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Home My Public Portal About6164 / 6168 HART AVE_Plumbing__ WORKERS'COMPENSATION DECLARATION nPp��'ATMNI FOR PL�Ul4V ONG PERMIT ri t?EreUy'affirm that I have a certificate of. consent to self 20-0026 DPW 6/87 u insure(, or a certificate of Workers' Compensation Insurance, 76A667A or a certified copy thereof (Sec. 3800, Lab. C.) COUNTY OF LOS ANGELES DEPT. OF PUBLIC WORKS Policy No. Company Pol Certified copy is hereby furnished. FOR APPLICANT TO FILL IN(PRINT OR TYPE) BUILDING ❑ Certified copy is filed with the county,building inspec- ADDRESS V Hari tion department. NUMBER FIXTURE OR ITEM @ FEE LOCALITY If. Date Applicant WATER CLOSET NEARESTy� 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($100)or less.) LAVATORY ADDRESS Z Aqr I certify that in the performance of the work for which this � peimit is issued, I shall not employ any.person in any manner SINK CITY ,. 1 ` �t TEL. NO. so as to become subject to the Work nsation Laws. //� . DISHWASHER CONTRACTOR Date a 4?Applica CLOTHES WASHER o NOTICE TO APPLICANT: If, after making this rtificate of ADDRESS' Exemption, you should becom subject to e Workers' SWIMMING POOL RECEPTOR P y I CITY TEL. NO. Compensation provisions of the Labor Code, you must forth- LAWN SPRINKLER SYSTEM with comply with such provisions or this permit shall be STATE LIC. deemed revoked. WATER HEATER LICENSE NO. CLASS LICENSED CONTRACTORS DECLARATION DIST ICT NO. P CESS D BY. I hereby affirm that I am licensed under provisions of Chapter 9 GAS SYSTEM OUTLETS (commencing with Section 7000) of Division 3 of the Business OUTLETS OVER and Professions Code,and my license is in full force and effect. 5 PER SYSTEM FINAL VALIDATION DATE ` o• License Number Lic. Class IU. LBY AL Contractor Date ❑ ®� I am exempt under Sec. B.&P.C. for this reason �• Plan check fee Date: PLUMBING PERMIT ISSUING FEE$ Q io • Signature TOTAL FEE Plan check applicant 7 SINGLE FAMILY HOME OWNER-BUILDER DECLARATION Name I hereby affirm that,I am exempt from the Contractor's LicenseAddress ACCT.Law for the following reason (Section 7031.5, Business and •-:' ' Professions Code Cit �.._-_, .. d�a+JM1 y Tel. No. 1, as owner of the property, will do the work and the _........ I ITEM structure is not intended or offered for.sale (Section 7044, Business and Professions Code). TOM ... CONSTRUCTION LENDING AGENCY 16oI 1 hereby affirm that there is a construction lending agency for �y the performance of the work for which this permit is issued ....... btlt nlln G .00 (Sec. 3097, Civ. C.). S' _... ......._..... f g Lender's Name ' 6/23/89 Lender's Addres's4143 d AH 90 lei 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 A' representatives of this C'unty to enter upon the tionedproper ction purposes. SEE REVERSE FOR EXPLANATORY LANGUAGE f Permi tee Date • COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0703280013 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: '(626) 285-0488 EXT: - ILEGAL ID: I FEES PAID . - I BUILDING ADDRESS: 1 ITR: 5904 LT: 229 I 1 6164 HART AV I - IFEE DESCRIPTION: QUANTITY: UOM: -AMOUNT:( TEMP CA 917801628 1 (ASSESSOR INFORMATION NUMBER: _ I I NEAREST CROSS STREET: LONGDEN 15384-010-010 101 PERMIT ISSUANCE.FEE 27.75 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl 107 BATHTUBS/SHOWERS 1.00 FIX - .,16.20 1 (TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: . EXPIRES ON: -I I 145 WATER CLOSET/URINAL 1,00 FIX 16.20 103/29/07 JK 09/25/07 I I 1 TOTAL FEES 76.35 1 10WNER: _ TEL. N0: 1 IFINAL DATE FIN BY: CODE: ICHU, MING RONG (626) 446-3586- 1 1120 S. 3RD, AVE I I C IARCADIA, CA 91006 - 1 1DESCRIPTION OF WORK I 1 IPLUMBING FOR SECOND BATHROOM (APPLICANT: TEL. N0: ICHU (626) 446-3586- I 11120 S. 3RD, AVE I ISPECIAL CONDITIONS: - I IARCADIA, CA 91006 I i I I ICONTRACTOR: TEL. NO: I (APPROVALS DATE INSPECTOR SIGNATURE 1 IMING RONG CHU (626) 446-3586- I _. 