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Home My Public Portal About6039 HART AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION /pl PP��C/p��( N FOR PL() (fin({ O ,MG PER (�n�5'( r I hereby affirm that I have a certificate of consent to self 76A667A [ry try u uv u�1 l�Juvu llV uauvu u insure, or a certificate of Workers' Compensation Insurance, CE 817(REV. 10/81) crr a certified copy thereof (Sec. 3800.,,,.1�Lob. �� ,RI C.)f + COUNTY OF LOS ANGELES BUILDING D SAFETY Policy NoS QMw- Company S\c�\g_.. Inn ❑ Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING Certified copy is filed with the county building inspect. ADDRESS tion department.. NUMBER FIXTURE OR ITEM t?n FEE LOCALITY Dateii%� Applicant �� + �_ WATER CLOSET. NEAREST CERTIFICATE OF EXEMPTION FROM WORKERS' BATH TUB CROSS ST. COMPENSATION INSURANCE OWNER SHOWER (This section need not be completed if the work involved by MAIL ' the permit is for one hundred dollars ($100)or less.) LAVATORY ADDRESS I certify that in the performance of the work for which this - permit is issued, l shall.*not employ any person in any manner SINK CITY \q.� TEL. NO. ss �y so as to become subject to the Workers Compensation Laws. DISHWASHER `9 CONTRACTOR Date Applicant CLOTHES WASHER f NOTICE TO APPLICANT: If, after making this Certificate of ADDRESS Exemption, you should become subject to the Workers' SWIMMING POOL RECEPTOR Compensation provisions of the Labor Code, you must forth- CITY TEL. N LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. S�S CLASS LICENSED CONTRACTORS DECLARATION I d I60Y PROCESSED BY I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license its in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE O� License Number �Q �� Lic. Class_ �/ 7 AA FINAL Contractor��.q+a �� Date\\AA—'R BY ❑ 1.3 4J I am exempt under Sec. � amt� B.BP.C. for this reason % Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Signature TOTAL FEE SINGLE FAMILY Plan check applicant c HOME OWNER-BUILDER DECLARATION Name �`.�'�e4 I hereby affirm that I am exempt from the Contractor's License Address . Law for the following reason (Section 7031.5, Business and 3307 50 Professions Code): City Tel. No. ITE �r ❑ I, as owner of the property, will do the work and the _ _ structure is not intended or offered for sale (Section t I ITAL 6 m !To 7044; Business and Professions Code). CONSTRUCTION LENDING AGENCY CHECK 16.50 I hereby affirm that there is a construction lending agency for 1•HANGE E 110 the performance of the work for which this permit is issued (Sec. 3097, Civ..C.). 0000-Cl0I 11/16/89 Lender's Name 68321 u*14 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 r rceerrfasw��of this County to enter upon the abov entioned property r i pection purposes. j SEE REVERSE F013 EXPLANATORY LANGUAGE _ Signature of Permittee Date ' WORKERS'COMPENSATION DECLARATION n fob p n 4 O f�fl FOR (I�n o (��ra P 2 n n/� r 2070026 DPW•4/87 Gil lr L� A II N IT Ili U M u v V 1511�OUIl I hereby;"affirm that have a certifi cbte:of'coAsentto self in- 76g667A , sure or a certificate of Workers'Compensation Insurance,or a CE 817(REV. 8/86) certified copy thereof (Sec.-3800, Lab C:) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy:No:% b� Company - ❑ Ce'rtifiedlcopy.is hereby furnished _ FOR APPLICANT TO FILL 1N (PRINT OR TYPE) BUILDING. Certified copy is filed with the.countybuilding inspection ADDRESS NUMBER FIXTURE OR.ITEM FEE department @. µ ' LOCALITY D_ - �'� �Applicgnt ' _ -WA NEAREST TER CLOSET(TOILET) CERTIFICATE OF EXEMPTION FROM WORKERS' BATHTUB CROSS'ST. COMPENSATION INSURANCE OWNER (This section need not be,completed if the work involved by. SHOWER MAIL m ..,� the:pertt is for one hundred dollars ($100)-or less.).; LAVATORY A_DDRESS' I certify that,in the performance of the work for ,which this per- mit is'issued I shall not employ any in-any manner so SINK ; CITY" TEL. NO as . - y y p ...- _ to 6ecome'subjecT to,the,Workers'Compensation Laws.' " -DISHWASHER - 'CONTRACTOR NZ Date Applicant CLOTHES`WASHER` ADDRESS NOTICE TC) APPLICANT:.If, after'makmg this.Certificdte 6f.Ex' SWIMMING,POOL RECEPTOR , .empfion,you should become subject to the Wm orkers'�Compen CIT TEL. NO. sation provisions of the Labor Code, you must'forthvvith cop-, I.,AWN SPRINKLER SYSTEM ly with such provisions or this permit shall tie deemed revok STATE LIC. , -WATER HEATER. LICENSE NO: �� CLASS LICENSED CONTRACTORS DECLARATION. DISTRICTNO. OCESSED BY I hereby affirm that I am,licensed under provisions of Chapter, GAS SYSTEM OUTLETS 9(commencing,with Section 7000)of Division 3 of - ess OUTLETS.OVER and'Profe'ssions,Code, and my license is in full force and of 5 P FINAL ALIDATION fect. ` DATE ' `; '. License Number'•S� �y� � Lic. Class�_ .,.. .: :.. s ` " V,. - PER SYSTEM Q FINAL; cc 1�* Date' NO`�� !' BY P. O Contractor Lam exempt under Sec. U d B:"BP.0 for•this,reason e W H Date:" P ISSUING FE x Plan check fee PLUMBING PERMIT I E$ ' Signature ' TOTAL FEE SINGLE --HOME,OWNER-BU I LDER DECLARATION Plgn check applicant ` I hereby affirm that I am,exempt from the Contractor's Licenser. Name. Lavv'for'the.following reason (Section 7.031.5; Business and' Professions Code): Address 'ACCT'g a. – I as. w ,_'one'r of the property, will do the work.and the City. Tel. No. 5� 1 Y°e t ❑ structure is not intended or offered forsale(Section 7044; 1 TTEM S Business and Professions Code)'. ' -16 CONSTRUCTION LENDING-AGENCY D TOTAL - —8 J herebyciffi in'that there is a constructionlending agency for CHECK' 161.