Workers' Compensation Insurance, 76A667A :
_• or d'c6rtified copy thereof (Sec. 38000, Lab. C.) i.• COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS
Policy No. 7 Company.ST)"K FUN10 fA 1 "
Certified copy is hereby furnished. `'s /
FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING..
Certified copy is filed with the county building inspec- ADDRESS
T� tion department. NUMBER FIXTURE OR ITEM @ // FEE LOCALITY
Date Applicant ✓ WATER CLOSET b V NEAREST
CERTIFICATE OF EXEMPTION F M WORKERS' BATH TUB J X� CROSS ST.
COMPENSATION INSURANCE C� OWNER
(This section need not be completed if the work Involved by SHOWER
/the permit is for one hundred dollars($100)or less.) :LAVATORY MAIL .� ADDRESS
I certify that in the performance of the work for which this
SINK CITY TEL. NO. 2 �
permit is issued, I shall not employ any person in any manner � 89'x,27
so as to become subject to the Workers'Compensation Laws. DISHWASHERM�^
CONTRACTOR
Date Applicant CLOTHES WASHER ADDRESS
NOTICE TO APPLICANT: If, after making this Certificate of off.•
Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR
CITY I-�, TEL. NO. p
Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM r CCAM4 ��Z/
with comply with such provisions or this permit shall be STATE LIC.
deemed revoked. WATER HEATERLICENSE NO. CLASS
LICENSED CONTRACTORS DECLARATION' DI TRICT NO. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS
(commencing with Section 7000) of Division 3 of the Business OUTLETS OVER
and Professions Code, and.my license is in full force and effect. 5 PER SYSTEM.
FINALt� VALIDATIONDATE
a
License Number cthw� Lic. Class U.
FINAL _ p
Contractor Date BY 1 Ir
0,
❑ I am exempt und/1 Sec. IV IW
B.BP.C. for this reason :A 0
Plan check•fee _ D �
Date: PLUMBING PERMIT ISSUING FEE$
Signature
TOTAL FEE D
Plan check applicant
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Name '
I hereby affirm that I am exempt from the Contractor's License Address P44To4
Law for the following reason (Section 7031.5, Business and
Professions Code): City Tel. No. 3307 , 40,50
❑ I, as owner of the property, will do the work-and the. 1 1TMS
structure is not intended or offered for sale (Section yy p, '
7044, Business and Professions Code). TOTAL 40 o 50
CONSTRUCTION LENDING AGENCY
Gn �Vo�
I hereby affirm that there is ci construction lending agency for upu 50
the performance of the work for which this permit is issued . CHAS ,Q�r
(Sec. 3097, Civ. C.).
Lender's Norrie 00IM—Ml
6/ 9/89
Lender's Address �IJ1►tiV Aq q�
I certify that I have read this application and state that the D 3MI f AN t9►d44
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
gnoture of Pe
ittee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0211190028
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: FEES P D BUILDING ADDRESS:
TR: 13986 LT: 12 BL: .001 9837 HALLWOOD DR
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917803917
ASSESSOR INFORMATION U BER: NEAREST CROSS STREET: AGNES
8589-021-004 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
r 07 BATHTUBS/SHOWERS 1.00 FIX. 16.20
TENANT: 25 LAVATORIES/SINKS 1.00 FIX 16.20 ISSUED ON: PROCESSED-BY:- PLA BY: EXPIRES ON:
45 WATER CLOSET/URINAL 1.00 FIX 16.20 11/19/02 JK 05/18/03
_ TOTAL FEES 76.35
OWNER: TEL. NO: FINAL DATE FINAL BY: CODE:
KWOK KING H;WONG LINDA L (626) 285-8920-
9837 HALLWOOD DR 03 '
TEMP 917803917 DESCRIPTION OF WORK
PLUMBING FOR ADDITION
APPLICANT: TEL. NO:
KIM WONG (626) 448-1383-
9631 ALPACA STREET SPECIAL CONDITIONS:
S EL MONTE 91733
CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE
KIM WONG PLUMBING (626) 448-1383-
9631 ALPACA ST. LIC. NO UNDER SLAB WORK
SOUTH EL MONTE CA 91733 752619 B
WATER SERVICE
PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO:
KAO, JUSTIN 1626) 839-9385- ROUGH PLUMBING
2321 FALLEN DRIVE LIC. NO: /
ROWLAND HEIGHTS, CA 91748 322022 GAS PIPING
GAS VENT--
HOT WATER HEATER
PL MBING FIXT RES
LAWN SPRINKLERS
GAS TEST
UTILITY COMPANY NOTIFIED
C V
GR Y WATER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR263 ROUTE TO: BS0508