1 I IMING EING CHU. - LIC. NO I (UNDER SLAB WORK I 11120 S. 3RD AVENUE NONE I 1ARCADIA, CA 91006 IWATER SERVICE I _ IPLASTIC Y/N METAL Y/N 1 1 1ARCHITECT OR ENGINEER: TEL. NO: 1 I I I I ICHU, MING RON '(626) 446-3586- 1 IROUGH PLUMBING I� I 11120 S 3RD AVE LIC. NO: I 1ARCADIA, CA 91006 _ 52926 GAS PIPING I I 1 1 IGAS VENT I I I IHOT WATER HEATER I I I 1 1 1PLUMBING FIXTURES I I 1 I I I 1 I ILAWN SPRINKLERS I I I I I IGAS TEST I I I 1 1 1UTILITY COMPANY NOTIFIED( I I I ICWV 1GRAY WATER SYSTEM I I I I I 1 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 REPORT ID: DPR263 ROUTE TO: BS0508 I I COUNTY OF' LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0703190014 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 ' PHONE: (626) 285-0488 EXT: ILEGAL ID: I - FEESPAID I BUILDING ADDRESS: 1 ITR: 5904 LT: 229 1 1 6164 HART AV 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801628 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 1 15384-010-010 101 PERMIT ISSUANCE FEE 27.75 I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, C1 1 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 I I (TENANT: Ill CLOTHESWASHER(S) 1.00 FIX 16.20 (ISSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 1 113 DISHWASHER(S) 1.00 FIX 16.20 103/19/07 JK 09/15/07 1 1 121 HOSE BIBB(S) 1.00 FIX 16.20 1 I (OWNER: TEL. NO: 145 WATER CLOSET/URINAL 1.00 FIX 16.20 IFINAL DATE FINAL BY: CODE: 1 ICHU, MING RONG (626) 446-3586- 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 1 I 11120 S. 3RD. AVE 1 TOTAL FEES 124.95 1 k� I 1ARCADIA, CA 91006 1 ID SCRIPTION OF WORK I I 1 IPLUMBING FOR MAIN HOUSE I 1APPLICANT: TEL. NO: ICHU (626) 446-3586- 11120 46-3586 11120 S. 3RD. AVE 1 ISPECIAL CONDITIONS: 1ARCADIA, CA 91006 I I I ICONTRACTOR: TEL. NO: 1 (APPROVALS DATE INSPECTOR SIGNATURE I IMING RONG CHU (626) 446-3586- I 1 1 IMING EING CHU LIC. NO 1 (UNDER SLAB WORK l I 11120 S. 3RD AVENUE - NONE I I / I 1ARCADIA, CA 91006 1 IWATER SERVICE I 1 I I IPLASTIC Y/N METAL Y/N 1 1 I 1ARCHITECT OR ENGINEER: TEL. NO: .r ICHU, MING RON (626) 446-3586- 1 IROUGH PLUMBING 1 I I 11120 S 3RD AVE LIC. NO: I I. I I I 1ARCADIA, CA 91006 52926 1 IGAS PIPING I I I 1 I IGAS VENT I I 1 I. I I I I I I 1 (HOT WATER HEATER I I 1 1 1 IPLUMBING FIXTURES I I 1 1 1 ILAWN SPRINKLERS I I 1 1 I IGAS TEST I I1 11 I I 1 1UTILITY COMPANY NOTIFIED( I I I ICWV 1. I I I I IGRAY WATER SYSTEM 1 ( I I I I 1 I 1 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 1 I I I I I I COUNTY OF LOS ANGELES TEMPLE CITY # 0508 PLUMBING PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS PL 0508 0703190013 BUILDING AND.SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 DUPLICATE PHONE: (626) 285-0488 EXT: ILEGAL ID: FEES PAID I BUILDING ADDRESS: 1 ITR: 5904 LT: 229 1 I 6164 HART AV 1 I IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: 1 TEMP CA 917801628 1 (ASSESSOR INFORMATION NUMBER: I I NEAREST CROSS STREET: LONGDEN 1 15384-010-010 101 PERMIT ISSUANCE FEE 27.75 THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl I 107 BATHTUBS/SHOWERS 1.00 FIX 16.20 1 I (TENANT: 125 LAVATORIES/SINKS 1.00 FIX 16.20 11SSUED ON: PROCESSED BY: PLAN BY: EXPIRES ON: 145 WATER CLOSET/URINAL 1.00 FIX 16.20 103/19/07 JK 09/15/07 I I 147 WATER-HEATER(S) 1.00 WTH 16.20 1 I (OWNER: TEL. NO: 151 LOW PRS GAS 5 OUTLET 1.00 SYS 16.20 IFINAL DATE FIY: CODE: 1 ICHU, MING RONG (626) 446-3586- I TOTAL FEES 108.75 1 i•/� 1 11120 S. 3RD. AVE I I 1 1 1ARCADIA, CA 91006 1 IDESCRIPTION OF WORK 1 I IPLUMBING FOR 2ND: UNIT I I I I I (APPLICANT: TEL. NO: I I ICHU (626) 446-3586- 1 I I 11120 S. 3RD. AVE I ISPECIAL CONDITIONS: I 1ARCADIA, CA 91006 I I I I I I I I I I I ICONTRACTOR: TEL. NO: I 1APPROVALS DATE INSPECTOR SIGNATURE 1 IMING RONG CHU (626) 446-3586- I 1 I IMING EING CHU LIC. NO 1 (UNDER SLAB WORK I I I 11120 S. 3RD AVENUE NONE I I I I 1ARCADIA, CA 91006 1 IWATER SERVICE I 1 I (PLASTIC Y/N METAL Y/N I I I (ARCHITECT OR ENGINEER: TEL. NO: I I I ICHU, MING RON (626) 446-3586- 1 - IROUGH-PLUMBING 11120 S 3RD AVE LIC. NO: I I IARCADIA, CA 91006 52926 - IGAS PIPING I I I I I I I I I IGAS VENT I I I I I I I I I-HOT WATER HEATER 1 I I I I I I IPLUMBING FIXTURES I II 1 I ILAWN SPRINKLERS I 1 I I I I I I I I IGAS TEST I I I I I 1 11 1 I I (UTILITY COMPANY NOTIFIEDI I I I I I - I I I I ICWV . I 1 I I I I I I I IGRAY WATER SYSTEM I I I Y 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 IREPORT ID: DPR263 ROUTE TO: BS0508 I I I I I I I I I I