�O theperformance of the work for which this permit is issued CHANGE (Sec. 3097;'Civ..C.). Lendera Name 10/16139.. Lenders Address ' I'certify:`tha' I have read'"this application and'state that the .�9 above,information is correct:.l agreeLto comply with all County D ordina a'f�'tRws=r ulpting'Plumbing, and hereby a arize representatives of s my to enter upon the above-men one r r spect n purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE SigncKure of Perm.ittef Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0411030003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: - LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 322 6039 HART AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801915 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 5384-015-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 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 11/03/04 JK 05/02/05 , TOTAL FEES 76.35 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: CAI, SHENG HONG, OIAN, HUIMING (626) 287-7859- y��/��Z�I) 6039 HART AV L /� TEMP 917801915 DESCRIPTION OF WORK PLUMBING FOR NEW BATHROOM. 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: BS0508 COUNTY OF.LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0811170005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID BUILDING ADDRESS: I ITR: 5904 LT: 322 6039 HART AV 1 I 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: I TEMP CA 917801915 1 (ASSESSOR INFORMATION NUMBER: 1 I NEAREST CROSS STREET: LONGDEN 15384-015-018 101 PERMIT ISSUANCE FEE - 27.75 I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl 107 BATHTUBS/SHOWERS 2.00 FIX 32.40 1 1 1TENANT: 121 HOSE BIBB(S) 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 I 125 LAVATORIES/SINKS 2.00 FIX 32.40 111/17/08 SR 05/16/09 I 145 WATER CLOSET/URINAL 1.00 FIX 16.20 1 (OWNER: TEL. NO: 147 WATER HEATER(S) 1.00 WTH 16.20 IFINAL DATE FINAL BY: CODE: 1 ILY, CANH H (626) 286-0639- 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 1 16039 HART AV I TOTAL FEES 157.35 1TEMP 917801915 1 jf)EtRIPTIOIN OF WORK 1 I IPLUMBING FOR KITCHEN AND BATHROOM 1 I I I I (APPLICANT: TEL. NO: I 1AU (626) 319-2021- I 1145 ORANGE STREET 1 1SPECIAL CONDITIONS: 1 ISM GABRIEL CA 91776 I I I I I CONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 1THOMSON MAC (626) 378-2899- 1 1 I 14419 N HALIFAX RD LIC. NO I 1UNDER SLAB WORK � 1 (EL MONTE CA 91731 730284 B I I I (WATER-SERVICE IPLASTIC YIN METAL YIN 1 I 1ARCHITECT OR ENGINEER: TEL. NO: I I I -- I 1AU, HERRICK Y. (626) 319-2021- 1 IROUGH PLUMBING 1 1145 ORANGE ST. LIC. NO: ISAN GABRIEL, CA 91776 C26770 I IGAS PIPING 1 I I IGAS VENT 1 1 I I I I I IHOT WATER HEATER I 1 I I 1 I IPLUMBING FIXTURES I 1 I I I I I I I (LAWN SPRINKLERS I I I I I I I I I I I IGAS TEST I I I I I I I I (UTILITY COMPANY NOTIFIEDI I I I I I I I I 1CWV I I I I I I I I Y 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 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 1 IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0402260005 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 322 6039 HART AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801915 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 5384-015-018 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 07 BATHTUBS/SHOWERS 1.00 FIX 16.20 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 02/26/04 VG 08/24/04 TOTAL FEES 76.35 OWNER: TEL. NO: FINAL DATE FI BY: CAI, SHENG HONG, OIAN, HUIMING (626) 287-7859- 6039 HART AV TEMP 917801915 DESCRIPTION OF WORK PLUMBING FOR NEW BATHROOM 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 ARCHITECT OR ENGINEER: TEL. N0: PLASTIC Y/N METAL Y/N f 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: BS0508 COUNTY OF LOS ANGELES TEMPLE CITY '# 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0403150003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 322 6039 HART AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801915 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: GARIBALDI 5384-015-018 01 PERMIT ISSUANCE FEE. -.. 27.75 THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY 11 CLOTHESWASHER(S) 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 03/15/04 VG 09/11/04 OWNER: TEL. NO: FINAL DATE FINA Y: CODE: CAI, SHENG HONG, QIAN, HUIMING (626) 287-7859- 6039 HART AV TEMP 917801915 DF WORK PLUMBING FOR CLOTHES WASHER APPLICANT: TEL. NO: PA LAM CONSTRUCTION CO. (626) 293-1612- SPECIAL CONDITIONS: CONTRACTOR: TEL. NO: APPROVALS DATE INSPECTOR SIGNATURE PA LAM CONSTRUCTION CO. (626) 695-3439- 819 N. GARFIELD AVE. LIC. NO UNDER SLAB WORK ALHAMBRA, CA 91801 NONE WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: LIC. N0: ROUGH PLUMBING �--- 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: SS0508