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Home My Public Portal About6117 HART AVE_Plumbing__ WORKERS'.COMPENSATION DECLARATION 76A667A �PPLICATI®N FOR PLUMBING ,-PERMIT I hereby.d'ffirPW that" I have a' certificate of consent to self ce en (z-ao) PERMIT If`h insure, or a certificate of Workers'Compensation Insurance,or a certified copy thereof(Sec. 3800,Lab.C_) n'- Ins-- COUNTY OF LOS ANGE LES , (?: BUILDING AND SAFETY PolicyWC940357 Company Aetna Certified copy is hereby furnished. FOR APPLICANT TO FILL IN (PRINT OR TYPE) BUILDING - �rrcilADDRESS 6117 Hart- 1131 Certified copy is filed with the county building inspection NUMBER FIXTURE OR ITEM 0 FEE d WATER CLOSET ® LOCALITY Temp 1e Clt: Dated Applicant Owen Bros.PlUllL�7n ' V`� NEAREST 1105 . BATH TUB 6® CROSS STt CERTIFICATE OF EXEMPTION FROM WORKERS' COMPENSATION INSURANCE SHOWER cm OWNER erle.- Gillett: MAI L. } LAVATORY 143" Z. -Sycamore (This section need not be completed if the work involved 8® ADDRESS �- by the permit' is for one hundred dollars ($100) or less.) SINK 66 Arcadia ad.i a 3 5 8-5 9 8 O. CITY TEL.NO. U I certify that.in the performance of the work for which this DISHWASHERIM .permit is issued, I shall not employ any person in any manner '306 CONTRACTOR Owen Bros .-Plumbing_ 0 so as to become subject to the Workers' Compensation Laws. _ CLOTHES WASHER 0 ADDRESS 42.65 N. *Ba.ldwin-Ave. U Date Applicant SWIMMING POOL RECEPTOR d NOTICE'TO APPLICANT: If, after making this Certificate of CITY E.1 Monte TEL.N 0443-007E 0 Exemption, you should become subject to' the Workers' LAWN SPRINKLER SYSTEM STATE LIC. Compensation provisions of the Labor Code, you must forth- LICENSE NO. 231 741 CLASS C36-20 with comply with such provisions or this permit shall be WATER HEATER deemed revoked. GAS SYSTEM OUTLETS AA DISTRI/CfT NO. PROCESSED BY LICENSED CONTRACTORS DECLARATION OUTLETS OVER U �v I hereby affirm that I am licensed under provisions of Chapter 5 PER SYSTEM - 9 (commencing with Section 7000) of Division 3 of the Busi- FINAL `q VALIDATION ness and Professions Code, and my license is in full force and DATE tea- Q le ffect. It f 231. 741. C36-20 FINAL License Number Li,.Class BY Contra then 'Rms Xl bg: Date 9/23/80 ' I am exempt from the licensing requirements as I am a Plan check fee licensed architect or a registered professional engineer PLUMBING'PERMIT ISSUING FEE$ acting in my professional capacity (Section 7051, Bus- iness and Professions Code). TOTAL FEE Lic.or Reg.No. Date Plan check applicant HOME OWNER-BUILDER DECLARATION Name I hereby affirm that I am exempt from,the Contractor's Address License Law for the following reason (Section_7031.5, Busi- City Tel.No. ness and Professions Code): 1, as owner of the property, am exclusively contracting with licensed contractors to construct the project (Section 7044, Business and Professions Code). r' zp 2 2'3 5 A CONSTRUCTION LENDING AGENCY #•o.o'o o o 5 I hereby affirm that there is a construction lending agency for the performance of the work for which this permit is 2.o o b a 5 0 issued(Sec. 3097,Civ.C.). Lender's Name .0 o o 68,505 Lender's Address ;r'' 4,2 3.—8 0 I certify that I have read this application and state that the above information is correct.I agree to comply with all County SEE REVERSE FOR EXPLANATORY LANGUAGE ordinances and State laws regulating Plumbing, and hereby auth a re resentati'ves of this County to enter upon the abo - n one property for i ection purposes. 9/23/80 rgna r of Permittee Date COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9801290026 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: LEGAL ID: FEES PAID BUILDING ADDRESS: TR: 5904 LT: 220 6117 HART AV FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801629 ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET: 5384-008-022 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY 13 DISHWASHER(S) 1.00 FIX 16.35 TENANT: TOTAL FEES 44.10 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 01/29/98 UT 01/29/99 OWNER: TEL. NO: FINAL DATE FINAL BY: CODE: HAYES ROBERT A;MARY BETH (626) 287-2244- 6117 HART AV _ TEMP 917801629 DESCRIPTION WORK CHANGE OUT OF DISHWASHER APPLICANT: TEL. NO: D & H SERVICE (818) 343-4009- 6029 1/2 RESEDA BLVD s SPECIAL CONDITIONS: RESEDA, CA SEE ILLw �� CONTRACTOR:CE TEL. N343-4009- APPROVALS DATE INSPECTOR SIGNATURE 6029 1/2 RESEDA BLVD. LIC. NO y \ �, UNDER SLAB WORK TARZANA, CA 704779 y W WATER SERVICE PLASTIC Y/N METAL Y/N ARCHITECT OR ENGINEER: TEL. NO: , ROUGH_PLUMBING LIC. N0: _ _ ___ x`"1111111 GAS PIPING- _ -- -- - - - - GAS VENT , - - HOT WATER HEATER PLUMBING FIXTURES LAWN SPRINKLERS GAS TEST G^ / UTILITY COMPANY NOTIFIED " CWV GRAY WATER SYSTEM REPORT ID: DPR263 ROUTE TO: BS0508