HomeMy Public PortalAbout6129 HART AVE_Plumbing__ WORKERS'COMPENSATION'DECLARATION -P(i �CAYMN FOR PLUMBING
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' � 120-0026 DPW 4/90' L� 13 II�J fl`� I�L�V lA� Ill U" 11�01`9ll
I'hereby,''-affirm that I have a certificate of consent to-self in- 76A667A
sure,or a certificate of Workers'Compensation Insurance,-or a
certified copy thereof'(Sec. 3800, Lab.C.)
COUNTY OF LOS ARIGELES'` ' DEPT :OF PUBLIC UVORKS;,
Policy No Company r'
Certified copy'is hereby furnished.
FOR APPLICANT TO FILL IN(PRINT OR TYPE): BUILDING
Certified copy is filed with the county building inspection ADDRESS
department. NUMBER FIXTURE OR ITEM
TUFEE
@ LOCALITY
ti. .
WATER CLOSET(TOILET)
Date Applicant, ' NEAREST a t
CERTIFICATE OF EXEBATH TUB CROSS ST.
MPTION FROM WORKERS' '
COMPENSATION INSURANCE SHOWEROWNER'
' "
(This section need not be completed if the work involved by.. MAIL
the permit is for one hundred dollars'($100)or less.) 1, LAVATORY- ADDRESS
I certify that in the performance of the work for which this per- Ar-
INK
mit is issued, I shall not employ any person in any manner so CITY TEL. NO.
as to become subject to the Workers Compensation Laws. DISHWASHER s
CONTRACTOR
Date Applicant i-- , CLOTHES-WASHER.
NOTICE O APPLICANT: If, after making this Certificate of Ex- ' ADORES Q Nr -
tionyou should become subject to the Workers'Com" CITY
en- SWIMMING POOL RECEPTOR
P Y I P ' TEL. NO. -f7
sation provisions of the Lab-a rode,you must forthwith comp-
em ,
LAWN SPRINKLER SYSTEMS
ly with such provisions or this permit shall be deemed revok- STATE LIC. /
ed, WATER HEATER, LICENSE NO. �✓ CLASS' (�
LICENSED CONTRACTORS.DECLARATION DISTRICT NO.. PROCESSED BY
I hereby affirm that I am licensed under provisions of Chapter GAS SYSTEM J'oUTLETSD c
9(commencing with Section 7000)of Division 3 of the Business OUTLETS OVER O
and Professions Code, and my license is.in full force and ef- 1 5 PER,SYSTEM - �W e?sK� FINAL VALIDATION! '
fect �y 11 NOSE BIB- DATE
License Number " Lic. Class
tt�rL� FINALO
ACCT
Contractor3303 514.50
Date r
BY °s
I amexempi under Sec. ITEMS
-& U
B.&P C. for this reason LU
Plan check fee. TOTAL. 5 1r.4 m 50%
Date: PLUMBING PERMIT ISSUING FEE$ V� �� 51/,°5('•l 3
s2 o C: CK
Signature
TOTAL FEE - Q CHANGE .00
SINGLE FAMILY
HOME OWNER-BUILDER DECLARATION Plan check applicant.
I hereby affirm that I am exempt from the Contractor's,License Name -0001 6/14/96
Law,for the following reason (Section.7031.5, Business and
Professions Code):. - Address c3� 1 AC11 '
I, as owner of the property, will do the work and the City Tel. No. -
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-mentioned property for inspection purposes.
SEE REVERSE FOR EXPLANATORY LANGUAGE
Signature of Permitfee Date
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS PL 0508 9701290008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: FEES PAID BUILDING ADDRESS:
TR: 5904 LT: 218 6129 HART AV
FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: TEMP CA 917801629
ASSESSOR INFORMATION NUMBER: NEAREST CROSS STREET:
5384-008-019 01 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
05 BACKFLOW DEVICE(S) 2.00 DEV 32.70
TENANT: TOTAL FEES 60.45 ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON:
01/29/97 TC 01/29/98
OWNER: TEL. NO: FINAL DATE FINAL BY: ODE:
TRAC XANH C;TA PHUNG MY (818) 288-8994-
9260 GUESS ST 2'2�✓g�
ROSM 917701906 DESCRIPTION OF WORK
SPRINKLER SYSTEM FOR NEW SINGLE FAMILY RESIDENCE
APPLICANT: TEL. NO: 4 ��
T. Y. CONSTRUCTION (818) 281-7307-
SPECIAL CONDITIONS:
CONTRACTOR: TEL. NO: G:APPROVALS DATE INSPECTOR SIGNATURE
T. Y. CONSTRUCTION, INC. (818) 281-7307-
104 S. ALMANSOR ST. #B LIC. NO ('.'! ti �� UNDER SLAB WORK
ALHAMBRA, CA 91801 716679 B -T
—�- -- ---- -'-- `WATER SERVICE
c, �u��i�n� /, �C���L PLASTIC Y/N METAL Y/N
ARCHITECT OR ENGINEER: TEL. NO: (I S//L 11 Ij l U
L_-- ---.---- ----- -- --- --- ROUGH PLUMBING
LIC. NO: -) \ !1, } - —-
�`/ I GAS PIPING
9
GAS VENT
HOT WATER HEATER
PLUMBING FIXTURES
LAWN SPRINKLERS
O� 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 1204050004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 'EXT:
(LEGAL ID: 1 FEES PAID 1 BUILDING ADDRESS:
ITR: 5904 LT: '218"- _ I 6129 HART AV
I - IFEE DESCRIPTION: QUANTITY.: UOM: AMOUNT: (• TEMP CA 917801629
.1ASSESSOR INFORMATION NUMBER: I - I NEAREST CROSS STREET: GARIBALDI
15384-008-019 _ 101 PERMIT ISSUANCE FEE 27.80 I THOMAS PAGE: 596 GRID:. H2 LOCALITY: TEMPLE CITY, Cl
125 LAVATORIES/SINKS 5.00 FIX 81.00_ (
(TENANT: I - TOTAL FEES 108.80 (ISSUED ON: PROCESSED BY: . PLAN BY:
104/05/12 SR
(OWNER: - TEL. NO: ". (FINAL DOTE FINAL BY: CODE:
IZHANG, YIN OING (312) 965-5523- I
19260 GUESS ST - I �
IROSM 917701906 - (DESCRIPTION OF WORK
(REPLACE JACCUZZI AND FIVE LAVATORIES
1APPLICANT: TEL. NO:,
SAME AS OWNER
' ISPECIAL CONDITIONS:
I I I
(CONTRACTOR: - TEL. NO: 1APPROVALS DATE INSPECTOR SIGNATURE'
ISAME AS OWNER - 1 - ' -I
I - LIC. NO (UNDER SLAB WORK ' I
IWATER SERVICE
-I IPLASTIC YIN METAL YIN
(ARCHITECT OR ENGINEER: TEL. N0:
- (ROUGH PLUMBING
I LIC. NO: I I I I
I IGAS PIPING 1 I
IGAS VENT 1 1 1
I I I
IHOT WATER HEATER I
I (PLUMBING FIXTURES I
LAWN,SPRINKLERS
IIGAS TEST I
(UTILITY COMPANY NOTIFIED(. -
I I
CWV
1 1 LGRAY WATER SYSTEM.
1 1 I I I
I IREPORT'ID: DPR263 ROUTE TO: BS0508 I I I
I I I I I I